Epidural Anesthesia

 

What is an epidural? 

 

Benefits of Epidurals: why would you ask for one in the first place?

                                     

How is an epidural administered, what equipment is involved, and what are the side effects? 

 

Time for the Birth

- Can you feel the urge to push? Generally not. Medical staff will check cervix to tell you when to start pushing; and will watch monitor to tell you when a contraction comes so that you can push with the contraction.

- Can you push as effectively with an epidural? No. Abdominal muscles are weakened: normal pressures exerted during second stage are 120-135 mm Hg, with an epidural, they barely reach 100 mm Hg. Also, you can’t use your voluntary muscles as well to aid in the pushing, and you can’t move into the most effective positions (i.e. squatting)

- Does the baby rotate as well into the correct position if mom has had an epidural? No. Amongst non-epidural mothers, only 4% had a posterior baby persisting into second stage; after epidural, 19% failed to rotate.

As a result of these factors, there’s an increased risk of: forceps, vacuum extractor, and c-section. Of 24 studies reviewed, 22 studies showed a significant association between epidural and instrumental delivery; other 2 suggested an association, but it was not statistically significant. With narcotics, instrumental delivery: 3-7% With epidural: 15-53%

Thorp referred to some studies where the epidural medication was stopped once the mother reached 8 cm dilation, so that sensation would return for second stage labor. You may wish to consult with your caregiver about whether this practice is currently recommended.

Increased Risk of Cesarean

In a review of 15 available studies, 12 suggested a significant association between epidural and c-section. Risk of c-section generally found to be 2-3 times more likely with epidural.

An influence on this is what point in labor the epidural was administered. One study found that cesarean rates were 11% if epidural was given at 5 or more cm dilation, 16% at 4 cm, and 28% at 3 cm. Another study was even more striking, finding that cesarean rates increased to 26% when epidural was given at 4 cm, dilation, 33% at 3 cm, and 50% when the epidural was given at 2 cm dilation. So, the longer you can wait to have an epidural, the better.

Possible Effects After the Birth.

Backache. 10% of new moms develop a backache for the first time that lasts at least 6 weeks. Among women who’d had epidurals, the number jumps to 18%. This may be due to poor positioning during birth: women with epidurals may not be able to sense discomfort when they are in a position which is straining muscles, so support people need to pay attention to keeping mom in a comfortable, healthy position.

Medications cross the placenta and may have subtle side effects on the baby, including more difficulty in self-soothing, subtle changes in reflexes.

Decrease in maternal oxytocin during labor may interfere with oxytocin release after birth. Bonding and milk letdown reflexes may be decreased.

Some uncontrolled studies have been done, which aren’t conclusive due to lack of controls, but interesting nonetheless: unmedicated mothers reported that their babies were more sociable, more rewarding, and easier to care for. Unmedicated moms were more responsive to their babies’ cries. Women who had epidurals smiled less at their infants.

 

 

Janelle Durham, 2002

Sources: Statistics cited are from “Epidural Anesthesia in Labor: An Evaluation of the Risks and Benefits” by Thorp and Breedlove, Birth, June 1996. This was a literature review article, which summarized the results of numerous studies involving thousands of births. Other information from: Pregnancy, Childbirth, and the Newborn by Simkin, Whalley, and Keppler (1991 edition). Maternity & Women’s Health Care by Lowdermilk, Perry, and Bobak (6th Edition, 1997). Family-Centered Maternity and Newborn Care by Celeste R. Phillips (Fourth edition, 1996). “Epidural Epidemic” by Dozer and Baruth, Mothering, July-August 1999. “What no one tells you about Epidurals” by Penny Simkin; “The Cascade of Interventions” by Pam England; and Epidural’s Effects on Babies” by Beverley Lawrence Beech, in Mothering, March-April 2000.

“So you Want An Epidural” by Kim James.

 

An overview of epidural side effects (a chart based on the data cited above, from 2002 and before.)

A more recent examination of epidural side effects. Written for professionals, it is more difficult to read than the information above.

 

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