What is an Epidural?

Epidural is a common short form for Epidural analgesia or painless labour. This is a procedure where an anaesthetist passes a very fine plastic catheter into a pregnant woman’s epidural space in the lower back and small doses of medication are pushed through this to reduce the pain of labour contractions. One needs to have at least some active labour pains and the cervix has to be at least 3 cm dilated before it can be sited. The catheter is normally removed after the episiotomy has been sutured.

What are the advantage of taking an epidural?

Epidural analgesia is a relatively safe and effective method of relieving pain in labour. The pain relief starts within 15-30 min and the effect may last for a variable number of hours depending on the dose and type of medication used. The good thing is that multiple or continuous infusion can be given if required.

It reduces the pain sensation while retaining the muscular strength to push out the baby. One is relatively relaxed during labour and it prevents undue fatigue and strain as well. Since the labouring woman is not crying in pain even the husbands and birth attendants are relaxed.

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If urgent C-section is required for some reason, the same epidural can quickly be topped up, and it works very well especially in women having high blood pressure.

Are there any side effects because of epidural?

If an epidural has been sited nicely, the side effects are almost negligible. In general, the larger the dose of medication used, the bigger are the side effects.

Epidural can only be taken in equipped centers where round the clock monitoring for the mother and fetus are available. One must ask beforehand about the increase in your delivery cost because of the procedure and whether your insurance going to cover it.

Some women feel backache and headache afterwards and this is more likely when Dura has been punctured causing leakage of fluid which surrounds the brain.

Sometimes the blood pressure may fall transiently requiring administration of fluids and drugs. If the labouring woman has a continuous infusion on flow, she will be confined to bed even in the first stage of labour. There is a risk of fall and injury due to decrease in the lower limb strength and blood pressure.

The block may be one sided or blotchy resulting in partial pain relief(5-15% of cases). Some women develop shivering, fever and rash due to reaction to the drug used.

The biggest drawback of the epidural is considered to be a decrease in the pushing ability of the mother. This is because she no longer feels the pain and the expulsive efforts are not up to the mark. All this may result in a delay in descent of the baby’s head, higher incidence of forceps/ vacuum extraction and caesarean sections.

There may be urinary retention in the postpartum period due to diminished sensations and mother does not need to feel to use the toilet. This may lead to catheterisation and subsequent urinary infection in the mother.

On a serious note, meningitis and serious brain infections can happen if the skin preparation is not adequate. There can be bleeding, hematoma or abscess formation in rare cases. Though extremely rare, a drug called Bupivacaine can sometimes act very toxic causing excitation, nervousness, tingling around the mouth, ringing in the ears, tremor, dizziness, blurred vision, or convulsions, followed by depression: drowsiness, loss of consciousness, and breathing difficulties. Bupivacaine may cause cardiac arrest and even death if it accidentally gets inserted into a blood vessel instead of epidural space in the spine.

There is some evidence that newborns of mothers who have received epidurals are less likely to take to breastfeeding, especially in the first 48-72 hours.

Are there women who should not be offered an Epidural?
Yes,

1) Women who have a bleeding disorder, low platelet count or are on anticoagulants for some reason,
2) If you have a skin infection in the area where epidural had to be given,
3) Septicemia or history of allergy to the drug in the past,
4) If you are not willing to undertake the risks or give consent for the same.
5) There are situations where epidural is riskier than normal and these circumstances are; in people having spinal or brain deformities, bent back(scoliosis),previous surgeries on the spinal cord, multiple sclerosis, and heart valvular defects.

If an epidural has been sited correctly and fully, it will prevent a labouring woman from walking at all. So, most hospitals would not allow patients to walk during labour. Modern epidural procedures are being done in some hospitals without compromising the mobility of the patient. This is generally referred to as a “walking epidural” and is actually a combination of a traditional epidural block with a spinal injection.