Your Pregnancy After 35 : Labor and Delivery (part 13) - Epidural Block

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Epidural Block

An epidural block involves a tube inserted into a space outside your spinal column in the lower back. Medication is administered through the tube for pain relief; you remain conscious during delivery. The tube remains in place until after baby is born so pain-relief medication can be readministered; sometimes it is delivered continuously by pump. Many hospitals use patient-controlled epidurals—you press a button to receive more medication if you need it.

If you have an epidural, it can take up to 25 minutes before you experience pain relief. Most healthcare providers agree you can have an epidural anytime after active labor begins.

An epidural helps relieve painful uterine contractions, pain in the vagina and rectum as the baby passes through the birth canal, and the pain of an episiotomy. With an epidural, you should be able to feel enough pressure to push, but it does cause some loss of sensation in the lower part of the body. It may make it harder to push, so vacuum extraction or forceps may be necessary during delivery. If you have an epidural, you may spend longer pushing than if you have other pain relief. On the average, epidurals slow labor by 45 minutes.

Some medical conditions, such as scoliosis, previous back surgery, a serious infection when you begin labor or some blood-clotting problems, may prevent you from having an epidural. Talk to your healthcare provider at a prenatal visit if you have any of these conditions.

We’ve heard rumors that women who have tattoos on their lower backs can’t have an epidural. However, no studies have shown this to be true. Discuss any concerns you have about anesthesia and your tattoos with your healthcare provider.

Martha was certain she wouldn’t need an epidural. At one of her visits late in the pregnancy, she tried to make me promise I wouldn’t make her have one. I explained that an epidural was an option, not a requirement, and no one would “make” her have one. I knew she thought I was trying to talk her into it, but I wasn’t. Experience has taught me no matter how much a woman prepares, no one knows what labor will be like for her. I try to help a woman keep an open mind about the experience. Among her other requests, Martha didn’t want an I.V., an enema and certainly not an episiotomy. Martha’s labor turned out to be an adventure—a long one. At 3cm, she was screaming for relief. She got to 5cm and stayed there for quite a while. In the end, I had to do a Cesarean to deliver her 9-pound, 4-ounce healthy baby boy. I wasn’t sure what her reaction was going to be after the birth. When I saw her the next day, Martha was in good spirits and very happy. She felt her expectations before delivery had been misdirected. She jokingly said to me, “The only thing on my list that didn’t happen was an episiotomy.”

An epidural block may cause a woman’s blood pressure to drop suddenly, which can cause a decrease in the baby’s heart rate. Epidurals are not used if a woman is bleeding heavily or if baby has an abnormal heartbeat. One other possible side effect is severe headache if the needle punctures the covering of the spinal cord. This is an unusual complication.

Some women have heard if they have epidural anesthesia during labor, they have a greater chance of having a Cesarean delivery. Research shows no connection between the use of epidurals and the rate of Cesarean sections. Nor is there evidence an epidural lengthens the first stage of labor (from the beginning of contractions to dilatation at 10cm). If it affects your ability to push during the second stage of labor, your healthcare provider can wait a little while and let the epidural wear off so you can push.

 
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