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Pregnancy Week by Week : Week 39 (part 2) - What Is an Epidural Block?

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6. Your Nutrition

If you’re going to breastfeed, you need to begin thinking about your nutrition for the time you will nurse. It’s important because it can affect the quality of your milk. You may have to avoid some foods because they can pass into breast milk and cause your baby stomach distress. And you’ll need to continue to drink lots of fluids.

Keep up your calcium intake. Ask your healthcare provider about any vitamins you should take.

If you choose to bottlefeed, you have a few more options. However, it’s still important to follow a nutritious eating plan. You may need fewer calories, but don’t drastically cut your calories in the hopes of losing weight quickly. You need good energy levels. Keep up your fluid intake.

7. You Should Also Know

Pain Relief during Labor

Your uterus has to contract a lot so your baby can be born. Labor can be painful. Unfortunately, you won’t have any idea what your labor is going to be like until it begins. When you’re afraid of the pain you expect during labor and delivery, you tense up, which can make it worse. Listen to your body, and do what’s necessary to get through labor and delivery. If you choose anesthesia, studies show it can speed up labor because you’re more relaxed. Another study suggests anesthesia in early labor does not increase the Cesarean-delivery rate.

Labor-pain relief is approached in many ways. When you use medication, there are two patients to consider—you and your unborn baby. Find out in advance what options are available for pain control, then see how your labor goes before making a final decision.

Anesthesia is a complete block of all pain sensations and muscle movement. An analgesic is full or partial relief of pain. Narcotic analgesics pass to your baby through the placenta and may decrease respiratory function in a newborn. They can also affect baby’s Apgar scores. These medications should not be given close to the time of delivery.

Anesthesia for delivery may be given as an injection of a particular medication to affect a particular area of the body. This is called a block, such as a pudendal block, an epidural block or a cervical block. Medication is similar to the type used to block pain when you have a tooth filled. The agents are xylocaine or xylocainelike medications.

Occasionally, it’s necessary to use general anesthesia for delivery, usually for an emergency Cesarean delivery. A pediatrician attends the birth because the baby may be asleep following delivery.

Dad Tip

Who do you and your partner want in the delivery room? Having a baby is a personal experience. Some couples choose the intimacy and privacy of being alone during the birth. Other couples want family members and friends to share the experience with them. If you talk about it ahead of time, you can decide together what you both want. After all, it’s your baby’s birth.

What Is an Epidural Block?

An epidural block provides excellent relief by blocking painful sensations between the uterus and cervix, and your brain. Medication in the epidural prevents pain messages from traveling up your spinal cord to your brain.

Focusing on your breathing can help you stay relaxed during labor.

An epidural is one of the most popular anesthetics today and provides relief from the pain of uterine contractions and delivery. It should be administered only by someone trained and experienced in this type of anesthesia. Some obstetricians have this experience, but in most areas an anesthesiologist or nurse anesthetist administers it.

In 1986, only 10% of women in labor in the United States received an epidural. Today, over 70% of women in labor have an epidural.

While you are sitting up or lying on your side, an area of skin over your lower back in the middle of your spinal cord is numbed. A needle is placed through the numbed skin; anesthetic flows through the needle and around the spinal cord but not into the spinal canal. A catheter is left in place to deliver anesthesia. It can take up to 25 minutes before you experience pain relief.

Epidural pain medication may be delivered by a pump. The pump injects a small amount of medicine at regular intervals or as needed. Many hospitals use patient-controlled epidurals (PCEA)—you press a button for more medication when you need it.

You may have heard various things about when an epidural can be given. Most healthcare providers believe an epidural block should be given based on your level of pain. Most agree a woman can have an epidural anytime after she begins active labor. You may not be required to be dilated to a specific point before getting an epidural.

Some medical conditions may keep you from having an epidural, such as a serious infection when you begin labor, scoliosis, previous back surgery or some blood-clotting problems. If you have one of these problems, discuss it at a prenatal visit.

You may have problems pushing if you have an epidural. But you should be able to feel enough pressure to push. An epidural may increase the chances forceps or a vacuum extractor may be needed during delivery.

An epidural block can make your blood pressure drop. Low blood pressure may affect blood flow to the baby. Fortunately, I.V. fluids given with the epidural help reduce the risk.

Studies have not shown epidural anesthesia increases the risk of Cesarean delivery. And no link between use of epidurals during labor and back pain after delivery has been established.

On the average, epidurals slow labor by 45 minutes.

An epidural can cause shaking, as well as itching and headache. There are remedies for these problems. If you have trembling (nearly 50% of all laboring women do), ask for blankets, a heating pad or a hot-water bottle.

If you itch, wait a bit. Itching is usually mild and goes away on its own. Put pressure on the area with a towel, or apply lots of lotion. If itching doesn’t go away, your healthcare provider may recommend medication, such as naloxone (Narcan).

Very occasionally, you’ll get a headache. Drink a caffeinated beverage, such as coffee, tea or a caffeinated soda. Try resting on your back. If the headache persists for more than 24 hours, talk to your healthcare provider. If you become nauseous, breathing deeply can help. Inhale through your nose, and exhale through your mouth.

Combined Spinal-Epidural Analgesia (CSE). A combined spinalepidural analgesia (CSE) uses epidural and spinal techniques to relieve pain. It is one of the most popular epidural options. The combination provides the quick relief of a spinal block, with the option of an epidural if your labor is longer. It is sometimes called a walking epidural.

A walking epidural doesn’t have much to do with walking. It refers to regional labor-pain relief in which a woman maintains some strength in her legs. Few women actually walk after receiving pain relief, although some may walk to the toilet, while others use their legs to position themselves for delivery.

With CSE, there is a lower incidence of spinal headache. There may be less numbness with a CSE. CSE can also be delivered as PCEA.

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