1. Pregnancy
  2. Giving birth
  3. Labor and delivery

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Epidural Anesthesia: Ultimate Pros and Cons

There’s no doubt about it; pain is a normal part of labor. That’s why many women decide to get epidural anesthesia to relieve the pain. An epidural is one of the most popular methods of relieving pain during labor. Check out the benefits and risks associated with epidural anesthesia to help make a decision about pain management during labor and childbirth.

Epidural anesthesia is commonly administered to women who don’t want to feel any pain during contractions and delivery. The main aim of epidural anesthesia is to relieve pain. An epidural blocks the nerve signals that come from the lower part of the spinal canal, leading to reduced sensation and pain relief in your lower half.

Epidural medicines are local anesthetics that can include chloroprocaine, lidocaine, or bupivacaine. Your doctor may deliver them along with narcotics or opioids such as sufentanil or fentanyl to reduce the amount of local anesthetics.

To extend the effect of epidural anesthesia and stabilize your blood pressure during delivery, your doctor may use these medicines along with fentanyl, morphine, epinephrine, or clonidine.

Here are some of the benefits of epidural anesthesia:

  • Getting epidural anesthesia is among the most effective ways to relieve pain during labor and childbirth. Furthermore, it produces minimal adverse effects on the mother and baby. It starts working quickly and may provide pain relief within 11 to 20 minutes.
  • Getting relief from labor pain may help you get better rest. This is particularly beneficial if you have prolonged labor. By decreasing the pain and discomfort associated with delivery, epidural anesthesia may help you have a more relaxed and positive childbirth experience.
  • Epidural anesthesia may help you stay alert during labor and delivery and better enjoy the experience. It may also help you avoid discomfort if your doctor uses a vacuum or forceps during delivery to take your child out.
  • If you need a Cesarean delivery, epidural anesthesia may keep you awake at the time of surgery and also provides effective pain relief during recovery.
  • An epidural may help you deal with fatigue, irritability, and exhaustion when other kinds of coping techniques aren’t helping. Studies have shown that using an epidural may reduce the risk of postpartum depression in some females.
  • You can get an epidural at any time during your labor, even if it wasn’t included in your birth plan.
  • An epidural may provide continuous relief from pain during long operative procedures such as a cesarean section or while you recover from certain other procedures.

These are some of the risks and side effects of epidural anesthesia:

  • Epidural anesthesia may cause a sudden drop in your blood pressure. Because of this, your doctor will check your blood pressure routinely to make sure there’s adequate blood flow for the baby.
  • You may develop a severe headache due to leakage of spinal fluids. This is a very rare adverse effect that happens in about one percent of women giving birth. If your symptoms persist, your doctor may perform a procedure referred to as a blood patch. In this, a small amount of your blood is injected in your epidural space to relieve the pain.
  • After you get an epidural, you may need to shift positions frequently while you are lying in bed. The doctor will also continuously monitor the baby’s heart rate. Lying in one position can sometimes slow or stop labor.
  • You may develop ringing in your ears, shivering, nausea, dizziness, difficulty passing urine, backache, or soreness at the injection site.
  • You may find that epidural anesthesia makes pushing difficult and need additional interventions such as a cesarean section or forceps. When preparing your birth plan, talk to your doctor about what they generally use in such scenarios.
  • For several hours after childbirth, you may feel numbness in the lower half of your body. Because of this, you may need help walking.
  • In rare cases, permanent damage to the nerve can occur at the injection site.
  • According to research, getting an epidural may increase the risk of a perineal tear.
  • You may have trouble urinating and need a catheter to help empty your bladder. However, this is temporary and gets better once the numbness improves.

In epidural anesthesia, the doctor inserts a hollow needle along with a small, flexible catheter in the peridural space or epidural space (between the outer lining of the spinal cord and the spinal column) in your lower or middle back. The doctor first numbs the area using a local anesthetic, then inserts the needle, and removes it after the catheter passes through the needle. The catheter stays in place. The doctor then injects anesthetic medicine through the catheter to numb your body below and above the injection point. The medicine should start to take effect in 10–20 minutes. Epidural anesthesia works well for longer surgical procedures.

Spinal anesthesia is performed the same way as epidural anesthesia. However, the doctor injects the medicine directly in the cerebrospinal fluid (fluid surrounding your spinal cord) using a smaller needle. For spinal anesthesia, a catheter is usually not used as the doctor injects the medicine only once. The medicine starts taking effect immediately. Spinal anesthesia usually works well for simpler and shorter surgical procedures.

Though the research doesn’t all agree, most studies say some babies born to moms who received epidural anesthesia may have problems latching on, causing trouble when breastfeeding. According to other studies, babies may experience respiratory distress, a more variable heart rate, and fetal malpositioning (the baby may become lethargic while in the uterus). This may increase the need for a vacuum, forceps, episiotomies, or cesarean deliveries.

The exact effect of epidural anesthesia can vary, depending on the dosage of medicines, duration of labor, and characteristics of the individual baby. Though these medicines may not harm the baby, they may produce subtle effects on your newborn.

You may not be able to receive epidural anesthesia in the following situations:

  • You are on blood-thinning medicines.
  • Your platelet counts are low.
  • You are in shock or are hemorrhaging (bleeding).
  • You have an infection in or on your back.
  • You aren’t at least four centimeters dilated.
  • You have a systemic (blood) infection.
  • Your physician can’t locate your epidural space.
  • Your labor is very quick, and the physician doesn’t have enough time to inject the drug.

Epidural anesthesia is the most popular choice among women who want to relieve pain during labor. It is safe to use, and whether to get it is your personal decision. You can talk with your doctor about the various benefits and side effects of epidural anesthesia and other options for pain management.

1. https://www.ncbi.nlm.nih.gov/books/NBK279567/

2. https://www.ncbi.nlm.nih.gov/pubmed/24529800

3. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5673041/

4. http://europepmc.org/abstract/med/18162274

5. https://www.asahq.org/about-asa/newsroom/news-releases/2014/06/epidural-myth

6. https://www.womenshealth.gov/pregnancy/childbirth-and-beyond/labor-and-birth

7. https://fn.bmj.com/content/99/2/F116

8. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3404542/

9. https://www.ncbi.nlm.nih.gov/pubmed/24797120

10. https://www.uofmhealth.org/health-library/rt1583

11. https://medlineplus.gov/ency/article/007413.htm

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