It’s safe to say that epidurals are here to stay but even so, it’s surprising to see how little women, in general, know about this procedure apart from the fact that it offers them a pain-free birthing experience.
Here, we hope to simplify things for you so that you’ll be better informed to choose what’s best for you.
Some women are reluctant to consider an epidural for they worry about being labelled weak compared to moms who did not have one. Firstly, here’s the truth: Everyone experiences pain differently; the intensity of the pain women feel during labour and birth is something they’re born with, and has nothing to do with being a tough or weak person.
As for the possible side-effects of an epidural on a baby, researches and studies conducted on the matter haven’t found a significant difference in APGAR scores or the results of other specialized tests of babies born to mothers with labor epidurals and babies born to mothers who did not receive any medications during labor, so moms-to-be who are worried about this can rest assured that it’s alright.
Types of epidurals
For pain relief during labour and childbirth, there are two main types of epidurals used, which are the standard epidural and the combined spinal-epidural, known as the “walking” epidural. The procedure for receiving both types of epidurals are almost the same, with small differences in the placement of the catheter used.
With the standard epidural, the needle does not interact with the spinal fluid and stops just outside the “dura” column, where else with the walking epidural, the epidural needle comes into contact with the fluid which surrounds the spinal cord.
Both procedures also require that the woman keeps very still, even during a contraction during the initial moments. She will be asked to get into a “cat” spine position or a C curve spine position. The anesthesiologist will have to clean her back with iodine and then place a plastic sheet over a portion of her lower back. A local anesthetic will then be administered — this usually feels like a bee’s sting. The anesthesiologist will then proceed with placing the needle for either the walking epidural or the standard one and then threading a catheter in place. The catheter is left in place and well taped to the woman’s back for the rest of her labor and delivery. In both procedures, the needle is removed and a catheter is left to continuously deliver pain medication to the woman.
Standard Epidural
The two epidurals mentioned using different drugs. The standard epidural entails the use of purely local types of anaesthetics and it has the effect of a heavy or “dead” feeling to the lower extremities. As a result, apart from just shifting their body from side to side, movements become very challenging for most women, and assistance may be needed to move their bodies around. Compared to the walking epidural, it’s rather confining.
Combined Spinal-Epidural (CSE) or Walking Epidural
The walking epidural is a “cocktail” of narcotics, local anesthetic, and epinephrine. The mother will still have some sensation in her lower body and will have flexibility and ease when shifting from one position to another. The advantage of maintaining some mobility is that it can help facilitate the baby into a more favorable birthing position, which can lead to quicker labor. The labouring mom may even be stable enough to assume a position on all fours on the bed and do some hip movements. This is a very helpful position since it encourages an optimal fetal position and takes the pressure off the mother’s back. This won’t be possible with the standard epidural because the legs will be too numb to support the body’s weight.
A plus point of epidurals
Intense pain can cause the release of stress hormones into the bloodstream, which can increase your heart rate and divert blood from the uterus. If the pain is too strong, it can also make you hyperventilate, which can also divert blood away from the placenta, the part of the uterus where your baby gets oxygen and nutrients. Epidurals are known to block this pain from happening, hence helping to eliminate this ill effect.
No cause for worry
A common misperception about epidurals is that they are placed into a nerve or the spinal cord. This is not true, for the needle, catheter, and medication go into the compartment that the nerves pass through. Your spine is a protective bone structure surrounding your epidural space. Bumping into the spine (the bone) with the epidural needle should not hurt. You probably wouldn’t realize it if your anesthesiologist bumps into the spine. It’s also extremely difficult to bump any nerves, especially your spinal cord, with the epidural needle. The nerves enter the epidural space from the sides, while the needle is placed in the center.
