Labour is one fearful stage during pregnancy as it is very painful. Contractions, a sensation experienced during labour is somewhat similar to cramps. The pain caused by contractions varies in intensity and through this, one can identify whether they are having true labour or false labour.
True labour can be progressive, which means that the contractions one will feel will increase in intensity with every hour that passes. On the other hand, false labour will progress to rhythmic contractions which are stronger and come every 10 minutes or more in two successive hours. At this point, the one experiencing early labour should have to call the doctor to see if she should go in to be evaluated.
As labour is very painful, there are some remedies to ease the discomfort and pain the one undergoing labour will experience. One is by having epidural anaesthesia, the most common pain reliever during labour. In most cases, pregnant women undergoing labour requests for an epidural more than any other method that there is. By statistics, there are more than 50% of the women giving birth at hospitals use epidural during labour. However, as you wish to get an epidural when the time of your labour comes, here are some things that have to be learnt before taking the procedure.
- What is epidural anaesthesia? Epidural anaesthesia, a type of regional anaesthesia which basically blocks pain for a certain region of a human body is a medication which falls in a class of medicines called locals anaesthetics. This is also a commonly used drug to provide pain relief instead of not allowing the body to feel any feeling which is the main use of anaesthesia. These epidural anaesthesias block nerve impulses from segments of the lower spine which results in decreasing the sensation in the lower half of the body this is being injected to.
- How is an epidural given? The anaesthesia is given by starting an IV or intravenous fluids before active labour begins. An amount of one to two litres of IV fluids should be given expectedly throughout labour and delivery. This procedure will be given by an anesthesiologist, and obstetrician, or nurse anaesthetist. The procedure will start by using an antiseptic solution to swipe the waistline part of the patient’s mid-back to decrease the likeliness of infection. A small area then on the back will be injected with a local anaesthesia to block feelings or numb this part. After, a needle will be inserted into the numbered area surrounding the spinal cord in the lower back. After, a small tube or a catheter will be threaded through the needle into the epidural space. After this, the needle used will be carefully removed, leaving the catheter in place to give medication through periodic injections or continuous infusion. The catheter will be taped at the back of the patient to prevent it from falling or slipping out.
- What are the different types of epidural? There are two types of epidurals in which hospitals use and doctors prescribe. One is the regular epidural and the other one is the CSE or combined spinal epidural also known as the walking epidural. Regular epidurals are medications that are administered through the patient by a pump or by periodic injections. The injected medication consists of a combination of narcotic, such as fentanyl or morphine and anaesthesia. This narcotic is used in replacement to some of the higher doses of anaesthetic like lidocaine or chloroprocaine. This epidural is designed to help the patient reduce the adverse effect of the anaesthesia. CSE on the other hand is a dose of narcotic, anaesthesia, or could be a combination of both by injecting the outermost membrane that covers the spinal cord, and inward of the epidural space. Anaesthesiologists are required to pull back the needle into the epidural space, thread a catheter through the needle, and then withdraw the needle and leave the catheter in place. This epidural type allows patients to have more freedom to move while they are in bed and will be able to change positions with assistance. Using these drugs, muscle strength, balance, and reaction are reduced.
- What are the benefits of epidural anaesthesia? There are several benefits of using epidural anaesthesia during labour. Epidural anaesthesia allows you to rest if labour is prolonged, results to more positive birth experience, stay alerted and help you in remaining active in your birth, effective pain relief during recover if caesarean, and helps patient in being relaxed. In addition to this, epidural anaesthesia might also help in dealing exhaustion, irritability, and fatigue while you are in the delivery table. The medication allows patient to rest, get focused and move forward as an active participant during child birth.
- What are the risks of epidural anaesthesia? As good as it is, epidural anaesthesia also has its drawbacks. One is this anaesthesia may cause your blood pressure to drop, suddenly. Because of this, blood pressure of the patient will be checked every now and then to ensure that there is enough blood flowing to your baby. When a sudden drop of blood pressure happens, treating b IV fluids, oxygen, and other medications are advised. Another disadvantage is an occurrence of a severe headache which may be caused by a leak of the spinal fluid. However, there is a very rare chance that women under epidural anaesthesia would feel this. Aside from these, there are also reported side effects of having an epidural anaesthesia during labour such as shivering, ringing in the ears, backache, feeling nauseous, difficulty in urinating, and soreness on the area where the needle was inserted. Also, after the epidural is administered, patient will have to lie in alternate sides and will have continuous monitoring for changes in fetal heart rate since lying in position can sometimes cause labour to slow down or stop. Lastly, in very rare cases, there will also be a difficulty in breastfeeding.
- Is there a chance epidural anaesthesia won’t work? This sounds absurd, but yes. There are reported cases, thought very rare, are reported that epidurals may not work. There are various possibilities that might happen after going through two needles in your spine and one is the ineffectiveness of the epidural. No worries though. If the epidural does not work, there are other pain management options your doctor has to offer.
- How long does epidural last? The effect of the anaesthesia lasts for around four to eight hours. However, there are times where the effect of the epidural can last too long. Some stated that their epidural still has its effect even after 24 hours of injecting the anaesthesia. To avoid such mischief, it is better to get an advice from a professional health practitioner or doctor.
- Does placing the anaesthesia hurt? Well, different women have different levels of tolerating pains. What might not be painful for others may not be as much to some. Just think how it will feel to have a numbed back and then placing a small tube or catheter.
- When is epidural exactly placed? Typically, the epidural is placed when the cervix of the patient is dilated to around four to five centimeters and when the patient is in true active labour.
- How can epidural possibly affect the baby? Research may have shown little to no results of negative effects of the baby after using epidural anaesthesia but as mentioned earlier, rare reports stated some mothers find it hard to breastfed their child. This difficulty may be caused from various factors. It could be due to the amount or dosage of the medication, the length of labour, and the characteristics and conditions per baby. Dosage may be a factor since the amount of medication varies from patient to patient depending on the cases of each pregnant woman under labour. Aside from difficulty in breastfeeding, there are reports that newborns may experience respiratory depression and decreased fetal heart rate. Since these are not official reports or studies, it can be concluded that epidural anaesthesia may have just a subtle effect on newborns.
Of course, just like any other medication, your epidural anaesthesia also has its limitations when it comes to application. Not every pregnant woman about to give birth can have the privilege to use the anaesthesia as a pain reliever. Example of cases where you might be prohibited to use the anaesthesia are when you use blood thinners, have low platelet counts, have too fast labour where it makes it impossible to administer the drug, have a blood infection, and are haemorrhaging or in shock. There are still other factors that may or may not allow you to have epidurals and there are also times where it is recommended and not because you want it. When these happen, it is best to talk to the attending physician or your obstetrician to know the full details with regards to applying the epidural anaesthesia.