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Epidural Anaesthesia During Labour- Risks and Benefits
As D- day approaches, every mom finds herself wondering 'how painfulis labour?'. Labour is surely painful , however thanks to modern medical science, we now have several medication and techniques that can reduce (if not stop) pain during labour and delivery.
Epidural anaesthesia is a popular and safe method of pain relief during labour. Opting for an epidural indicates having a small amount of medicine injected in the body to produce desirable pain relief. However, like all medicines, it is important that you understand the benefits and risks involved in epidural, so that you can make an informed choice well before getting into labour.
What is an Epidural?
An epidural is a local anaesthetic that aims to provide pain relief or an analgesic effect, rather than a total lack of feeling (anaesthesia). It blocks the nerve signals from both motor and sensory nerves to reach your brain. It shields you from pain while immobilising your lower body while allowing you to stay conscious during labour. Epidural can be used for both vaginal (normal) and a caesarean delivery.
Epidural anaesthesia during labour is administered on your lower back into a small space (also called epidural space) outside the spinal cord through a hollow needle or a catheter. A catheter allows for repeat or continuous delivery of the anaesthetic medication, when needed. An epidural injection for pregnancy is designed to provide partial pain relief for women, however, the decision to opt for it is entirely up to you.
Types of Epidurals
While hospitals and anaesthesiologists differ on the dosage and combinations of medication, there are broadly three type of epidurals that are used during labour.
Traditional/ Standard Epidurals
Apart from the regular use of a cathedar, traditional epidural uses regular anaesthesia medications such as bupivacaine or lidocaine that eliminates pain to a great extent. It is injected around the spine creates a heavy feeling and numbs the lower body. Therefore, mothers find it difficult to move during labour. However, you will still be able to move with some help in walking or moving.
Spinal Epidurals/ Spinal Block
Unlike a traditional epidural, spinal epidural involves the anaesthesia being injected into the spinal cord fluid directly. This gives faster relief from the labour pain but the effect of the drug wears off after a few hours. Spinal blocks are generally used late in labour. Spinal epidural once administered also makes body movements limited.
Walking Epidural or Combined Spinal Epidural (CSE)
This is a combination of drugs, local anaesthetic medication and epinephrine. Unlike other epidurals, CSE allows you to have slight sensation in your lower body. Hence, mobility is not much of an issue in this case. The advantage of maintaining some mobility in spite of the motor block, potentially helps in getting the baby into a better position for faster delivery.
How is an Epidural Injection Administered?
An epidural injection is usually given during the 'active' stage of labour by an anaesthesiologist or gynaecologist. You will be asked to sit at the edge of the bed, bend your back and remain steady. This position is important for preventing any complications and thereby increasing the effectiveness of your epidural medications. Another favourable position to do so is to lie on one side, bend and curl your knees to as high as you can possibly bring them. Both of these allow a good spinal curve to assess the exact location where the injection must be administered.
An antiseptic solution is applied on your skin to eradicate any chances of infection. A small area on your back is made numb by local anaesthesia administered through an injection. A needle is then directed into the area surrounding the spinal cord in your back followed by a catheter through the needle into the epidural space. The anaesthesiologist then carefully removes the needle, leaving the catheter in its place, in order to give medication as per requirement. The catheter is then safely taped on to the back to maintain its position.
Once you are through with the above procedure, there are a few ways to administer an epidural that can be adopted. All these methods are crucial to determine the amount of medicine that needs to be administered for an effective pain relief depending on your threshold and condition:
1. Epidural using a catheter: A catheter (a bendable thin and hollow tube) is put in carefully into the epidural space created by using a hollow needle. This allows the continuous or intermittent administration of medication just outside the membrane surrounding your spinal cord and spinal fluid. Your anaesthetist will first give you a "test dose" to check the placement of the catheter tube and check for any adverse drug reactions. If you do not develop any reactions, the test dose is followed by a full dose.
2. Intermittent Epidural: In this case, the medicine is given on a need basis. Based on your tolerance level for the labour pain and desired level of movement your anaesthesiologist will decide the dose .
3. Mix and Match: The anaesthesiologist mixes medicines (anaesthetics and analgesics) to match the degree of sensation and movement you want.
4. Patient-Controlled Epidural Anaesthesia: With the help of this epidural, you can regulate the amount of medication injected into the epidural tubing.
5. New Epidural Births: Also called as “walking epidurals,” this particular analgesia gives the mother freedom to stand, kneel, squat, or even walk with some help.
6. Spinal Analgesia: The newest pain reliever is known as spinal analgesia or a “walking spinal.” Only a tiny dosage of medicine is injected into the spinal fluid to reduce the agony of labour but still allows movement.
7. Low-Dose Epidurals: This is a type of combination (narco-anaesthetic) epidurals. They are designed to relieve some of the pain of labour so that an exhausted mother can relax a little and get some energy back for pushing.
How Does an Epidural Anaesthesia Work?
An epidural temporarily blocks the nerves in your cervix and uterus that carry pain signals to your brain and thereby decrease the sensation.
Epidural medications include drugs called local anaesthetics, such as bupivacaine, chloroprocaine or lidocaine. They are usually given with opioids or narcotics so that local anaesthetics can be used less.
This produces pain relief with less side effects. Such medicines may also be used to prolong the epidural’s effect or to stabilize the mother’s blood pressure.
What is the Right Time to Have an Epidural?
There is no right or wrong time to have an epidural analgesia during labour. However, it is usually given during the active stage of labour, when you feel more frequent contractions and your cervix has dilated.
You may also be offered an epidural if your labour has to be sped up. This is done with a hormone called Syntocinon, administered in a drip which make your contractions more intense and painful.
The epidural has to remain in its place until after your baby is born . It can also provide pain relief after delivery if you need stitches from an episiotomy.
Advantages of Having an Epidural
Epidurals are a great choice to relieve labour pain better than any other medication. Women who have been administered epidural feel very less or no pain durimng labour. Other advantages are:
It does not significantly increase duration of labour.
You can stay awake and alert but you will still feel the pressure and some stretching during delivery.
Combined spinal-epidural (CSE) gives better results than does a standard epidural. It has lower doses of anaesthetic medications that give you more muscle strength.
It‘s strength can be enhanced with a local anaesthetic if needed. Though having an epidural does not increase your chances of needing a caesarean.
Possible Disadvantages of Taking an Epidural
An epidural can be used to deliver different types of local anaesthetics, which also differ in the side effects that they cause. Common epidural side effects include
Itching : If that happens, changing the drug may help in solving the problem.
Drop in blood pressure and fever : Even a small dose of epidural may cause a drop in blood pressure or induce fever. However, this is normal.
Numbness or tingling sensation in the legs : This can create difficulties in urinating. A urinary catheter is normally used in such cases to help you urinate.
Risk of spinal fluid leak: If the injection goes too deep, it can make a hole in the protective layers (dura) around the spinal cord, and spinal fluid might leak out. This may result in headaches that can last up to days. This can happen due to fluid loss.
Longer duration of childbirth: Delivery may take a bit longer on an average amongst women who have epidurals.
Assited delivery: Some women may feel the desire to push in spite of having an epidural. Due to the epidural they cannot feel when it is time to push, they may need assisted delivery (vacuum suction/forceps)
Does Epidural Have Any Side Effects on Baby?
In general, epidurals are safe for the baby as it is injected into the spine and not through veins. Any medication that is given to a woman during her labour surely reaches the baby’s bloodstream through the umbilical cord. This includes pain-relieving anaesthetics delivered through epidurals. But anaesthetics use drugs that are as safe as any other painkillers that are given to expectant mothers and hence do not affect the baby strongly. There aren’t any long term side effects of using epidurals.
However, since the babies’ immune system is weak, it takes more time for them to remove epidural drugs. Similarly a drop in the blood pressure of the mother due to epidural, may cause discomfort to the baby as it may affect his oxygen supply.
Is Epidural Birth Painless?
Parents have fear and anxieties involving labour pain and childbirth. Having an epidural does reduce pain, however doesn't eliminate it completely.
On an average epidural takes about 40 minutes to work after it is injected. The process of administrating it is painful and can be quite uncomfortable. If the same medicine is used in lower concentration, it will cause analgesia which means it will only relieve the pain without causing any muscle weakness. However, if the epidural does not work, your doctor may have to administer it again.
Taking an epidural will provide some pain relief however, a 'painless delivery' is not entirely possible.
Can the Use of an Epidural Injection Cause Back Pain in the future?
Even after going thorugh childbirth with the help of an epidural, some women may experience mild soreness at the catheter site where the medication was injected. Using an epidural pain relief during delivery does not cause long-term back pain. While many women believe that epidural analgesia causes severe or long-term back pain, they are not related. Back pain post-delivery happens due to the pre-existing prenatal backaches or are a result of normal physiological changes during pregnancy.
Epidural and Multiple (twin) Pregnancy
It is not necessary to have a caesarean delivery with twins. Just like a single child delivery, many twins are born vaginally too. Epidurals are often recommended by doctors for pain relief in labour and also in preparation to get the second child in position for delivery.
If there are any problems, it's practically easier for your antenatal team to deliver your babies quickly if you've already had an epidural.
What Happens After Delivery?
It's important to focus on your baby's birth during pregnancy. But it's a good idea to also know what to expect after labour.
The umbilical cord is clamped and cut, and your baby is dried and covered up to prevent catching cold.
Mucus is cleared out of your baby’s face. Some babies need assistance to get their breathing normal.
Bonding starts with skin-to-skin contact. Hold your baby close to you.
Your baby will be examined by a paediatrician, weighed and measured, and given a band with your name on.
Once your precious bundle of joy is born, the toughest journey of your pregnancy may be over, but the process of care bringing him up will always continue. Your body starts to recover and you learn to adjust to the new role of motherhood. Read more
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Career and Marriage: Analysing the Odds
Choosing career over marriage can be a hard decision which could alter your life forever. The same is true of picking marriage over a career. It's important that you analyse the situation with an open mind and then decide what you want. Learn how you can make things work and even enjoy the best of both worlds.
You may have seen your girlfriends and colleagues debating about making a choice between marriage and career. What if you were faced with such a situation one day? Many believe that making the right choice is the key to being happy. But what if it doesn't have to be an 'either-or' decision? There are many aspects to a marriage and whoever said that a woman can only have one sure needs to do some deep thinking.
Career or Marriage: How to Choose?
For many women, making a choice between career and marriage has one answer - it's either one or the other. Picking career over marriage would definitely propel one to great heights and let's face it, the idea of being financially independent is very attractive. But would your personal life suffer? On the flip side, if you gave up an enterprising career to get married and have children, would you feel a little saddened and frustrated about the sacrifice you made? It pays to analyse the odds and figure out how to juggle responsibilities so that you can have a fulfilling life with a career, marriage and kids.
What You Want
Perhaps the most important question you need to answer is what you expect out of life. If you have high career aspirations, giving up on your work completely to get married wouldn't be such a great idea. Your relationship could be marred by frustrations and regrets that may only grow with time. On the other hand, if you've always dreamt of getting married and having babies then prioritising your career wouldn't really be the way to go about things. You wouldn't want to wake up one day wondering how your brood grew up so fast and you weren't around to witness their precious lives.
How Much You Want
We may be in the 21st century but the male mind can sometimes make you think you've travelled to the past! Many still feel that a successful woman can't take care of a family. Who'd look after the kids? What about the chores? But if you want to have it all - career, a happy marriage, kids - then you need to have a partner who's broadminded and understanding. There's no reason why career women and marriage can't mix. It takes work but isn't that true of any marriage? It's very important that you speak with your partner about what he feels regarding any career plans you may have. You also need to make him see how he can contribute by being involved with family life. If he's willing to make some adjustments so that you can focus on your work and the home front, there's really no reason why you'd ever have to make an 'either-or' choice.
Be Prepared
Once you've decided to balance work and marriage, you'll need to be ready to make adjustments. You may have to postpone having babies for a while to concentrate on work. When you've worked a few years, you can prepare to hear the pitter-patter of little feet. Once your baby arrives and the demands of little sleep and constant caring have abated a bit, you can always opt to work from home. It'll prepare you for when you ever decide to get back to work full-time.
If you're ever faced with the dilemma of choosing between career or marriage, you know what to do. Dig deep and ask yourself what makes you happy. With you and your partner prepared to work hard, you can enjoy a successful career, a happy marriage, or both. Read more
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3 Tips to Revive Intimate Nights With Hubby!
If your relationship with your husband has hit a speed bump, don't fret! All relationships do from time to time. The trick is to identify the problems in your relationship and work together to revive the fun and excitement. Try out some of these marriage intimacy tips to help you out.
Have you sensed that your better half is more aloof these days? Chances are you need to work on intimacy issues in your marriage rather than over thinking about what's going wrong. Work upon the creases and smoothen them out to say hello to passion again!
Build Husband Wife Intimacy The Right Way
1. Reconnect with Love
Don't worry about coming up with an elaborate plan of seduction. A few simple ways to connect with your beloved is all it takes. In order to re-establish a connection, look into each other's eyes more often. Yes, even if you have to consciously make time to talk to each for an hour each day. Not only is it important to catch up on the happenings of the day, but it's also important to spend quality time together in the frenzy of life. The bonding hormone kicks in when you look at each other lovingly and this will tempt you to move in closer. Bingo! If your husband is the shy type, make sure you initiate the eye-gazing and he will surely follow suit. This is one of the simplest ways to learn how to revive intimacy in a marriage.
2. Role Play
Role playing is not just for the theatre but can be a great way to bring the spark back in your relationship. Pick a character you'd like to play and ask him to pick one too. You can pick characters from movies both of you enjoy or go generic with characters that never fail: the damsel in a torrid love affair, for instance. Go out to a restaurant or resort and enjoy a night of love-making. The excitement and fun will definitely bring back a renewed vigour in sex and intimacy in your marriage. If you can shed your inhibitions (as you certainly should with hubby!), ask him if he has a fantasy he wants you to play out. Watch out for fireworks.
3. Back in Action
If you have children, you are probably so caught up with chores and office work that you forget to enjoy each other’s company. You need to ensure the kids get their homework done or eat a wholesome meal. However, both you and your partner should absolve yourselves from some of these responsibilities once in a while. Find a trustworthy babysitter (or your parents) and go out with your husband on a date. A little dinner and dressing up are sure to help you re-connect. Not only will the intimacy in bed increase, the spark will soon be back as well.
When you're willing to make the extra effort, the everyday problems in your marriage will quickly dissipate. Married couples’ intimacy is essential to sustain a long-term relationship and the first step is to talk it over and chart a plan of action. All the best! Read more
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16:8 Diet Plan- My Experience
I have never dieted in my entire life. This is the first time I started to do but in a good manner. Dieting particularly does not mean to give up eating and starve the whole day. Dieting means to eat in a clean manner.
I am a first-time mom of 18 months baby. After pregnancy, I desperately wanted to lose so much of weight that I have put on, lot of weight you can say. I was 57 kg before pregnancy and 80 kgs at the end of my 3rd trimester. After almost 1 year I weighed 70 kgs approximately and I was just hopeless to lose weight.
One friend suggested me about 8 hours of eating diet plan. I was like, "Ok I can do this as this is simple and no need to cook and plan extra with this." What is 8 hours of diet? 8 hours diet or you can say 16:8 hours of diet, is where you eat for 8 hours do fasting for 16 hours. It is believed that our body works best when we eat and fast.
This diet plan basically limits eating to 8 hours and for the rest of the time, you can fast. There is no restriction on eating but eating healthy and avoid junk food. You can eat whatever and whenever you want to eat.
How to lose extra weight?
Eat your daily food during the 8 hours. You can create your own time frame like you can start your day with breakfast at 9 in the morning, lunch at 1 pm and dinner by 5 pm. You can take your snacks and drinks in between but keep in mind that you can't eat after 5 pm and before 9 am. Make a time frame of 8 hours which works best for you.
Eat your normal meals in an appropriate portion.
No sugary drinks. You can take only one cup of tea or coffee for the entire day (avoid fasting time and in the morning).
Exercise is not compulsory. If you want you can do it.
Drink plenty of water. whenever you feel hungry in 16 hours of fasting, drink water and nothing else is allowed.
If you want to follow 8 hours of diet just remember one thing. Taking tea or coffee with milk or sugar in the morning will destroy the magic of this diet. This is because, after 16 hours of fasting, your body starts burning fat but if you take any creamy or sugary foods, the body stops burning fat. It will burn fat but not as fast as you want. If you want to lose weight fast and without knowing anybody about your secret, just avoid sugar and cream in 16 hours. You can have as much water as you want.
Disclaimer: The views, opinions and positions (including content in any form) expressed within this post are those of the author alone. The accuracy, completeness and validity of any statements made within this article are not guaranteed. We accept no liability for any errors, omissions or representations. The responsibility for intellectual property rights of this content rests with the author and any liability with regards to infringement of intellectual property rights remains with him/her.
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Dr Priyanka Kalra has added a new answer
Expecting Mom due this month
14 hours ago
Q. i am 39 week of pregnant and having AFI level of 8 is this normal?and is delivery possible for me?
Dr Priyanka Kalra
Obstetrician and Gynaecologist
7 hours ago
A. yes. better to show to specialist always as they get the correct diagnosis. try to avoid self and extra medication that will only complicate this and create more damage to the childdo ultrasound n necessary tests after consulting a specialist. without proper check up we can't advise or help you.. Avoid shirt cuts when it comes to health if mother n baby. ok.
Vandana Sharma has added a new answer
Guardian of 0 children
9 hours ago
Q. please tale me how much dengerous for may 7 days old baby and she was 2.9 kg.
Vandana Sharma
Nutritionist
7 hours ago
A. Hello mom the blood sugar level of baby is quite low , could say hypoglycemia as well .
Dr Ghouse has added a new answer
Guardian of 0 children
7 hours ago
Q. hlw hospital bag main baby nd mom ke liye kiya kiya le jana chahiye???
Dr Ghouse
Paediatrician
7 hours ago
A. hospital bag mein baby ke essentials Deni hogi aap YouTube per dekh sakte hain. if there is no relief it is better you see your doctor for proper examination particularly physical examination if there is need for doing investigations to find out the problem and treatment ok
Rashmi has added a new answer
Guardian of 0 children
7 hours ago
Q. my last period was on 29 February 2024 according to which I am 8 weeks 4 days pregnant but my usg scan shows 7 weeks 3 days
Rashmi
Mom of a 9 yr 7 m old girl
6 hours ago
A. For this purpose I’d like to tell you plus -1 or two weeks is completely normal to be seen during ultrasound till the time doctor does not say anything in order of you need to worry about the don’t worry like I said this can be commonly seen in one plus or 2+ weeks or minus weeks is fine
Ashima Malhotra has added a new answer
Expecting Mom due in 5 months
6 hours ago
Q. Am craving to have a burger at McDonald’s. Am 15 week pregnant.
Is it safe to have
Ashima Malhotra
Mom of a 10 m old boy
5 hours ago
A. avoid it
Dr Ghouse has added a new answer
Expecting Mom due in 6 months
5 hours ago
Q. It's my 12th week of pregnancy but last night I noticed some bleeding. So, my doctor prescribed Duphaston for 2 weeks. Is there anything to worry about? Please guide me.
Dr Ghouse
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5 hours ago
A. at present take rest and use medicines as advised by the doctor. if there is no relief it is better you see your doctor for proper examination particularly physical examination if there is need for doing investigations to find out the problem and treatment ok
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