Epidurals

Dec 18

Epidurals are the most popular form of medication-based pain relief in childbirth. More than two thirds of all women birthing in Canadians hospitals receive an epidural (text.pg 430) - and that number is likely growing. Epidurals are used with, and without cesarean section, and are more effective than any other medication in relieving labor pain due to its direct and potent nature.

An epidural involves a precise injection within the epidural space (located outside the dura mater between the dura and spinal canal). It is accessed most commonly through the third and fourth lumbar vertebrae with a needle, along with a catheter which remains in the epidural space to add more as needed.

It is also important to note that in Canada, all women who receive an epidural must also receive an IV cannula placed in her arm which can be attached to a drip bag - which keeps her stationary for small to large amounts of time depending on the need.

It provides analgesia and anesthesia, which allows for significant pain relief. It works by providing continuous lumbar epidural infusion that is usually given in conjunction with an opioid (fentanyl/morphine) to further minimize pain.

Maternal Side Effects:

It is helpful to understand that the impacts of epidural are largely due to IV bolus (large amounts of fluids) and opioid administration. These side effects are common to occur when either of these are given, in any situation.

- Longer labor
- Higher use of forceps, vacuum & episiotomy

- Higher use of synthetic oxytocin (pitocin)
- drop in blood pressure

- inability to pass urine

- itchy skin

- nausea and vomiting

- shivering

- fever

- respiratory depression

- lack of stability and leg weakness

- headache that lasts 2-6 weeks

- puncture of the spinal cord (uncommon)

Fetal Impact:

It is well documented that ALL opioids and drugs are passed through the placenta to the fetus. We speak openly about this when it comes to alcohol during pregnancy, and yet the clarity becomes vague when speaking about drugs in labor. It is ironic that this is often the time when women are most likely to saturate their bodies with harsh toxins, as it is the closest time to the exit out of the constant safety and nourishment of the womb.

A fetus excretes drugs much less effectively than an adult body, meaning it is challenging to know exactly how it will impact them in utero. As within our own bodies, if there is an excess that cannot be properly processed, it will become stored in the tissues of the newborns brain and liver until it is slowly released.