The Pros & Cons of an Epidural

When I teach a childbirth education class this topic is always at the top of an expecting couples list of things they want to discuss. I’m all for a good discussion on interventions and how they affect mom and baby. So lets take a deeper dive into what an Epidural is.

There are many medications that a mother can take for pain management. They are normally grouped into two categories: Analgesics or Anesthesia. In this post we will be focusing on Anesthesia. Anesthesia is classified as either General or Local. The difference between these two classifications is that General Anesthesia involves a complete loss of consciousness, loss of body reflexes, elimination of pain, and other bodily sensations. General Anesthesia will also affect your respiratory system which is why persons are placed on a ventilator. General Anesthesia is commonly used during surgery. If you ever heard the term “I went under”, the person was referring to being placed on general anesthesia.

Local Anesthesia is slightly different. It provides a reduce sensation of pain in certain regions of the body. The medication interferes with nerve transmission in specific areas in the body, blocking the nerve conduction in the area in which the medication was applied. So what does that mean? Well, the anesthesia will only affect a portion of your body allowing you to still have all of your faculties. Certain procedures do not require you to be fully sedated, making local anesthetics the drug of choice.

Bridging The Gap

An Epidural is a route that the local anesthesia is placed. The medication is placed in a small tube (catheter) and injected into the epidural space just below the spinal cord. The catheter is placed between the L4 and L5 vertebrae. The placement of where the drug flows will provide a numbing sensation to moms lower back, abdomen and uterus. In my childbirth class I tell moms that the sensation will also affect you from the waist down.

Anesthesia is serious business which is why it can only be administered by an anesthesiologist or a nurse anesthetist. Before a mom can receive an epidural she has to receive at least one bag of fluids, which is about 1 liter of a Normal Saline Solution. She will also have to sign consent forms prior to the epidural placement. Her blood pressure will be checked frequently. Often times nurses will leave the cuff on mom. The mother will also be confined to the bed for lack of mobility related to the side effects of the drug. She will also be catheterized, placed on oxygen, and attached to continuous fetal monitoring.

Pros to Receiving an Epidural

An epidural is the drug of choice because it very effective in providing pain relief. It can help moms rest especially during a long difficult labor. What is also satisfying about an epidural is that it doesn’t affect moms state of mind. She can still be emotionally in sync with her labor.

Cons to Receiving an Epidural

  1. Mom may get incomplete areas of pain relief if the placement is off.
  2. When moms receive an epidural it can affect their blood pressure, which is why the staff will frequently assess moms blood pressure. This is also the reason why mom has to receive a bag of fluids. The nurse and doctor understand the importance of managing the blood pressure, because moms blood pressure affects babies heart rate.
  3. Mom is placed on continuous fetal heart monitoring.
  4. Mom has to wear a catheter, because the loss of sensation makes it hard to determine when the bladder is full.
  5. Stuck to laboring in bed because of limited mobility (there are positions that mom can get into that are bed friendly. It just requires mom to have some assistance.)
  6. Loss of sensation can make pushing difficult when trying to push baby out.
  7. May receive a Spinal headache, which is due to a spinal leak.

Epidurals can be very effective for a laboring mom and outcomes can result into a healthy baby and a well mother. On the flip side an epidural can lead you down a slippery slope of piled on interventions. Some interventions are very necessary while others may not be. Your job is to make an informed decision about what’s best for mom and baby. Talk to a healthcare provider if mom is thinking about getting an epidural. Depending on preexisting health conditions an epidural may not be a good fit.

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