EPIDURALS - AN EPIDEMIC?
If birth is a normal, natural process why are so many woman choosing epidurals during labour? And in making this decision are women doing themselves and their babies more harm than good without knowing it? We investigate the type of epidurals on offer and what, if any, side-effects epidurals may have.
The popular option. |  |
Epidurals on offer. |  |
Can anyone have an epidural? |  |
Possible side effects and negatives. |  |
Other forms of pain relief. |  |
The popular option.
Epidural anaesthesia is a popular choice of pain-relief for women in labour,
especially among moms having their first babies. But why should this be? One
of the arguments put forward is that plenty of women are just not prepared
to tough-out the pain of childbirth and don't trust their bodies to cope without
pain relief. But the counter argument of epidural devotees is that there are
no medals for bravery doing a drug-free labour, so why be a martyr?
Other moms opt for epidurals on the strength of a difficult first birth experience
and still others are simply unable to deal with the pain of natural childbirth
while they're in labour.
No two labours are the same and this extract from a piece written by Nina Shapiro published in the SEATTLE WEEKLY is a reminder that drugs can be a welcome release.
I have a friend who experienced labour with and without drugs in giving birth
to two children. She went natural the first time, which she says put her into
an extremely focused Zen-like state and gave her a feeling of tremendous accomplishment.
She's glad she did it that way. The position of the baby in the second birth,
however, prolonged her labour and intensified her agony. She finally got an
epidural. And she found an interesting thing: freed from her pain, she was
able to appreciate the moment of her child's arrival in a way she had not been
able to do the first time.
Epidurals are a wonderful alternative to general anaesthetic for moms delivering by Caesarean. But before deciding on your pain relief in a normal vaginal delivery, find out what you can expect.
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Epidurals on offer.
There are several types of epidurals used in hospitals.
Conventional epidural.
A dose of local anaesthetic is injected through the lower back into the epidural
space, around the spinal cord. This numbs the nerves which bring sensation
from the uterus and birth canal. The local anaesthetic can numb the nerves,
which control the pelvic muscles and legs, making you unable to move your legs.
This depends on the dose used and the time the epidural catheter has been in
place. Unless the epidural has worn off you won't be able to push your baby
out in the second stage of labour.
Low dose or walking epidural.
More recent forms of epidurals use a lower dose, so you have the option of
moving around with support. This option is not readily available in South African
hospitals and if you're interested in it, discuss it with your gynaecologist
or anaesthesiologist.
The "walking epidural" uses the same technique as the combined spinal epidural,
with the exception that the drug used is a one-off dose of opiate.
"Walking epidurals" may seem beneficial but being attached to a CTG machine
to monitor the baby and hooked up to a drip which is necessary when an epidural
is in place, can make walking impossible.
Combined spinal epidural.
Combines a spinal block with an epidural. An anaesthetic is injected directly
into the spinal fluid, which gives immediate pain relief, and at the same time
an epidural catheter is inserted. It's fast acting and if the mom-to-be has
her epidural catheter in place and needs a Caesar, it provides good anaesthesia
for surgery.
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Can anyone have an epidural?
Yes, with the exception of moms-to-be with blood disorders as the chances of bleeding or infection increase. Abnormalities of the spine such as scoliosis (spinal curvature) can also make it difficult to position the epidural properly.
An epidural may be recommended if you have raised blood pressure such as pre-eclampsia.
In these cases an epidural can be used to help control the situation. If a
difficult delivery is expected and there's a good chance that you may need
a Caesar, an epidural may be recommended.
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Possible side effects and negatives.
One of the most commonly recognised side effects of an epidural is a drop in blood pressure. Up to one woman in eight will have this side effect to some degree and for this reason extra fluids are usually given in a drip. A drop in blood pressure will affect how much oxygen is pumped to the placenta and can lead to less oxygen for the baby.
The pushing stage of labour may slow down because of the epidural effect on
a woman's pelvic floor muscles. These muscles guide the baby's head so that
it enters the birth canal in the best position. When these muscles
aren"
t working, forceps may be needed to turn the baby and assist with delivery of
the baby.
When forceps are used or the second stage is too long, a woman may also need an episiotomy to enlarge the birth outlet. Stitches are given and it may be painful to sit until the episiotomy has healed in two to four weeks.
Whether epidurals cause back pain is controversial - studies show that backache
is more likely after an epidural birth, although there seems no greater likelihood
of back pain a week or even six weeks later.
Women often worry about nerve injury after an epidural but this is rare and usually a temporary injury.
About one percent of women experience a bad headache caused by accidental puncturing of the membrane surrounding the spinal sac. This is treated with an injection to seal the hole through which spinal fluid is leaking.
All things considered, many women have good experiences with epidurals, as relief from pain can allow mom to rest and relax sufficiently to deliver vaginally.
But it's also worth knowing that an epidural or other drug used for pain relief
can also turn a normal birth into a medically managed affair, which can be
disappointing if you're not prepared.
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Other forms of pain relief.
Gas and Air (Entonox)
A mixture of nitrous oxide and oxygen inhaled through a mouthpiece or mask.
Pethidene
An analgesic given by injection. Takes the edge off the pain but doesn't provide
total pain relief. Can cross the placenta and make baby drowsy and you nauseous
and confused.
Tens.
Electrodes attached to the back, which emit mild electrical impulses that
interrupt pain messages to the brain and stimulate endorphin production, the
body's natural painkillers.
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