All you need to know about ‘EPIDURAL’

Around 80% of women in America get some form or the other of medical pain relief during childbirth. When Victoria Beckham a.k.a Posh Spice of the Spice girls chose to get drugged on her ‘D’ day, the media dubbed it as ‘too posh to push’.

What do you mean by the term ‘epidural’?

The term is short for ‘epidural anesthesia’. These are generally injected using catheters that are placed into the epidural space. The injection is meant to cause a loss of sensation as well as a loss of pain. It does so by blocking the transmission of signals to the brain; which otherwise take the route of the nerves in or around the spinal cord.

When are epidurals used?

When a woman is around 40 weeks pregnant, she will begin experiencing labor pain. This will signify that the time for the delivery of the baby is coming upon her soon. To help alleviate the pain caused due to childbirth, many a women choose to have drugs administered to them, which helps in numbing the lower body.

What happens before the Epidural is given?

The woman may be given an IV infusion of fluids. This is done to maintain her blood pressure. In order to monitor the baby’s heart rate, a fetal monitor is placed on the woman’s abdomen.

Positioning for an Epidural

The to-be mother will be asked to assume a position that will help the anesthetist to correctly find the position to place the needle. Generally this may mean that she is asked to sit up on the edge of the bed, and leans over; or it may mean lying on the side, curled up like a ball. Both these positions allow for the back to be pushed out.

Administering the Epidural

Once the woman is in position, the doctor will locate the appropriate section of the spine. The area will then be cleaned, before a small amount of local anesthesia is given to numb the area.

It is of utmost importance that the woman remains absolutely still while the doctor inserts the large needle into her spiral column. After the needle enters slightly, a syringe is attached to the open end of the needle.

The space that lies outside the membrane surrounding the spinal nerves should be reached by the needle. The membrane is called the ‘dura’, and that is where the procedure gets its name from.

When the needle reaches the epidural space, the plunger will start releasing saline into it. At this juncture, the syringe can be detached and a thin catheter will replace it. Medication is then continuously administered through the catheter.

Risks

As with any medical procedure, there are risks that are associated with the concept of epidurals.

Infections

These are highly rare; with an occurrence rate of 0.1 – 0.01%.

Dural Puncture

It occurs in 0.5% of cases. It might cause a post dual headache, which will be temporary in nature. A blood patch may be essential to alleviate the headache. A blood patch is a simple procedure, wherein, a small amount of blood is taken from the arm vein and immediately injected into the epidural space to allow it to clot around the spinal sac and thus, stop the leaking.

Nerve Damage

This is also a highly rare side effect. It can be caused either by the direct trauma from the needle, or from infection or from bleeding.

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