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Is there a possibility of paralysis as a direct result of an epidural?
In years gone by, severe neurological damage taking weeks, even months, to recover was occasionally reported. This involved injection of other chemicals (not the local anaesthetic used in epidural) and also involved injection of those chemicals in the sub-arachnoid space (not epidural). Childbirth that has been improperly managed has a far greater potential of producing neurological damage than an epidural ever can.
Are there any circumstances where an epidural is specially recommended?
An epidural is first and foremost a method of pain relief. There are, however, circumstances in labour when it has additional advantages by facilitating successful vaginal delivery and preventing potential complications.
It is strongly recommended in pre-eclampsia as it improves blood supply to the womb (which may be tenuous in such cases) and hence the baby. It also effectively combats one of the principal causes of worsening blood pressure, i.e. Pain.
It is also strongly recommended in the case of a breech presentation or twin delivery. In the latter case, it is especially useful if the second twin is in an abnormal lie, where some kind of manipulation may be required.
Epidural analgesia is also quite useful in preterm labour where the fetus is rather delicate, and in medical conditions such as heart disease, where maternal exertion may be a bad idea. It also prevents maternal exhaustion and distress in prolonged labour.
Are there any other benefits from the epidural?
An indirect benefit is that of removing the need to use any other drugs for pain which inevitably reach the baby and may have various effects on him or her.
The drugs (local anaesthetics ) used in an epidural have no direct effects on the baby.
The lowering of blood pressure is a worrying thing. How is this handled?
This is never a serious problem. The infusion given just before inserting the epidural is usually an adequate measure against this. Even if the blood pressure fall was found to be severe enough to require further action (which is very rare), an injection of a common drug Ephedrine quickly and effectively reverses this effect.
Are there any contraindications to epidural analgesia?
Yes. Some heart conditions are considered a contraindication to using epidural analgesia. These include aortic stenosis (where the valve that leads from the heart to the artery known as the aorta is narrowed) and pulmonary hypertension (where the blood pressure in the arteries supplying the lungs is abnormally high). In these cases, such patients are usually delivered by caesarean section and pain relief in labour is not an issue.
Other situations where epidural may not be recommended is current use of anticoagulant medication. This is because of a theoretical increase in the risk of bleeding. It is also contraindicated in the presence of an infection in the vicinity of the injection site, such as an abscess, or even in the case of a systemic infection such as septicaemia.
The most important contraindication is maternal wishes NOT to have one.