Epidural Analgesia| Types| Benefits and Risks Involved

Women looking forward to attaining motherhood mostly have the common fear of acute labor pain at the time of child delivery. The quantum of labor pain differs from a mother to another. Some mothers experience less labor pain and easy delivery, whereas others may have prolonged labor pain.


Labor pain is unbearable for most women without pain relief support. The introduction of modern medicine in obstetrics and the availability of the latest procedures with qualified practitioners have made labor pain relief possible. Pain Management is the most important thing during childbirth. Techniques of painless delivery are provided to respite the mother from excessive pain in both:


  • 1. Normal delivery

  • 2. Caesarean delivery


The procedure of painless delivery is performed by Epidural Analgesia|Anaesthesia. This popular technique, advised by the doctor during labor, gives relief from unbearable labor pain. The anaesthesiologist in charge and the Obstetrics-Gynaecologist monitor the level of blood pressure and keep a track on the epidural to confirm whether it is working well. The baby’s heart rate is checked intermittently or constantly.


Types of Epidurals


Anaesthesiologists prepare different dosages and combinations of epidural medication based on the condition of the would-be-mother. One should discuss the health condition and pain tolerance capacity with the care providers at the clinic/hospital in this regard prior to the application of epidural.


Common Epidural Births


There are different ways of administering epidural anaesthesia during labor. The 7 most common types of epidural births are:


1. Continuous Epidural: Continuous epidural refers to the bedside pump that constantly supplies the dura with active pain-relieving medication. The constant epidural administration is the most popular type of epidural births as it offers continuous pain relief. Blood pressure remains more stable in the continuous epidural, and a lesser dose of sedative medication is needed.

2. Intermittent Epidural births: In an intermittent epidural, the sedative medication is injected periodically. It allows mothers to tolerate the level of pain until they desire.

3. Mix and Match: The anaesthesiologist mixes aesthetics and analgesics medicines to match the degree of pain in this form of epidural. However, there is no guarantee to receive exact pain relief as desired.

4. Patient-Controlled Epidural Anaesthesia: Patient-controlled epidural anaesthesia (PCEA) helps the would-be-mother to regulate the amount of relief by her as she desires. She can do it by pressing a button connected to a preset computer-controlled medication. It injects medicines into the epidural tubing as the mother presses the button. PCEA uses less medicine and is as per the mother’s choice.

5. New Epidural Births: This epidural procedure allows the mother to enjoy the sensation and the movement during labor without any pain. It allows the mother to kneel, squat, stand and even walk with support.

6. Spinal Analgesia: Spinal analgesia, also known as “walking spinal” is technically not an epidural. In this procedure, a small amount of narcotics is directly introduced into the mother’s spinal fluid to ease the pain of labor.

7. Combination of narcotic-aesthetic epidurals: This is a combination of narcotic-aesthetic epidurals to relieve labor pain. The exhausted mother is allowed to relax and gain energy for a second wind of pushing. It relieves maximum pain and allows the mother to feel the sensation and movement of childbirth in her body.

Key Points to Know About Epidural Anaesthesia Administration:


  • 1. Epidural analgesia, combined with opioid and local aesthetic provides comprehensive analgesia.

  • 2. Epidural analgesia sedates the stress response to the delivery procedure.

  • 3. Epidural analgesia, being the part of a multimodal recovery program, enhances the patient recovery quality after delivery and shortens the hospital stay.

  • 4. Epidural analgesia reduces the occurrence of thromboembolic, cardiac complications and postoperative pulmonary.

  • 5. The risk of severe complications due to epidural analgesia is outweighed by its benefits in would-be-mothers undergoing labor and childbirth. The right supervision by an acute pain management service technician assures painless childbirth with minimum pain.


Eligibility for Epidural


Positives:


  • 1. Epidural is recommended in some patients to optimize outcomes.

  • 2. Women with complicated or prolonged labor

  • 3. Women trying for a vaginal birth after cesarean section (VBAC)

  • 4. Women with medical conditions like heart conditions, preeclampsia, and hypertension.


Negatives:


  • 1. Women with bleeding disorders

  • 2. Women under medications like clopidogrel, heparin, warfarin, etc., that can potentially affect blood clotting

  • 3. Women with lower back surgery

  • 4. Women with certain neurological disorders


Discuss and determine your epidural eligibility with your obstetrician and anaesthetist before delivery. Like every other treatment and surgery, epidural delivery has pros and cons.


Benefits of Epidural Anaesthesia


There are quite a few advantages of Epidural Analgesia. These are:


  • 1. It allows the mother to rest in case of prolonged labor.

  • 2. It reduces the discomfort of childbirth.

  • 3. It provides a more positive birth experience.

  • 4. An epidural allows the mother to stay alert and active to participate in the childbirth.

  • 5. During a cesarean delivery, epidural anaesthesia allows the mother to stay awake. It provides functional pain relief during the phase of recovery.

  • 6. An epidural helps to deal with exhaustion, fatigue, and irritability. It allows the mother to rest, and remain focused, and be an active participant in the birth experience.

  • 7. The use of epidural anaesthesia during labor and childbirth has been constantly refined, and skillfully administered by qualified anaesthetists.


Risks of Epidural Anaesthesia


1. Epidurals can suddenly drop blood pressure levels. That is why the blood pressure is routinely monitored to ensure adequate blood flow to the baby. The sudden drop in blood pressure levels needs to be immediately attended with medications, IV fluids and oxygen.

2. Some women may experience a severe headache due to leakage of spinal fluid. This is a rare side effect noticed in less than 1% of women. If the symptom continues, “blood patch” injection is pushed in the blood of the epidural region to relieve a headache. 3. Once the epidural is placed the mother needs to alternate her sides as she is lying on the bed. It helps in continuous monitoring the changes in fetal heart rate. Lying in only one position causes the labor to suddenly stop or slow down. 4. Mothers might experience side effects like the ringing in the ears, shivering, backache, soreness in the area where the needle is placed, nausea, or difficulty in urinating. 5. Soon after the birth, the lower portion of the body tends to feel numb for a few hours. Numbness affects the normal walk of the mother and she requires assistance to walk.Some studies suggest that the baby might experience fetal malpositioning, respiratory depression or a sudden increase in fetal heart rate variability due to the side effects of an epidural. Hence, it increases the need for cesarean deliveries, vacuum, forceps, and episiotomies. Conclusion Painless delivery through epidural anaesthesia is constantly monitored by the qualified and experienced anaesthetist, gynaecologists, and obstetricians. The mother is always under expert the supervision of the anaesthetist and her gynaecologist during the epidural anaesthesia administration. Constant monitoring is done to note the changes in blood pressure levels. Blood pressure checking is done at an interval of about 15 minutes in the beginning and then at comparatively long intervals. The baby’s heart rate is checked as per the Obstetrician’s advice to ensure a healthy and safe delivery.

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