Epidural anesthesia

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Epidural anesthesia is the most common method of pain relief during labor. More than 50% of women request epidurals before birth.

If time of birth approaches, you might want to know as many details about pain relief options to be prepared and to make better decisions about labor and birth.

Understanding different types of epidurals, how they are managed, risks and benefits can help you take the best decisions during labor and birth.


1. Overview
2. What is epidural anesthesia?
3. How is epidural anesthesia done?
4. Types of epidural anesthesia
5. The benefits of epidural anesthesia
6. Disadvantages of epidural anesthesia
7. Frequently asked questions about epidural anesthesia
8. How could the child be affected by epidural anesthesia?
9. Useful tips

What is epidural anesthesia?

Epidural anesthesia is an anesthetic that blocks pain in certain areas of the body. Its purpose is to relieve pain or lock it, rather than an anesthesia of area – a situation that leads to total lack of sensation.

Epidural blocks nerve impulses from the lower segments of the spine. Drugs involved in epidurals are included in a class of medicines called local anesthetics such as bupivacaine.

They are often administered in combination with opioids or narcotics, with the main purpose to reduce the required dosage of local anesthetic. In this way the pain is relieved, and the consequences are minimal.

They can also be used in combination with epinephrine, fentanyl, morphine or clonidine to prolong the epidural or to stabilize the mother’s blood pressure.

How is epidural anesthesia done?

Before the onset of labor, mother will receive intravenous fluids and before beginning the procedure the epidural will be placed. During labor and delivery, the woman will receive 1-2 liters of fluid intravenously.

An anesthetist, obstetrician or nurse will administer the epidural. She will be asked to sit on a bed and crouched to one side. This position is essential to prevent problems and increase the efficiency of epidurals.

The doctor will use an antiseptic solution to clean the back of the waist and minimize risk of infection. Then a small area of the seventh will be numbed with a local anesthetic. It will insert a needle into the numbed area around the spinal cord in the lower back.

The needle will be inserted through a tube or catheter into the epidural space. Then the needle is carefully removed leaving the catheter in place in order to provide various drugs through it easily.

Types of epidural

Currently, two basic types of epidural anesthesia are used. Doses and combinations of drugs may be different from one hospital to another. You can ask your doctor who will make the epidurals about:

- Normal epidural – after the catheter is fixed, a combination of drugs and anesthetics will be administered by regular injections of anesthesia into the epidural space. A narcotic such as fentanyl or morphine will be used to replace high doses of bupivacaine, chloroprocaine or lidocaine. In this way it will reduce potential adverse effects of anesthesia.

- Combined spinal epidural – an initial dose of narcotic, anesthetic or a combination of the two is injected under the outer membrane covering the spinal cord and inside, through the epidural space; this is the intrathecal area. The anesthetist will insert the needle into the epidural space through a small catheter, then remove the needle but leaves local the catheter.

This allows the possibility to perform several types of movements in bed and a greater ability of the patient to change positions, with help. When the catheter remains in the same position, epidural anesthesia can be done anytime, if the initial intrathecal injection is inadequate.

You should ask the physicians if you can move and if you can drink and eat after the epidural was placed. After you have used drugs for epidural anesthesia, muscle strength, balance and responsiveness are reduced. Spinal epidural should relieve pain for 4-8 hours.

The benefits of epidural anesthesia

- Epidural anesthesia will allow you to rest if your labor is prolonged

- By reducing discomfort caused by birth, becomes more positive birth experience

- Normally, epidurals will not make you sleep and this way you can actively participate in the birth

- If you give birth by caesarean section, epidural anesthesia will allow you to stay awake and pain will be acceptable at this time.

- When other relief mechanisms are not helpful, epidural anesthesia may be useful in case of fatigue, irritability and fatigue of the mother.

An epidural can help pregnant women to rest, relax, focus and will provide power to move forward as an active participant in the birth experience.

Disadvantages of epidural anesthesia

- Epidural anesthesia can cause a drop in blood pressure. For this reason blood pressure will be monitored to confirm that the mother and child is an adequate flow of blood. If there is a sudden drop in blood pressure may need intravenous fluids, medications and oxygen.

- Can cause severe headaches due to the leak of cerebrospinal fluid. This side effect is seen in less than 1% of women.

- After the epidural is placed, the patient should alternate parts that will be stretched and to continuously monitor fetal heartbeat. Position one side can cause slow or even stop labor.

- May experience these side effects: chills, tinnitus, back pain, pain when the needle is inserted, nausea or difficulty urinating.

- In case of epidural anesthesia and other interventions may be needed more during labor using oxytocin, of forceps, a vacuum extractor or cesarean may be necessary.

- A few hours after birth, the lower half of your body is numb and you need help to go.

- In rare cases, permanent damage may occur to the nerves in the area where the catheter was inserted.

Although researches are ambiguous, most studies suggest that some children of mothers who give birth with epidural anesthesia will suffer a blockage that can cause breastfeeding difficulties.

Other studies imply that infants may experience respiratory depression, inadequate fetal position and will be increased fetal heart rate variability, a situation that requires the need for use of forceps, of birth vacuum extractor, cesarean and episiotomy surgery.

Frequently asked questions about epidural anesthesia

- Placing the epidural can cause local damage? The answer depends on who asks it. Some women have reported the presence of discomfort when placed epidural, spinal portion which was numb and feel like the pressure when the catheter was inserted.

- When will the epidural be placed? Typically epidurals will be when the cervix is dilated 4-5 cm and a pregnant woman is in labor.

- How can labor be affected by the epidural? Epidural can slow labor and may weaken contractions. If this happens, pregnant women should be administered oxytocin, a drug that speeds up labor

- How epidurals affect the newborn? Researches on the effects of epidurals on newborns are insufficient, and the health of the newborn may be affected by many factors.

It is difficult to predict how drugs will influence the new-born, as this can vary depending on the dose, duration of labor and characteristics of each child.

Because the doses and drugs can vary, there are not currently available concrete information gained from research. However it is assumed that a possible side effect of epidural anesthesia in children is a blockage that will cause breastfeeding difficulties.

Another is that the child may become lethargic and may have difficulties in engaging the birth canal. Drugs used during epidural anesthesia are known to cause respiratory depression and lower fetal heart rate in newborns.

- What will be the manifestations after epidural installation? Uterine nerves are numb within minutes after the initial dose of anesthetic was administered. You feel, probability, a state of numbness in 10-20 minutes maximum. When the effect of anesthetic dose begins to diminish, the mother will receive a new dose, usually one dose every two hours.

Depending on the anesthetic used for epidural anesthesia and dosage, pregnant women will not be allowed to get out of bed and its movements are restricted. If labor lasts more than a few hours, probably will be necessary to introduce a urinary catheter as abdomen will be numb and the urination will be difficult.

After the baby is born, the catheter will be removed and anesthesia effects will disappear within one to two hours. Some women have reported a burning sensation and discomfort around the birth canal after they stopped taking medication.

- Will it be possible for the mother to actively participate in the birth? Perhaps you can’t know for sure when you have a contraction due to epidural. If you do not feel contractions, active participation in birth could be difficult to control.

For this reason the newborn may need extra help to engage the birth canal, including applying pressure on the abdomen, on top of the uterus and / or forceps.

- Epidural anesthesia always takes effect? For most people epidural anesthesia is effective for pain relief during labor. Some women claim inability to feel pain and / or feeling that the medication works better on one side than the other.

Here are some questions you can ask your doctor before labor and epidural anesthesia:
- What combination and dose of drugs will be used?
- How the child could be affected by drugs?
- I will be able to get up and walk?
- Which are the liquids and solids that I can eat?
- What are situations in which epidural anesthesia isn’t used?

An epidural anesthesia is not an option for pain relief during labor in any of the following:
- When using anticoagulants
- You have a low platelet count
- When you are suffering a hemorrhage or shock
- You have an infection in the back
- You have a blood infection
- If the mother does not have a vaginal cervical dilation of at least 4 cm
- When the epidural space can’t be located by the physician
- If labor progresses too quickly and not enough time for drug administration.

How could the child be affected by epidural anesthesia?

- If there is a drop in blood pressure the oxygen flow to the fetus could be affected. In this situation, you will need to introduce intravenous cannula in the hand or arm, if blood pressure drops suddenly.

Lower blood pressure can be treated by drinking fluids introduced by cannula to increase blood volume.

- Epidural solutions contain opioids such as fentanyl or similar drugs that can cross the placenta. In higher doses (more than 100 mcg), these drugs can affect breathing and can make your child fell sleepy.

Useful tips

Epidural anesthesia will only be done just in maternity, by an anesthetist under the supervision of obstetrician, not at home! Not even maternities can’t even offer epidural anesthesia kits 24 hours 24. It is therefore recommended that the mother to procure such kit of pharmacy, as recommended by the obstetrician to be prepared when the labor starts.

Try to remain calm when mounted epidural anesthetics. You sit in squatting position on one side, on the bed, to open spaces between the bones of the spine. Try to focus on your breathing: breathe in slowly through your nose and exhale through your mouth. Try to keep eye contact with your partner if it is present.



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