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All You Need to Know About Epidural

calendarJuly 26, 2016
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Anesthetics

During pregnancy, most women contemplate on how they will manage labor pains during delivery. Some women choose to avoid medication, while others, their minds are set at ease knowing that there are effective ways of lessening birth pain. Most women choose to have an epidural.

What Is an Epidural?

An epidural is a steroid injection or pain killing drug that is injected into the small of your spine also knows as epidural space. This form of regional anesthetic bars the pain signals from reaching the brain during labor, thereby numbing your belly.

It is considered to be a very effective pain reliever for women in labor. Statistics report that approximately 30% of women in the UK have an epidural during labor or even after birth. Before we dig deeper on this form of anesthesia, let’s first understand how anesthesia works.

How Does Anesthesia Work?

If you have ever had surgery before, chances are you were put under anesthesia. Back then before the invention of anesthesia, surgeons had to perform surgical procedures on patients without anything to dampen the pain. They used booze or opium, which helped numb the patient but couldn’t stop the pain or obliterate the memory of it for that matter. But that was back then. These days, doctors employ drug concoctions to relieve pain, relax muscles and sometimes send people in a deep state of hypnosis which provides brief amnesia.

There are two main types of anesthesia drugs; those that render the entire body unconscious known as general anesthesia and those that numb a specific targeted area, known as local anesthesia. Local anesthetics hinder the nerves that link a specific part of the body or section of the brain, averting the nerves from transmitting pain signals to the brain.

They include:

  • Epidurals- they block childbirth pain.
  • Novocaine- Are shots that dentists’ use to numb nerves in the mouth when performing root canal.

General anesthesia is used for serious surgeries that require a patient to be entirely unaware. The patient is rendered unconscious with no awareness or recollection of the surgery. However, the patient will experience pain from the surgical procedure once they awaken. General anesthetics minimize the physiological responses to surgical cuts, hence retaining the blood pressure, stress hormone release and heart rate resolute during the procedure. This form of anesthetic is administered in form of gas mixtures such as nitrous oxide also known as laughing gas, and varied derivatives of ether such as Desflurane, Sevoflurane and Isoflurane. 

The other type of anesthesia is known as regional anesthesia which numbs only part of the body, often below the waist. Expert anesthesiologists dispense the drug through machines which measure the precise amount required to keep the patient out throughout the entire surgical procedure. Moreover, since the drug obstructs breathing, patients are usually intubated and kept on a mechanical ventilator. Other than the fact that anesthetics are a requirement in modern medicine, it still remains unclear among scientists as to precisely how they work. The closest believable theory suggests that anesthetics liquefy some of the brain cell’s fat, hence altering the cell’s performance. Nonetheless, the exact mechanisms remain a mystery.

Read also: Contractions and Labor Pains

Anesthesia Side Effects

Just like any other drug, be it an injection or taken orally, have a certain reaction to the human body. Side effects of anesthesia can take place during a procedure or during recovery period as the anesthesia wears off. The side effects one is likely to experience differ from one individual to another and also depending on the kind of anesthesia you have been induced with. Although most side effects are experienced after a procedure, which tend to be frustrating or uncomfortable, they don’t usually last long. Here are the side-effects you are likely to experience depending on the kind of anesthesia.

General Anesthesia

They include:

  • Vomiting and nausea. This is a very common side effect experienced by patients a few days after the procedure. It can be prompted by various factors, for example, movement, type of surgery and medication.
  • State of confusion. This is also common for most people after waking up from surgery. It may go on for a week or two.
  • Sore throat. This may result from the tube inserted in your throat to help you with breathing when you are passed out.
  • Hypothermia.
  • Itching due to narcotics (pain medication).
  • Muscle aches. The medication utilized to ease muscles during the insertion of the breathing tube can result in sore muscles.

On rare occasions, general anesthesia may result in coarse side effects such as cognitive dysfunction where memory loss lasts for days or even weeks. People who suffer from Alzheimer’s, lung disease or heart disease are more prone to suffering this side effect. Another serious but rare side effect is malignant hyperthermia which occurs during surgery.

Regional Anesthesia

Potential side effects of regional anesthesia as applicable in epidural include:

  • Minor back pain after epidural at the point of entry for the needle.
  • Headache which may take place a few days following the procedure if spinal fluid happens to have leaked out.
  • Hematoma where the needle was injected.
  • Difficulty in passing out urine due to numbness below the waist line.

Other graves but rare side effects include nerve damage resulting in temporary or permanent damage and Pneumothorax. Pneumothorax occurs when the needle accidentally enters the lung causing the lung to collapse.

Local Anesthesia

The side effects of local anesthesia are very minimal and usually depend on the amount of anesthesia that was injected. In order to prevent adverse side effects from taking place, it is important to inform your physician anesthesiologist if you’ve encountered any of these side effects or complications from your previous procedures or surgeries. He or she may provide you with medication before or after the procedure, or alternatively make a few alterations in order to avert the side effects from taking place once again. Now that you understand anesthesia and how it works, you are in a better position to understand epidural anesthesia.

Read also: Top 10 Labor Signs and Symptoms

Epidural Anesthesia

Epidural Anesthesia

Epidural anesthesia is a very popular pain relief method applied during the first stage of labor. Over 50 per cent of women who conceive in hospitals employ epidural anesthesia. If you are pregnant, it is important to be aware of what to expect during labor and delivery for example, what are the pain relief options, to help you decide during the labor and birth procedure. Having a better understanding of the various types of epidurals, process of administration and the benefits and risks involved will help you decide on whether or not you should get an epidural.

Epidural anesthesia is a form of regional anesthesia which targets a specific part of the body. The aim of an epidural is to offer pain relief, contrary to anesthesia which leads to complete numbness. Epidurals impede the nerve impulses from the lower spinal section which results in minimized feeling in the lower part of the body. Epidural medication can be classified under local anesthetics, such as lidocaine, chloroprocaine or bupivacaine. They are normally injected together with narcotics or opioids such as sufentanil and fentanyl. This cocktail is necessary in order to lessen the needed dose of local anesthetic. The result is pain relief with the least effects. These medications can be combined with clonidine, morphine, fentanyl or epinephrine to extend the effects of the epidural or to keep the mother’s blood pressure in check.

Epidural Risks

There are various potential epidural risks involved that every mother considering this should be aware of. Similar to invasive medical procedures as an entity, there are probable dangers of epidural steroid injections. Other than temporary numbness of the bladder and bowels, the most anticipated potential risks include:

  • Dural puncture. This occurs in 0.5% of injections, which may result in a post-puncture headache, also referred to as spinal headache. It usually lasts for a few days. Although rarely, a blood patch may be required to stop the headache.
  • Infection. There’s a 0.1% to 0.01% chance of incurring infections from injections.
  • Bleeding. This is a rare complication usually noticed in patients who suffer from bleeding disorders.
  • Nerve damage. This may take place if the patient suffers direct trauma from the needle or bleeding or from infection.
  • Sudden drop in blood pressure. It is important to have your blood pressure examined from time to time in order to ensure there is sufficient blood flow to your infant. If your blood pressure does drop, an IV fluid treatment should be prescribed together with oxygen and medications.
  • Throbbing headache. This may be as a result of spinal fluid leakage; however, this is a very rare case. It is best to stay alert. If the symptoms persist, a blood patch will be performed.
  • You are required to switch sides while lying down and be under constant monitoring after the placement of the epidural. Your physician will check for any changes in fetal heart rate. The downside to this is that sometimes lying on one side may result in slow-down of labor or no labor at all.
  • Shivering, backache, ringing in the ears, nausea, difficulty in passing urine and soreness where you were injected.
  • Sometimes epidurals make it hard to push and more thusly, interventions may be required for example cesarean. Consult with your physician when scheduling your birth plan about the kind of interventions he’ll opt to use in such a scenario.
  • You may experience numbness on the lower part of your body after conceiving.

Epidural Effects on Baby

Although research is still inconclusive, several studies reveal that some infants will have difficulty "latching on" hence experiencing challenges while breastfeeding. More studies reveal the likelihood of a baby to suffer from respiratory depression, enhanced fetal heart rate variability and fetal malpositioning, hence increasing the need for vacuum, forceps, episiotomies and cesarean deliveries.

Epidural Side Effects

To top up the risk factor involved in epidural injections, there are some potential side effects as well from the steroid medication that one is likely to experience. The side effects are rare as well as less frequent compared to the side effects experienced from taking oral steroids. Some of the side effects cases reported from the epidural injection include:

  • anxiety;
  • heightened pain;
  • facial flush;
  • non-positional headaches which end within 24 hours;
  • high blood sugar;
  • cataracts;
  • avascular necrosis also known as severe hips arthritis;
  • sleeplessness;
  • stomach ulcers;
  • a transient lowered immunity due to the steroid’s suppressive effect;
  • high fever on the night of having the injection done.

Wall the outlined facts, which one would you choose, Epidural vs. Natural Birth?

This still remains debatable for some women prefer to avoid all the risks involved by giving birth the natural way through enduring pain, while others argue that the chances of great risks occurring due to epidural are very rare, hence they still opt for the epidural anesthesia. The most important this is having all the information required about epidural before deciding on whether or not you’ll partake in it. Giving birth without epidural was the norm for our ancestor, back then when they didn’t have an option of anesthetics. Living in the modern times provides us with the opportunity to choose. The thing majority women fear most is the contractions pain during labor.

One question that is often asked is, “Does baby move during contractions?” The answer is yes. The baby’s head presses against the cervix, which results in dilation of the cervix into the birth canal. The baby normally twists and turns during labor to find the simplest way to squeeze through. Once the baby’s head is out, the rest of the labor becomes quick and smooth. For this reason, most women rush to get epidural to numb the pain experienced during childbirth. One thing you should note is that vaginal birth with epidural does occur and it requires proper planning and timing done by your physicist. In the event things don’t go as planned, a plan B is formulated where the mother has to undergo cesarean. Therefore, think long and hard before deciding on what method of birth you’ll choose.

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