Epidural Block

What is Epidural and Epidural Block?

Epidural is a medication that helps in reducing the pain during labor and delivery. An Epidural Block is a regional pain-blocking procedure.It blocks pain in a specific body part, like the belly or the hips or the legs or pelvis.

How does Epidural Block work?

An epidural blocks the nerve signals coming from the lower spine area. These nerve signals are responsible for pain.

An Epidural Block contains one or more pain medications called anesthetics injected through a catheter into the Epidural space. Epidural space is the area between the vertebral canal and the spinal cord. Due to the catheter, the medications can be continuously given.

Initially, you may be administered a test dose just to ensure that the Epidural is at the correct place. The medication is effective in about 1 to 15 minutes based on the type of anesthetic used.

Your doctor will tell you about the best time to request an epidural during labor.

There are some conditions in which you may not be able to take Epidural:

• If you have had major lower back surgery
• If you suffer from low blood-clotting factors
• If you have an infection in your lower back
• If you are on any blood thinner

Note: Besides being used in labor, Epidural has other uses as well, such as:

• During lower body surgical procedures, like surgery on the pelvis or legs
• To provide pain relief after a procedure.

What are the pros and cons of an Epidural?

Following are some of the pros of having an Epidural:

• Pain relief: Epidural is a very potent method to relieve women of pain during delivery and childbirth.

It starts showing effects rapidly and can start alleviating pain in 10 to 20 minutes - the women who take Epidural feel no or minimal discomfort and pain during labor and delivery.

• Allows you to rest: If and when your labor-related pain alleviates, you get a chance to rest. This rest is especially important if you have had a long labor. Moreover, due to the reduced pain, you will have a positive experience while giving birth to your baby.

• It makes you more alert: As a result of the reduced pain, you will be more alert and can focus better. Due to the Epidural block, you won’t feel uncomfortable if your health care provider uses forceps or vacuum to deliver your baby. The increased comfort, in turn, would allow you to have a positive experience while giving birth.

While having a C-section, you can stay awake during the procedure if you have had an Epidural block and even reduce the pain during recovery.

• Helps with Postpartum Depression (PPD): Based on the results of a recent study- the women who used an Epidural at the time of the labor showed lesser symptoms of PPD. Therefore if your healthcare provider has a pain management plan for you, chances of PPD decrease considerably.

• You can request Epidural anytime during labor: Regardless of whether Epidural is part of your birth plan or not, you can get it anytime the need arises during labor.

• Relief during lengthy surgical procedures: Epidural can help decrease pain during long surgeries or recovering from certain procedures.

Some of the cons of an Epidural:

• Low blood pressure:Due to Epidural, you may notice a drop in your blood pressure. Your healthcare providers will closely note your blood pressure in labor and at the time of delivery. They monitor the blood pressure to ensure that your body and the baby are getting blood in proper amounts. If the blood pressure drops, you would need:
  • Oxygen
  • Fluids
  • Medication
• Side effects: You may experience the following side effects due to epidural:
  • Shivers
  • Fever
  • Itchiness

After the Epidural goes away from your body, you may experience:

• Nausea
• Dizziness
• Back pain
• Soreness at the place where the doctor inserts the needle.

• Pushing may become tougher: For some women pushing may become more difficult under the Epidural effect. This may precipitate your doctors to resort to:
  • Use of forceps
  • Use of medication
  • C-section
• Increased chances of a perineal tear:Women who have Epidurals, are more prone to perineal tears.

Some other factors that increase the risk of a perineal tear include:

• baby with heavier birth weight
• labor induction
• episiotomy
• Numbness may last longer than expected: Numbness in the lower half of your body may continue for a few hours after birth. Hence you may have to stay in bed for a longer duration until the numbness wears off.
• Problems in urinating:If you have been given Epidural, it is highly likely that you would need a catheter to empty your bladder. The catheter is removed once the numbness from the lower half of your body goes away.

Is natural birth better for the baby - Epidural vs. Natural birth

Which method is “better” depends on:                                     

• Your situation
• Your individual needs

Hence, your healthcare provider will make a recommendation based on these two factors. The specific details of a method don’t necessarily make it better.

Many factors determine the amount of pain you may experience during labor and delivery: Based on these factors, your doctor will decide and recommend if any medication is needed:

• Physical and emotional health
• Size of the baby
• The baby’s position
• Intensity of contractions
• Pain tolerance capacity
• The size of your pelvis

It is impossible to predict how you will feel or what kind of mindset you will have when the time comes. Therefore it is crucial to keep an open mind and focus on having a positive experience even if things don’t go as planned. It is better to have two birth plans:

• Optimal plan – main plan
• Fall-back plan – back up plan

Having two birth plans will save you from the feeling of being caught off guard if things don’t go as planned and plans change during labor.

Is an Epidural the only option – alternatives?

Besides Epidural, you have many other options for pain management. Discuss with your healthcare providers to find out what works best for you.

Medicinal pain relief alternatives of Epidural include:

• Opioids:

Opioids are narcotics. These are given either through an injection or an IV (intravenously). These are generally considered safe; however, they cannot be administered right before the delivery as it may slow down:

• Baby’s heart rate
• Baby’s breathing rate

Disadvantage over Epidural: Not as effective since they provide less pain relief in comparison to Epidural. However, they are strong enough to make pain bearable.

Advantage over Epidural: They don’t cause numbness

Side effects: itching, drowsiness, vomiting and nausea.

• Nitrous Oxide: Also known as “laughing gas”, Nitrous Oxide is an inhaled analgesia. It is taken through a handheld mask. It takes about a minute to show its effect; therefore, it will be administered to you about 30 seconds before your contractions begin.

Advantages over Epidural: You can take nitrous oxide either continuously or as needed to relax during labor.

Disadvantages over Epidural: it does not eliminate the pain completely.

Side Effects: dizziness, vomiting, nausea, drowsiness.

• Pudendal Block: it is a numbing medication. It will be injected late during the labor(just when the baby’s head is about to come out) in your:
  • Vagina, and,
  • Pudendal nerve (main nerve of the perineum – the area between the anus and the vulva)

Non-medicinal pain relief alternatives of Epidural:

If you want an entirely natural delivery or some non-medical home remedies to complement the medicines, you can try out the following:

• Massage
• Using a labor ball
• Warm baths or showers
• Applying heat compresses to the lower back
• Applying cold compresses to the lower back
• Adjusting positions like walking standing or crouching to find the one that is comfortable for you.
• Meditation
• Essential oils
• Yoga
• Breathing exercises
• TENS unit – a battery-operated device that helps in treating pain
• Doula – a trained professional who would be with you through every step of the process to give you physical, informational and emotional support.

Is it worth getting an Epidural?

Delivery of a baby is painful and the decision to use Epidural block is a personal choice.  Before making the final choice, you should consider:

• Pros of Epidural
• Cons of Epidural
• Alternatives of Epidural

Your healthcare providers will share with you what are the risks and benefits of Epidural for you and will also lay out the details of other pain management options.

If you have a plan to manage the labor, you will feel more ready for it. However, even the best laid out plans may prove to be ineffective at the last moment, therefore always discuss the backup plans with your doctor.

Final Verdict: AnEpidural block is safe for pain relief during labor and is effective in reducing chronic pain. However, it does have some risks, which are either temporary or very rare.

References:

1. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4864700/
2. https://pubmed.ncbi.nlm.nih.gov/28930940/
3. https://pubmed.ncbi.nlm.nih.gov/24529800/
4. https://www.royalberkshire.nhs.uk/patient-information-leaflets/Maternity/Maternity---bad-backs-during-pregnancy-and-labour.htm
5. https://www.fda.gov/drugs/drug-safety-and-availability/fda-drug-safety-communication-updated-recommendations-decrease-risk-spinal-column-bleeding-and
6. https://pubmed.ncbi.nlm.nih.gov/2295098/
7. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5558305/
8. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4297456/
9. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3404542/
10. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3392605/

By -
Dr. Ruchika Singh

14-April-2023