Wednesday, November 28, 2012

Epidural analgesia in labour-Facts and fictions

Epidural analgesia......whether it is good or bad?I think it is good as labour pains are really bad pain.But in this post I  don't wish to talk about my view point on epidural analgesia.It is all evidence based medicine.As chance would have been in last few days there have been many incidents involving me, ladies in Labour,expectant mothers ,other obstetricians and labour room nurses and anaesthetists.....and common factor was epidural and some associated myth about epidural analgesia.I realized that my years in UK have helped me understand epidural analgesia better.Would like to share the answers of some common queries:

Is epidural safe?What are the side effects?

It is !! But there  can be associated complications just like any other intervention and would depend on the competence of the anaesthetist. Accidental puncture of meningeal membrane can lead to dural tap with leakage of spinal fluid.It can lead to severe headaches .the definitive treatment is blood patch injected in the epidural space.It is recommended to deliver the baby by vaccum rather than allow the lady to strain to deliver the baby.

At times if the dose of local anaesthetic medicine becomes more it can impair diaphragmatic innervation and thus arrest of respiration.This is called total spinal.

Some ladies can be allergic to the local anaesthetic agent which is used.

Epidural at times can cause lowering of blood pressure typically after administration of bolus dose of medicine.It can lead to lowered pulse rate of the foetus and is corrected by putting the Lady in left lateral position and hydrating the lady.

It is a known fact that epidural increases the length of 1st and 2nd stage of labour and there is increased used of instrumental delivery.Anaesthetist at times are touchy about this fact and would not like use of a vaccum for delivering a lady who has been given epidural analgesia as this confirms the age old fact that epidural administration is associated with increased used of instrumental delivery.I have found my patients quite cool of the fact that a vaccum will be used if they are unable to push. I think most of them are well read people and they talk to me to clear their doubts. Few Gynaecologists like to push the fundus of the lady to deliver the baby if she is not able to push.This is perhaps not recommended in modern day obstetrics.Though technically a normal delivery and not a instrumental delivery it is much dangerous with a possibility of injury to spleen,liver,ribs etc. (Again if I had not been to UK even I  would be pushing the uterus hard.There they would have struck my name from the GMC register for something as dangerous as this)

When can epidural analgesia be given?

There is no arbitrary dilatation based on which the administration of epidural should be stopped.

Should the Epidural be stopped at the time of bearing down?

Many Gynaecologists stongly believe that epidural should be stopped when the ladies pain is at it's peak and when she is bearing down to help in getting her motor impulses back.Fact of the matter remains that once epidural has been administered it should be stopped only after 1st,2nd,3rd stage of labour as well as perineal repair if needed is all complete.There is no role of stopping the epidural intermittentely.

So , epidural will cause me life long back ache? won't.There is no evidence to the same effect.

Should I go for it or not?

If I had a competent Gynaecologist who can perform safe instrumental delivery and an anaesthetist who could give me epidural without a dural tap,I would have surely gone for it myself.

Dear patients of mine, anyone of you who would like to share their good,bad or ugly experiences about epidural are most welcome at my blog.


Anonymous said...

Thanks doctor. this cleared loads of my doubts for "painless delivery".

Anonymous said...

I would like to share my experience as i have taken epidural for painless delivery.I also personally thought that epidural would delay process of labour bt to everyones surprise i delivered within 2hrs of takin it.Yes i also had assisted delivery using vacum and i am glad dr Kaushki was handling it as it took her 5-10mins to help me deliver the baby without straining me for pushing. I. Glad i chose i doc as i along wid ir team makes this process simpler.And yes anothr myth people hv that tjey will have c sec if dey go hor painless but i had a normal delivery.
So it all depends on u hw u react to med and on ur team of docs that hw well dey handle..
Thanks doc for bringing such expertise from UK amd u r duin a good job by helpin ladies deliver normalyy.