The first recorded use of an epidural was in 1885, when New York neurologist J. Leonard Corning injected cocaine into the back of a patient suffering from “spinal weakness and seminal incontinence.” More than a century later, epidurals have become the most popular method of analgesia, or pain relief, in US birth rooms.

The research is overwhelming, though... It is just not openly shared with moms.

What is an Epidural?

• The Epidural: The anesthesiologist inserts a needle into the epidural space, which lies between the tough, outer membrane that covers the spinal cord and the next deeper membrane. A tiny tube or catheter is threaded through the needle. The needle is removed and the anesthesiologist or anesthetist injects an anesthetic similar to those used in dentistry or, in most hospitals today, a mixture of anesthetic and narcotic into the catheter.

continuous infusion: The catheter is attached to a syringe driven by a pump that gradually delivers a continuous dose. This technique is the standard because it provides steady labor pain relief.

intermittent top-ups: The anesthesiologist or anesthetist returns to inject more pain medication into the catheter when the dose wears off.

• The "Walking" or "Light" Epidural: The anesthesiologist may inject narcotic only, a very low dose of anesthetic, or a combination of the two in an attempt to achieve complete mobility with good labor pain relief. These variations are intended to leave some sensation and ability to move the legs. However, many women with such epidurals never walk, even when encouraged to do so. It was hoped that these innovations would achieve equally good labor pain relief while reducing adverse effects, but instead, women still experience the same side effects.

• The Combined Spinal-Epidural: The anesthesiologist injects pain medication (usually a narcotic, occasionally an anesthetic) into the space that lies deeper than the epidural space ("spinal"). The anesthesiologist then pulls outward into the epidural space, threads a catheter into the epidural space, and removes the needle. The spinal cannot be repeated, but the catheter remains for an epidural should you want additional labor pain relief later.

Epidural medications fall into a class of drugs called local anesthetics, such as bupivacaine, chloroprocaine, or lidocaine. They are often delivered in combination with opioids or narcotics such as fentanyl and sufentanil in order to decrease the required dose of local anesthetic. Epidural anesthesia is a regional anesthesia that blocks pain in a particular region of the body. The goal of an epidural is to provide analgesia, or pain relief, rather than anesthesia, which leads to total lack of feeling.

How is an Epidural Administered?

• An IV (intravenous drip): About a quart of IV fluid is administered before the epidural is given.
• Continuous Electronic Fetal Monitoring (EFM)
• Frequent monitoring of blood pressure, usually with an automatic blood pressure cuff that periodically self-inflates and records the results.

What are the Benefits of an Epidural?

• Allowing you to rest if your labor is prolonged.
• Reducing the pain, increasing the enjoyment of the birth (for some).
• Remaining alert and being an active participant in the birth.
• If you deliver by cesarean, an epidural anesthesia will allow you to stay awake and also provide effective pain relief during recovery.
• When other types of coping mechanisms are no longer helping, an epidural can help you deal with exhaustion, irritability, and fatigue.

What are the Risks of an Epidural?

• IV Pitocin (oxytocin), a drug to make contractions stronger
• drugs to fight a drop in blood pressure
• a urinary catheter for inability to pass urine
• a vacuum extraction or a forceps delivery.
• cesarean section.

• You may experience a severe headache caused by leakage of spinal fluid.
• After your epidural is placed, you will need to alternate sides while lying in bed and have continuous monitoring for changes in fetal heart rate. Lying in one position can sometimes cause labor to slow down or stop.
• Shivering
• Ringing of the ears
• Backache
• Soreness where the needle is inserted
• Nausea
• Difficulty urinating.
• For a few hours after the birth the lower half of your body may feel numb. Numbness will require you to walk with assistance.
• In rare instances, permanent nerve damage may result in the area where the catheter was inserted.
• Serious tears in your perineum: this is the tissue between your vaginal and anal openings (this is probably due to increased use of vacuum extraction or forceps)
• Adverse behavioral effects on the newborn
• Newborn jaundice
• Life-threatening complications (dangerously low blood pressure, respiratory or cardiac arrest, severe allergic reaction, convulsion)

First-time mothers tend to have more difficulties with epidural side effects than women who have previously given birth. 20% of women who receive an epidural end up with an unplanned c-section.

How can an Epidural Affect the Baby?

• Any medication that a woman uses during labor enters the child’s bloodstream as well via the umbilical cord. This includes pain-relieving drugs and anesthetics delivered through epidurals.
• Epidurals might make it more difficult for some babies to get into the best position for birth.
• Research shows that an epidural has a large impact on the placenta, causing it to block oxidized stresses and other important processes that are supposed to take place during labor and birth.

Breastfeeding After an Epidural

Mothers who received an epidural reported more difficulty with breastfeeding in the first week early on, and were twice as likely to give up breastfeeding within the first six months. Evidence suggests that fentanyl can interfere with infants' ability to suckle.

Despite a woman’s best efforts to have a natural, undisturbed birth, complications can occur that require medical attention. In these circumstances, whatever interventions may protect the health and safety of both the mother and baby are what should take place. At the end of the day, that is by far more important than how the baby was born.

References:

http://www.ncbi.nlm.nih.gov/pubmed/27050812: http://articles.mercola.com/sites/articles/archive/2007/01/06/epidurals-affect-a-moms-ability-to-breastfeed.aspx http://www.ncbi.nlm.nih.gov/pubmed/16235275/ http://www.ncbi.nlm.nih.gov/pubmed/10796196 http://www.ncbi.nlm.nih.gov/pubmed/27013783 http://www.ncbi.nlm.nih.gov/pubmedhealth/PMH0072751/ http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3622113/

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