Birthing a child is a process that demands a lot from a woman’s mind and body. Labour can be as hard, painful and unbearably long as it can be beautiful and spontaneous. This spontaneity requires decisions to be made amidst all the chaos and pain — and these judgements must not be marred by any misinformation that floats around.
The need of epidural injections for pain relief is met with raised eyebrows and speculations. But is there any weight in these doubts?
Some Basics
What are epidural injections and when are they administered?
American Pregnancy Association defines epidural injection as a method that provides pain relief during labor. These fall under the category of ‘local anesthetics’. To be precise, epidural injections block pain in a particular region of the body (lower half). They provide analgesia, or relief from pain, instead of anesthesia, which leads to complete numbness.
Dr Sudeshna Ray, Consultant & Coordinator, Obstetrics and Gynaecology at Jaslok Hospital and Research Centre, explains,
“The injection is given as staggered infusion in the epidural space around the spinal cord. It is an analgesia or pain reliever which acts on the pain pathway and makes the woman tolerate the pain comfortably without distress.”
FIT also spoke with Dr Nupur Gupta, Director - Obstetrics and Gynaecology , Fortis Gurugram, who said that epidural is only given after seeking informed consent. Both parents are explained the advantages and disadvantages. It is administered by an anesthetist or a trained specialist, who is required to stay throughout the delivery. The effect may wear down in one or two hours depending on the dosage. It can be given again as per requirement.
Short-Term Relief, Long-Term Problems? Not Quite
Misinformation surrounding epidural injections and the prolonged side-effects that they may lead to is escalating. In such a scenario, getting an unbiased perspective from experts becomes crucial in order to allow women to make more informed decisions.
1. Backache later on in life: It is widely believed that women who take the injection may suffer from backache years later. Both doctors refuted the claim. Dr Nupur Gupta explained,
“The backache is hardly ever related to the injection. There are many other factors that may cause the backache: weakness in a woman, nutrition and Vitamin D deficiency, increasing weight, or an incorrect posture while breastfeeding. Backache is common because of sedentary lifestyle, not epidural pain-relief.”Dr Nupur Gupta
2. Harm to the baby: Another myth is that epidural injections cause problems for the baby and may even lead to issues with breast-feeding. Dr Sudeshna Ray says that if the epidural is given at the right spot, in the right dose, and by a trained specialist —The outcome both to the baby and the mother would be rewarding.
“It is essential to constantly monitor the baby’s heart rate with electronic fetal monitoring (EFM). Decisions can be made depending on how the baby and mother are doing.”Dr Sudeshna Ray
Dr Nupur Gupta, in fact, informed that opioid injections that used to be given earlier, were observed to have caused respiratory depression when the baby was born. “Epidural is considered better. It is tried, tested and safe.”
3. Slows down labor process: It is also speculated that by reducing a woman’s pain sensation, epidural could make it difficult for her to feel her contractions and push the baby. Even American Pregnancy Association has included this as one of the risks associated with the injection.
“It may so happen that the woman’s bearing down effort is reduced. In such cases, chances of instrumental delivery are high. Vacuum or forceps are some options.”Dr Nupur Gupta
Dr Sudeshna Ray, however, explained that while concerns regarding the slowing down of labor have been there, recent researches have refuted them and shown that epidural injection alone may not increase the chances of instrumental delivery.
For instance, this study concluded that “epidural medication had no effect on the duration of the second stage of labor, normal vaginal delivery rate, incidence of episiotomy, the position of the fetus at birth or any other measure of fetal well-being.”
4. Increases the chances of cesarean delivery: The same logic is applied here, where it is believed that the woman may not be able to feel her contractions and push, leading to the need of a cesarean delivery. But that’s not the case, argued both the doctors.
“In most cases where we give epidural injection, we usually expect that the delivery is going to be normal”, says Dr Nupur Gupta.
According to Dr Sudeshna Ray,
“You can’t draw a causal link between epidural and cesarean deliveries. Till the time the baby isn’t born, it is always a trial. Yes, cesarean may be done in the end, but the chances are the same even if the epidural isn’t administered. Infact if a woman needs a ceserean for any other reason, the cesarean can be done with anesthesia through the same route. Till the very end, one can’t be sure.”
So Are No Risks Involved?
Epidural injections are usually safe and do not lead to any serious complications. However, there is a possibility of certain risks — most by virtue of the injection being located so close to the spine.
“The risks are not exclusive, but since the needle is being pierced near the spinal cord, the specialist has to be highly precise. If the spinal cord is attacked, there can be a leakage of cerebrospinal fluid.”Dr Nupur Gupta
Dr Sudeshna Ray adds that in extremely rare cases of faulty administration of the injection (pricking at the wrong place or giving the wrong combination of drugs), neurological complications may also arise or some nerve may inadvertently be injured. The mother’s and baby’s health could be at risk then. Hence, it becomes necessary to have a trained obstetric anaesthetic team.
“Some immediate effects could be being limited to the bed, transient drop in the mother’s blood pressure and fetal heart rate, loss in bladder sensation etc. But all this is temporary and usually wither within a short period of time.”Dr Sudeshna Ray
In fact, she adds that in western countries, even movement and walking has now become possible despite the injection.
Moreover, a woman is medically tested and the procedure is performed only when she is deemed fit. For instance, if her platelets count is less, she won’t be given an epidural injection.
Speaking of alternatives, there are other options available that could help with pain relief. Painkillers, inhalers, water birth and in some cases, hypnotic nurses. If a woman wants complementary interventions, acupuncture is also an option for relaxation.
However, both doctors agree that epidural is a safe procedure with no long-term side-effects if administered correctly and by a specialist.
Dr Nupur Gupta says,
“In India, women are scared of opting for the procedure because of two reasons. First, the myths associated with it and second, it needs to be paid for separately because it requires a special team.”
According to Dr Sudeshna Ray, “Labor can be a very painful process. epidural anesthesia help make the journey more comfortable, enjoyable and successful.”
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