Epidurals in Labour ~ Part 1
When you are pregnant there are many decisions to be made; which health care providers to choose, what tests to do, where to give birth, what “kind” of birth, the list goes on and on. When planning birthing experiences, pain management is one of the most discussed topics and “are you having an epidural?” Is one of the most commonly asked questions. Before deciding, you might want to look at some evidence based information so that you can make the decision that is most suitable for you and your baby. Hopefully this article can help you a bit on the way.
This article is published in two parts. This first part will guide you through the medical aspects of the epidural and its history. We will also give you some information on epidural use here in Italy as it might differ from what you are used to from your home country.
The second part discusses benefits of this type of pain management as well as its possible risks. There we go deeper into controversial topics such as if epidurals might affect mother-baby bonding and breastfeeding, or if choosing an epidural might give you a higher chance of having the happy birth you most likely are seeking.
As always, remember this article is not to be considered as clinical medical advice. If you have any doubts or questions make sure to discuss them with your gynecologist or midwife, as they are the ones who understand your personal circumstances and health history.
PART ONE
What is an epidural?
Today the epidural is the most popular form of medical pain relief used during childbirth. In the US, about 60% of women giving birth in hospitals get an epidural at some point during labor. (1) In Sweden this number is 52% (2) while about 77% of women in France will have an epidural during birth compared to 40% in the UK. (3)
Normally an epidural involves a “local anesthetic” drug along with an “opiate” drug related to morphine, pethidine/meperdine etc. The local anesthetic drug blocks sensory nerves, causing numbness, and also blocks motor nerves which leads to some degree of paralysis. The opiate drugs are added to increase the efficacy of the local anesthetic, so that there will be good pain relief with less blockage of motor skills. (4) Sometimes epinephrine or sodium bicarbonate is also added to the epidural to enhance its onset, duration or intensity. An epidural is a regional analgesic; it only removes some loss of feeling in the lower part of the laboring woman’s body. She can remain fully awake and she’s able to feel and move other body parts. (5) There are different gradations of epidural strengths. The one most recommended for a vaginal birth is a “walking epidural”, where the pain is reduced but a woman can still feel the pressure of her contractions and she is able to walk and move her body in response to the contractions. The other end of the spectrum is the epidural given during a Cesarian section, where the woman does not feel the pain of the surgery but feels only pressure on her organs durning the procedure.
How is it done?
When a woman chooses an epidural during labor it is given by a anesthesiologist or an anesthetist. Typically an epidural is given once active labor is established. She will be asked to sit down and lean forward or to lie on her side with knees drawn up and then a local anesthetic will be applied to numb the skin where the needle will be inserted (you can see a video here) . The anesthetist
uses the needle to insert the thin plastic tube called the epidural catheter between the vertebrae. The needle is then removed, leaving only the catheter and it is through this catheter that the pain relief drugs are delivered throughout labour either though a manual or automatic pump. It takes about 20-30 minutes for the pain relief drugs to take full effect.(6) As soon as the baby is born the catheter in the woman’s back is removed and the effect of the epidural usually wears off completely after one to two hours. At that time the mother might feel some sensation of burning around the birth canal. (7)
It is important to note that in Italy, many hospitals require anyone who thinks they might want en epidural during labor to book an appointment with a specialist ahead of the birth. During this appointment the woman is informed of potential risks and she goes through a simple medical visit and blood test to rule out any obstacles for her to receive this type of pain medication. Also, some public Italian hospitals and clinics do not cover the cost of an epidural so it is important to discuss this with your care providers or birth structure to clarify.
“Many Italian hospitals require anyone who thinks they might want en epidural during labor to book an appointment with a specialist ahead of the birth”
History
Believe it or not, epidural anesthesia has been in use for over 100 years. The first time an epidural was utilized during labor was in 1909. In 1931 the first catheter was utilized for an epidural which meant that pain relief could be continuous. The epidural reached it highest levels of popularity in the 1970’s due to the introduction of synthetic oxytocin (the drug also known as Pitocin). This pharmaceutical “speeds up” labour which meant that one of the most common side effects, the slowing down or stopping of labour which was reported in 40% of cases in which of an epidural was administered, could now be counteracted.
Synthetic oxytocin was not the only childbirth technology that was introduced in this era. Electronic Fetal Monitoring was also made available and C-sections had become much safer and were being performed more often. If a complication arose, like a baby in distress, doctors were more comfortable performing an emergency C-section than they had been in the past. Unfortunately, fetal distress was often a side effect of this newly combined cocktail of epidurals and synthetic oxytocin.
The epidural has continued to evolve over the years. In the 1990’s women received epidurals where they could not feel anything at all which was actually an impediment to the pushing phase of delivery. Today in hospitals women can opt for “walking” epidurals, patient controlled epidurals or continued epidurals. There are however still both risks and benefits with this type of pain relief, and that is what we will take a look at next. (8)
This is the end of Part One of Epidurals in Labor. Would you like to know more about possible benefits and risks with this type of pain medication? Can an epidural affect mother-baby bonding and breastfeeding? Please read Epidurals in Labor, Part Two coming next week.
RESOURCES:
- Epidural and Spinal Anesthesia Use During Labor: https://www.cdc.gov/nchs/data/nvsr/nvsr59/nvsr59_05.pdf
- Socialstyrelsen, Statistik om graviditeter, forlossningar och nyfodda: http://www.socialstyrelsen.se/statistik/statistikefteramne/graviditeter,forlossningarochnyfodda
- Why do so many French women have epidurals?: https://www.thelocal.fr/20150904/why-do-so-many-french-women-have-epidurals
- Epidurals in Labor: http://sarahbuckley.com/blog/httpsarahbuckley-comblogepiduralrisks-faqpt1
- Evidence Based Birth, Epidural Web seminar: https://evidencebasedbirth.com
- NHS, Epidural: https://www.nhs.uk/conditions/epidural/
- Epidural Anesthesia During Labor: https://www.healthpages.org/health-a-z/epidural-anesthesia-during-labor/
- Birth Beyond Bias, History of the Epidural: http://www.birthbeyondbias.com/birthbeyondbias/2014/4/24/history-of-the-epidural
