epidural anesthesia for Childbirth

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Epidural Anaesthesia for Childbirth
The use of epidural anaesthesia for childbirth exposes both the mother and the child to health risks and complications because of the drugs they contain. There is an increasing preference for epidural among a majority of women admitted to labour wards for the purpose of relieving pain. Close to a third of all women in the child-bearing age have used an epidural, and its use is particularly prevalent among first-time mothers. Those bearing children through the caesarean section use epidurals as a substitute for general anaesthetic, giving the women the ability to have a good experience during the birth process and carry and breastfeed from the very beginning. May, Anne and Leighton, however, raise questions regarding their use for normal vaginal birth (May, Anne and Leighton para. 111).
There is a wide range of epidural used by women giving birth. A traditional epidural anaesthesia involves the injection of a local anaesthetic into the epidural space, which can be accessed near the lower back, next to the spinal cord. The result is a numbing of the nerves response for sensation from the uterus and birth canal. However, according to Halpern and Douglas, the procedure similarly leads to a numbing of the nerves responsible for controlling the movement of the legs and contraction of the pelvic muscles making it challenging for a woman to control her legs and with the onset of the second phase of labour will not be in a position to push her child out (Halpern and Douglas para.

193).Halpern and Douglas point out that the latest varieties of epidural anaesthesia use a smaller percentage of the local anaesthetic, commonly in the combination of an opiate, for instance, pethidine, morphine or fentanyl. Similarly, the reduced combinations allow women to move about with a higher degree; though the possibility of not relying on forceps during the process continues to be low (Halpern and Douglas para. 173). The other type of epidural that is more prevalent in the United States is referred to as the combined spinal-epidural (CSE), in which there is a single injection of opiate into the spinal space, very adjacent to the end of the spinal cord. The procedure relieves pain for close to two hours, and in case there is a need for further relief of pain, it is injected as an epidural. These varieties of relieving pain might appear beneficial; however, the procedure can render walking difficult since the mother is attached to a CTG machine that monitors the child and is further connected to a drip, which is similarly a necessity when conducting an epidural. May, Anne and Leighton additionally indicate that a majority of women have had good experiences with epidurals (May, Anne and Leighton para. 211). In some occasions, it relieves the woman from the pain and offers them adequate rest and relaxation to continue and have a remarkable birth experience.
However, the procedure can similarly have its disadvantages, in which an ordinary birth can develop complications leading a woman to loss her control and freedom. In most circumstances, the choice to use an epidural is arrived at without understanding the risks it poses to both the mother and the child.
Siegenfeld argues that while the drugs used in the procedure are introduced into the body through the spinal cord, a greater percentage can enter the bloodstream of the mother, flow past the placenta and into the baby’s bloodstream (Siegenfeld para. 41). A high proportion of the negative repercussions of epidurals are as a result of these “systemic”, or entire-body consequences. The most prevalently identified side effect is a reduction in blood pressure. An eighth of women will encounter this side effect to a certain extent, and therefore, additional fluids are normally offered through a drip to avoid complications. A decrease in the blood pressure of the mother determined the amount of blood that reaches the placenta, and can reduce the amount of oxygen reaching the child. An epidural has the effect of slowing the duration of labour, and the chances of a woman being given oxytocin to fasten things increases by three times. There is especially a significant reduction in the second phase of labour, resulting in a three times higher possibility of using forceps. Siegenfeld points out that first-time mothers are especially affected, deciding to use an epidural can lessen their likelihood of an ordinary birth to lower than fifty percent (Siegenfeld para. 91).
The slow speed of labour is in part connected to the effect that epidural has on the pelvic floor muscles of the woman. The muscles are responsible for guiding the head of the child so that it reaches the birth canal in the most convenient position. The failure of these muscles, known as dystocia, could take place resulting in the high use forceps or even caesarean section. Shields and Lucy point out that the use of forceps necessitates that a woman is given an episiotomy, in which the perineum, or the tissues in the middle of the vaginal entrance and the anus are cut to make the outlet larger and speed up the delivery (Shields and Lucy para. 137). Stitches are required and pain while sitting may be experienced until the healing of the episiotomy, in two to four weeks.
Other than numbing the uterus, an epidural will result to a numbing of the bladder leading to difficulties in passing urine necessitating catheterization, a procedure that involved the passing of a tube from the urethra to the empty the bladder that might feel awkward and humiliating. The other negative consequences of epidurals differ depending on the nature of drugs applied. In a research Levinson, Gershon, Shnider, Samuel and Mark found out that the use of opiate drugs commonly leads to a generalized itching of the skin. The intensity also varies and affects a minimum of 25 percent of women. The use of morphine is known to cause oral herpes in about 15% of women (Levinson, Gershon, Shnider, Samuel and Mark para. 99). Vomiting and nausea are caused by the use of any type of opiate drug, even though the likelihood of this is reduced with an epidural in comparison to when the drugs are injected into the muscle or the blood stream, in which larger doses are required. Shivering affects up to 33 percent of women, which is related to the effects on the body system that regulates heat.
A woman is likely to experience increases in body temperature in case an epidural has been in use for more than five hours. The result will be a rise the heart rate of both the woman and the baby’s that can be detected by the CTG monitor. Shields and Lucy illustrate that a fast beating of the heart could be an indication of distress, and an increase in body temperature could be an indication of an illness, for instance, chorioamnionitis that can affect both the baby and the uterus. This may necessitate such interventions as caesarean section for conceivable distress or illness or examination of the infant after delivery, for example, blood and spinal fluid samples, and numerous weeks of separation, examination, and conceivably antibiotics, until the outcomes are obtained (Shields and Lucy para. 207).
An epidural also triggers less adverse side effects such as unintentional puncture of the dura that can lead to a lengthy and occasionally serious headache, continuing feelings of numbness that normally end after about twelve weeks; feelings of weakness and numbness in regions affected by the procedure similarly lasting for about twelve months. More adverse but seldom side effects are the long-lasting destruction of the nerves; difficulties associated with breathing and the heart, and mortality associated with an epidural. Breathing difficulties are experienced by women who have received injections of opiates, and it may take six to twelve hours for full recovery. Levinson, Gershon, Shnider, Samuel and Mark make the argument that there is a glaring deficiency of research and knowledge on the repercussions of epidurals on the health of infants. They point out that the drugs involved in epidurals can attain levels that are at least as high as those experienced by the mother, and since the liver of a baby is not fully developed, it takes a longer duration for them to disappear from the bloodstream of the baby (Levinson, Gershon, Shnider, Samuel and Mark para. 209). Even though there is a lack of consistency in findings, conceivable challenges, for instance, increased breathing in the initial few moments, and susceptibility to reduced sugar in the blood are a suggestion that these drugs have quantifiable repercussions of infants.
Carlson, Stephanie and Terra add that other than these effects, infants can be affected by the interventions related to the use of epidural; for instance infants delivered by caesarean section have faced an increased threat of breathing complications. In case observing the heart rate through CTG is problematic, infants can have a tiny electrode fixed on their heads that other than being uncomfortable, could lead to infection (Carlson, Stephanie and Terra para. 106). It has been pointed out that infants delivered following epidurals may experience complications with breastfeeding that can be attributed to the use of drugs, or may be associated with more indirect modifications. Researchers have pointed out that epidurals affect the release of oxytocin that, other than interfering with the breastfeeding process, motivates the connection between a mother and an infant.
Carlson, Stephanie and Terra contend that studies on epidurals, a majority of which were done by the anaesthetists who prescribe epidurals, have regrettably paid closer attention to the advantages and disadvantages of varied combinations of drugs than on plausible adverse negative consequences. There exists no thorough research for instance on whether epidurals interfere with the effective launch of breastfeeding (Carlson, Stephanie and Terra para. 176) A large proportion of research has however established indirect but definite alterations in the conduct of infants following epidurals, with one research concluding that, following an epidural, the time spent between mothers and their babies reduced significantly. Others found that the behavioural changes continued for a minimum of six weeks.
In conclusion, even though an epidural is definitely the most successful means of relieving pain, it is important to consider that the final contentment with the practice of delivering a child might not match the absence of pain. Indeed, a survey conducted in the United Kingdom asked about contentment twelve months after delivery and established that in spite of experiencing lowest pain during the delivery period, women who had delivered through an epidural had a higher possibility of being dissatisfied with the experience after one year. A proportion of the lack of satisfaction was associated with prolonged labour and the use of forceps, all of which could be a result of having an epidural delivery. Those who did not use any means of relieving the pain also experienced the highest level of satisfaction. While pain during delivery could be extreme, epidural pain relief is not the most convenient alternative.
Works Cited:
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Carlson, Karen J, Stephanie A. Eisenstat, and Terra D. Ziporyn. The New Harvard Guide to Women’s Health. Cambridge, Mass: Harvard University Press, 2004. Print.
Halpern, Stephen H, and M J. Douglas. Evidence-based Obstetric Anesthesia. Chichester: John Wiley & Sons, 2007. Internet resource.
Levinson, Gershon, Sol M. Shnider, Samuel C. Hughes, and Mark A. Rosen. Shnider and Levinson’s Anesthesia for Obstetrics. Philadelphia: Lippincott Williams & Wilkins, 2002. Print.
May, Anne, and Ralph Leighton. Epidurals for Childbirth: A Guide for All Delivery-Suite Staff. Cambridge: Cambridge University Press, 2007. Print.
Shields, Sara G, and Lucy M. Candib. Woman-centered Care in Pregnancy and Childbirth. Oxford: Radcliffe Pub, 2010. Print.
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Siegenfeld, R. The epidural book: A woman’s guide to anesthesia for childbirth. Baltimore: Johns Hopkins University Press. 2012. Print
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