The epidural for pain relief

WOMEN, from the time they discover their pregnancy, anticipate the moment that they will meet their bundle of joy.

And while most will enjoy their pregnancy experience, many dread the process that will allow them to meet their baby – labour.

Consultant obstetrician gynaecologist (Ob-gyn) at ICON Medical Centre, Dr Keisha Buchanan said that there are a few pain relief options, among the most effective – the epidural.

“Labour is the onset of regular uterine contractions that result in delivery of the baby. As labour progresses it gets progressively painful, and this is why pain relief is important. The commonest forms of painkillers are narcotic analgesics, which provide a partial relief to pain and relaxation. However, epidural anaesthesia provides complete pain relief during labour,” Dr Buchanan explained.

She pointed out that the drug, which is a form of localised pain relief given during labour, is applied in the epidural space around the spinal cord and blocks the nerves that send information to the brain relaying pain signal.

Dr Buchanan further explained that it provides full pain relief during labour and requires close monitoring by the nurse and anaesthetist, but may also be administered continuously by a pump or patient-controlled anaesthesia, which gives the patient control over administering the anaesthesia as needed in specified doses.

Though the epidural anaesthesia is touted by Dr Buchanan as a safe and effective revolutionary technique in providing pain relief during labour, the Ob-gyn said it is rarely used in public facilities primarily because of the costs associated with procuring the drug.

“In the USA 50 per cent of women receive epidural anaesthesia during labour, while most women in Jamaica still deliver with narcotic pain relief only. However, there are some women who require epidural, such as those who have heart disease or respiratory diseases. They cannot tolerate the stress of labour pains as this would cause undue stress to the heart and increase the risk of collapse from heart failure during labour, for example,” Dr Buchanan reasoned.

She added: “The epidural anaesthesia can certainly, once administered appropriately, make labour much easier for women and as such should be discussed prior to delivery as a part of the birthing plan where available.”

Dr Buchanan acknowledged that while the epidural anaesthesia is safe in pregnancy there are a few side effects. These include:

1. Low blood pressure associated with dizzy spells

“This can be prevented by proper hydration prior to administering and close blood pressure monitoring,” Dr Buchanan said.

2. Back pains

She explained that these may occur for a few days after the epidural is removed.

3. Nausea and vomiting

According to the Ob-gyn, though a possibility, medications are available to counter these side effects.

4. Shivering

Dr Buchanan said these are transient, meaning they last for a short time.

5. Headache

This may occur if the epidural space is inadvertently entered, but Dr Buchanan said it can be treated with analgesics, steroids or rarely a blood patch.

6. Weak abdominal muscles

“This makes it harder for the woman to push the baby out and this increases the need to assist the mother to deliver the baby, for example, by the use of a vacuum or forceps to help extract the baby or, if that fails, Caesarean section,” Dr Buchanan said.

7. Partial pain relief

The Ob-gyn said this rarely occurs, but the anaesthesia given may be patchy and pain relief may be partial.

8. Nerve damage

Also rare, Dr Buchanan said permanent nerve damage may occur from epidural.

– Penda Honeyghan