For women delivering babies, one of the most popular forms of analgesia is the epidural – a way of administering pain-blocking medication directly to the nerves. Because it doesn’t enter the mother’s bloodstream, it has little or no effect on the infant. And it prevents pain without sedating the mother, so she stays awake and alert.
How do epidurals work?
A pain medication, injected into the lower back, reaches the epidural space between the vertebrae and the spinal cord, where it bathes the nerves. It takes effect in about 15 to 20 minutes, blocking pain in the lower half of the body. A thin catheter is inserted into the epidural space as the injection is given, allowing additional medication to be given as needed.
In certain instances, some hospitals now offer women in labor a "walking" epidural. Doctors say that in this procedure, a pump is used to deliver continuous low-dosages of medication. The patient experiences little pain and does not lose feeling in her legs, so she is able to move around during labor, which may ultimately speed delivery.
If a surgical procedure, such as a cesarean section, becomes necessary, an anesthetic can be administered through the catheter. Since only the lower body is affected, the expectant mother remains conscious, and can see her newborn right after birth.
What are the possible side effects of using epidurals?
Most women in labor receive an epidural with few complications. Some experts believe that an epidural may prolong labor, but others contend that it doesn’t. Recent research shows that an epidural does not increase the risk of cesarean birth, as was once thought.
Still, this procedure is not considered risk-free. Epidural medication may cause a drop in the mother’s blood pressure that could affect the baby’s heartbeat. To help prevent this, intravenous fluids are given before the epidural is administered. Also, medical experts say that if large doses of the local anesthetic are injected into a blood vessel, the mother may experience drowsiness, breathing difficulties, slurred speech, blurred vision, heart-rhythm abnormalities, and possibly even convulsions. To reduce these risks, the anesthesiologist administers a small dose first to test the placement of the medication.
Postpartum problems, such as headache or difficulty urinating, sometimes occur. To head them off, the anesthesiologist will ask the patient to hold as still as possible while the injection is given so that the medication is inserted into exactly the right spot.
Long-term risks are quite rare, according to doctors. They include a possible epidural hematoma (an accumulation of blood under the tissues) or an abscess, which, if left untreated, can result in paralysis.