Sept. 25, 2023
Demystifying Epidurals and Labor Anesthesia with Dr. Bella Speight, MD (Rerun)
Unlock the truth behind epidurals and labor anesthesia in our enlightening conversation with Dr. Bella Speight, a board certified anesthesiologist. What are the actual risks? Dr. Speight debunks these myths and lays it all bare, offering a reassuring perspective on the minimal risks involved for healthy patients and the importance of correct positioning during the procedure. She also explores unmedicated delivery, shedding light on why some women may opt for this route.
Dive deeper as Dr. Speight reveals the intricate details about the medications used in epidurals and how they function in the body. Replacing an epidural, preparing for a C-section while an epidural is in place, and managing a one-sided epidural - she covers it all. And it doesn't stop there; she provides a comprehensive look at the symptoms of a spinal headache post-epidural and how to cope with it if you are one of the 1% of people who experiences this. With her expert guidance, you'll walk away with a solid understanding of epidurals, labor anesthesia, and what to expect. So, whether you're a budding parent or simply curious, this episode is a must-listen.
Coaching offer
Kelly Hof: Labor Nurse + Birth Coach
Basically, I'm your birth bestie! With me as your coach, you will tell fear to take a hike!
Connect with Kelly Hof at kellyhof.com
Medical Disclaimer:
This podcast is intended as a safe space for women to share their birth experiences. It is not intended to provide medical advice. Each woman’s medical course of action is individual and may not appropriately transfer to another similar situation. Please speak to your medical provider before making any medical decisions. Additionally, it is important to keep in mind that evidence based practice evolves as our knowledge of science improves. To the best of my ability I will attempt to present the most current ACOG and AWHONN recommendations at the time the podcast is recorded, but that may not necessarily reflect the best practices at the time the podcast is heard. Additionally, guests sharing their stories have the right to autonomy in their medical decisions, and may share their choice to go against current practice recommendations. I intend to hold space for people to share their decisions. I will attempt to share the current recommendations so that my audience is informed, but it is up to each individual to choose what is best for them.
Chapters
00:00 - Understanding Epidurals and Labor Anesthesia
12:04 - Epidurals, Positions, and Recovery
22:54 - Spinal Headaches and Epidurals
Transcript
WEBVTT
00:00:00.261 --> 00:00:02.347
Welcome to the Birth Journeys podcast.
00:00:02.347 --> 00:00:05.288
I'm your host, kelly Hoff, bsn RN.
00:00:05.288 --> 00:00:11.692
I am a wife, a mother of two and a nurse specializing in the care of women and newborns.
00:00:11.692 --> 00:00:27.568
In this podcast, we will share powerful journeys of birth givers with the goals of lifting the veil on the birth experience, healing through sharing and beginning an open conversation to strengthen trust and promote transparency between birthing people and healthcare providers.
00:00:27.568 --> 00:00:30.167
Today, I have with me Dr Bella Spate.
00:00:30.167 --> 00:00:35.031
Dr Spate is a board certified anesthesiologist who I've worked with for many years.
00:00:35.031 --> 00:00:43.091
She is the mother of two and she is here today to share with us everything she wants new moms to know about epidurals and labor anesthesia.
00:00:43.091 --> 00:00:44.865
Dr Spate, take it away.
00:00:45.079 --> 00:00:45.661
Hello.
00:00:45.661 --> 00:00:48.170
So hi, I am Dr Bella Spate.
00:00:48.170 --> 00:00:50.479
I am a board certified anesthesiologist.
00:00:50.479 --> 00:00:50.981
I do.
00:00:50.981 --> 00:00:52.067
What does that mean?
00:00:52.067 --> 00:00:59.048
The anesthesiologist is the person that comes in when you're screaming in labor and you need some pain relief.
00:00:59.048 --> 00:01:00.786
Usually you'll see a light behind us.
00:01:00.786 --> 00:01:03.427
No, that's just the door opening as we walk in the room.
00:01:03.427 --> 00:01:04.411
Now it is heaven.
00:01:04.540 --> 00:01:08.712
It is heaven coming down to escort you into the room and take away everyone's pain.
00:01:08.819 --> 00:01:17.725
So you know, usually we are met with a warm reception, but it's not infrequent that there is a good amount of apprehension about what to expect with an epidural.
00:01:17.725 --> 00:01:21.108
There are a lot of moms who have questions am I doing this too soon?
00:01:21.108 --> 00:01:23.227
Am I the only one getting one?
00:01:23.227 --> 00:01:24.906
Is this the right decision?
00:01:24.906 --> 00:01:27.528
And all those questions and thoughts and feelings are normal.
00:01:27.659 --> 00:01:31.331
So let me just tell you a little bit about what it means to get an epidural.
00:01:31.331 --> 00:01:39.310
So, as far as labor pain is concerned, I would classify labor pain as one of the worst human pains imaginable.
00:01:39.310 --> 00:01:42.066
10 out of 10 pain, don't let anyone tell you anything different.
00:01:42.066 --> 00:01:47.289
Okay, I see patients in pain all the time and there are very few things to compare to a woman in labor.
00:01:47.289 --> 00:01:51.349
The gold standard for pain relief is the epidural.
00:01:51.349 --> 00:01:53.808
Now people ask do I have to get an epidural?
00:01:53.808 --> 00:01:56.248
My mom didn't have an epidural and she had seven kids.
00:01:56.248 --> 00:01:58.046
No, you don't have to get an epidural.
00:01:58.046 --> 00:01:59.605
It is absolutely your choice.
00:01:59.605 --> 00:02:05.170
It will likely be offered to you by your nurse, even by your obstetrician, when they see that you're in excruciating pain.
00:02:05.170 --> 00:02:08.288
But an unmedicated delivery is always an option.
00:02:08.288 --> 00:02:10.948
I tell people you can have an unmedicated delivery.
00:02:10.948 --> 00:02:15.972
The same way you can have an unmedicated headache, stomach ache or fracture, your choice.
00:02:15.972 --> 00:02:21.164
But you can also take a Tylenol and you can also get your fracture fixed and get some real pain medicine.
00:02:21.164 --> 00:02:25.110
So the epidural, how it works and what we do.
00:02:25.110 --> 00:02:34.868
So as an anesthesiologist, I would come into your room once you said that you would care to have some pain relief for your labor and go through the risk and benefits of an epidural.
00:02:34.868 --> 00:02:39.271
The risks are really, for the average healthy patient, very minimal.
00:02:39.400 --> 00:02:42.550
There's a lot of urban legends out there about epidurals.
00:02:42.550 --> 00:02:49.467
One of the questions I am asked most frequently and one of the most prevalent urban legends is will I be paralyzed from this epidural?
00:02:49.467 --> 00:02:51.967
And the answer is a resounding no.
00:02:51.967 --> 00:02:57.912
Are there any stories or cases of patients being paralyzed from getting an epidural?
00:02:57.912 --> 00:03:12.008
In the literature there are stories, because there are always stories of people that had a lot of confounding factors, meaning a lot of other things going on that led to them having a problem after an epidural placement, and those things do not apply to pregnant women most of the time.
00:03:12.008 --> 00:03:23.729
If you are on some sort of prescription blood thinner, that will usually be in your medical history and we would have to time when we would put an epidural in because your risk for having a bad event after that would go up.
00:03:24.180 --> 00:03:42.283
If you are a normal, healthy, laboring pregnant woman, not on blood thinners, do not have a major infection going on on your back or within your body, you're not in septic shock, there's no reason that you couldn't have an epidural and no one would offer you an epidural if you met the above criteria anyway, what is the placement of the epidural?
00:03:42.283 --> 00:03:48.278
The things that are important for getting an epidural usually would be the way that you sit in our position.
00:03:48.278 --> 00:04:06.824
Anesthesiologists and your nurse will often ask you to sit on your bed and curve your body into a Uncomfortable position around your belly usually we say the shape of a letter C, the position of a shrimp, bad posture, everything your mom and grandma ever told you not to do will behoove you when it's time to get an epidural.
00:04:06.824 --> 00:04:07.687
So really curve.
00:04:07.687 --> 00:04:09.936
You're gonna really get into an awkward position and posture.
00:04:10.377 --> 00:04:15.425
While the anesthesiologist does a sterile Preparation of your back, they clean your back off with something cold and wet.
00:04:15.425 --> 00:04:24.370
It's usually a sterilizing soap or disinfectant, a little bit of both and then they'll put up a plastic drape, just again to keep the area nice and clean and sterile.
00:04:24.370 --> 00:04:27.117
Then what you usually feel is what we call it beasty.
00:04:27.117 --> 00:04:30.045
Now, beasty that's pretty subjective, so I'm not gonna lie to you.
00:04:30.045 --> 00:04:37.560
It's a little bit of an ouch, but it's a three second ouch and you can handle it, definitely worth the payoff of the epidural.
00:04:37.560 --> 00:04:42.685
So you get a little pinch in your back and then what you typically feel honestly is a lot of pressure.
00:04:43.125 --> 00:04:44.108
I have had an epidural.
00:04:44.108 --> 00:04:45.370
I've placed a lot of epidurals.
00:04:45.370 --> 00:04:46.173
Really.
00:04:46.173 --> 00:04:47.576
For the most part you'll feel pressure.
00:04:47.576 --> 00:05:01.928
Occasionally there's a little pinch or a little shock, and usually the Idea or the shock of the shock is worse than the actual pain of the shock, because you're expecting something bad to happen and you feel this little zip and you're like that's it, I knew it, this is the moment and it's not.
00:05:01.928 --> 00:05:05.543
It's just as we're trying to find the place to put the epidural.
00:05:05.543 --> 00:05:10.613
There are some Little peripheral nerves in the area, nothing that will cause catastrophic damage.
00:05:10.613 --> 00:05:13.338
Usually that give us feedback as to where we need to go.
00:05:13.338 --> 00:05:17.295
So we keep going and putting that pressure in your back till we find the exact perfect spot.
00:05:17.745 --> 00:05:19.750
Then we put in the epidural catheter.
00:05:19.750 --> 00:05:21.374
What is an epidural catheter?
00:05:21.374 --> 00:05:23.158
It's a skinny, skinny straw.
00:05:23.158 --> 00:05:35.786
It's tinier than the IV that you'll have placed in your arm or hand at that time and it stays in a location called the epidural space and that's where we put the medication in that you're gonna get for the rest of your labor.
00:05:35.786 --> 00:05:39.964
Once that catheter is in place, we tape it, we secure it nice and flat on your back.
00:05:39.964 --> 00:05:40.990
You barely feel it.
00:05:40.990 --> 00:05:43.444
After the tape is put on, you can lay flat on your back.
00:05:43.444 --> 00:05:44.865
You can move around in your bed.
00:05:44.865 --> 00:05:56.964
You can't get out of bed, but you can move around in your bed to wiggle and watch TV and reposition yourself, and then your Anesthesiologist, sometimes the nurse, will start an infusion of medication that keeps going the entire time you're in labor.
00:05:56.964 --> 00:05:58.651
So that's another question I get frequently.
00:05:58.771 --> 00:06:04.713
Once women get relaxed and feel that good epidural Comfort, they start to panic like I feel so good right now.
00:06:04.713 --> 00:06:05.776
How long is this gonna last?
00:06:05.776 --> 00:06:10.692
And we let them know it lasts the duration of your labor until the baby is born.
00:06:10.692 --> 00:06:16.692
Some of the other questions people have how much of this medicine is gonna get to the baby?
00:06:16.692 --> 00:06:20.843
Very, very little of what we give you in the epidural.
00:06:20.843 --> 00:06:25.704
And when I say little, I'm talking about micro, microscopic amounts that don't go to the baby's brain.
00:06:25.704 --> 00:06:26.125
They're not.
00:06:26.125 --> 00:06:27.149
It's not sedating.
00:06:27.149 --> 00:06:31.384
Your baby's not gonna come out tired or groggy because you got an epidural.
00:06:31.384 --> 00:06:36.757
They're not getting the medicine that you're getting because this is going into a different part of your body's system.
00:06:37.065 --> 00:06:46.692
Women do tend to get very, very relaxed after they get an epidural and they think, well, I don't know, I got an epidural and I got super sleepy, so you're telling me this isn't make it going to my brain and my baby.
00:06:46.692 --> 00:06:49.788
But I know I got super tired and went to sleep so something is off.
00:06:49.788 --> 00:06:57.918
So the explanation for that kind of simple what the epidural does it works by kind of quieting your sympathetic nervous system.
00:06:57.918 --> 00:07:03.076
So all of that gets toned down and your parasympathetic nervous system takes, takes over.
00:07:03.076 --> 00:07:07.471
The sympathetic is fight or flight, the parasympathetic is rest and digest.
00:07:07.471 --> 00:07:15.865
So you get that rest, that Total body relaxation, and you've just been in some of the worst pain of your life and been extremely tense.
00:07:15.865 --> 00:07:21.610
So when all of a sudden all of your muscles relax and your body becomes totally relaxed, you do feel a relief.
00:07:21.610 --> 00:07:28.345
And it is not uncommon for women to get very tired or sleepy or to finally be able to appreciate how hard they've been working up until that point.
00:07:28.345 --> 00:07:37.740
I tell my patients if you get sleepy and you want to take a nap, take a nap, because that epidural sleep is one of the Best sleeps that you can get on the planet.
00:07:37.920 --> 00:07:43.925
Another thing that can happen, in addition to just feeling very relaxed after getting me up a door place, is your blood pressure can go down quite a bit.
00:07:43.925 --> 00:07:56.415
So, yeah, your blood pressure has been up, you've been tense, you've been in labor or you've just been sitting there and you were just ready for your epidural, that same parasympathetic nervous system we're talking about kind of makes your blood vessels relaxed too.
00:07:56.415 --> 00:08:07.125
So where everything was tight, if you think about, like tight hose, when you're squeezing it, if you kind of let go, that pressure goes down, all your blood pressure goes down and that's not always a bad thing.
00:08:07.125 --> 00:08:11.805
But if it gets too low then there's not enough pressure to get the blood circulating to your baby.
00:08:11.805 --> 00:08:16.064
So you'll notice that your blood pressure goes down and sometimes the baby's heart rate can go down.
00:08:16.625 --> 00:08:23.605
So we will give you a lot of times blood pressure medicine, extra fluid through your IV, things like that, to kind of get your blood pressure back up any.
00:08:23.605 --> 00:08:36.408
And all anesthesiologists and labor and delivery nurses know that this is something that happens and we prepare for it usually by giving you a lot of fluid before you get your epidural and having those blood pressure medicines readily available and stabilize you.
00:08:36.408 --> 00:08:46.264
It's kind of like you know, when the plane first takes off and there's a little turbulence, sometimes you kind of have to Settle through that initial period so that you can coast the rest of your labor.
00:08:46.264 --> 00:08:53.804
That, for the most part is how epidurals work, and Most women are very happy to have had that experience.
00:08:54.125 --> 00:08:55.371
So I have a couple questions for you.
00:08:55.371 --> 00:09:01.431
Okay, when we finish the epidural during the recovery period, we usually have women lay flat with a little tilt.
00:09:01.431 --> 00:09:03.114
Can you kind of explain why we do that?
00:09:04.297 --> 00:09:04.538
Yeah.
00:09:04.538 --> 00:09:07.350
So we like you to lay flat because the epidural.
00:09:07.350 --> 00:09:20.323
There are different medications that we use for the epidural and some of them, without getting too technical, some of them kind of stay in the same place, some of them move by gravity, some of them tend to move downwards with gravity or just kind of stay where they are.
00:09:20.323 --> 00:09:26.059
What we try to do is keep you nice and even so that the epidural can evenly distribute to every side of your body.
00:09:26.059 --> 00:09:31.427
If we lay you completely on your left side then you may get numb only on one side.
00:09:31.427 --> 00:09:35.464
So imagine not feeling any contraptions on your left but feeling all the contraptions on your right.
00:09:35.464 --> 00:09:36.486
That would be pretty miserable.
00:09:36.486 --> 00:09:39.985
So we try to lay you flat so that all the medication can distribute evenly.
00:09:39.985 --> 00:09:48.462
We do tilt you somewhat because we do want to relieve some of the pressure on your major, our blood vessels, so that your blood can still continue to circulate through your body.
00:09:49.695 --> 00:09:58.722
And then after that 20 minute period, it's okay to position on the sides and do all those things we just kind of pay attention to if we start to wear off on one side.
00:09:58.923 --> 00:10:03.956
Absolutely so 20 minute period, once we've established that the epidural is working evenly on both sides.
00:10:03.995 --> 00:10:07.645
The other thing I didn't mention is that, yes, there is such a thing as a one-sided epidural.
00:10:07.645 --> 00:10:16.826
So sometimes when epidurals are placed that epidural catheter I mentioned earlier we put it in, but once it's in your body we can't really we can't see the tip of it.
00:10:16.826 --> 00:10:22.703
So we're putting it in based on your anatomy and our training and the feel we expect it to be where we leave it.
00:10:22.703 --> 00:10:29.503
But occasionally those catheters can wiggle or move or migrate a little bit inside your body and then the medicine is going more sort of one side or the other.
00:10:29.503 --> 00:10:34.826
We want to make sure that you have an epidural that's placed well, that's working on both sides.
00:10:34.826 --> 00:10:37.640
So we want to keep you nice and even make sure everything's working.
00:10:37.640 --> 00:10:39.145
Both sides are getting numb.
00:10:39.145 --> 00:10:48.163
And then, once we've established that your epidural is kind of set up, as we say, then you can definitely you can set up and watch TV, you can sit up in a chair position, lay on your side.
00:10:48.163 --> 00:10:51.945
As long as the medicine keeps working evenly, you can be in any position you want.
00:10:52.875 --> 00:10:56.004
And then it's not the end of the world if we have a one-sided epidural.
00:10:56.004 --> 00:10:58.863
There's things that we can do to kind of rectify that situation, right.
00:10:59.443 --> 00:11:00.125
Oh, absolutely.
00:11:00.125 --> 00:11:03.784
If you have a one-sided epidural, there's a lot of troubleshooting we can do for most.
00:11:03.784 --> 00:11:12.085
You know epidural issues, whether that be the epidural is kind of one-sided or you feel maybe it's not going up high enough, or it's, or you're too numb.
00:11:12.085 --> 00:11:13.760
That's another thing women sometimes complain about.
00:11:13.760 --> 00:11:19.427
We can troubleshoot and adjust the dosing of the epidural, adjust the positioning of the patient.
00:11:19.427 --> 00:11:21.902
There are a lot of things we can do to try to get your epidural working.
00:11:21.902 --> 00:11:29.804
Or, as I often will tell patients, if we've done all of the usual troubleshooting and you're still uncomfortable, it's okay to have that epidural replaced.
00:11:29.804 --> 00:11:31.740
Don't be afraid to sit up and get another epidural.
00:11:31.740 --> 00:11:34.682
Most likely you're going to get a bill for your epidural.
00:11:34.682 --> 00:11:37.643
You should make sure that it works for you.
00:11:37.643 --> 00:11:39.902
So don't feel like you're being a nuisance.
00:11:39.902 --> 00:11:42.482
Don't be afraid to speak up and advocate for yourself.
00:11:42.482 --> 00:11:52.323
If you're asking for an epidural, it means that you would like to have pain relief during your labor and your delivery and you deserve to have that option optimized for you.
00:11:53.616 --> 00:11:55.062
Yeah, that's so true.
00:11:55.062 --> 00:11:59.946
So after the epidural we've had our baby, we've repaired anything that might have gone on down there.
00:11:59.946 --> 00:12:05.927
How long should someone expect for it to take before they can get up and walk safely?
00:12:07.736 --> 00:12:14.802
Well, first of all, if you have an epidural, do not ever attempt to stand up, walk, move, go to the bathroom.
00:12:14.802 --> 00:12:20.320
I know a lot of us are like independent women and we're used to doing everything and getting it done, but now is not the time.
00:12:20.320 --> 00:12:21.624
Definitely ask for help.
00:12:21.624 --> 00:12:25.605
You may take up to four hours for an epidural to completely resolve.
00:12:25.605 --> 00:12:29.645
So you need to be assessed by your nurse before attempting to do anything.
00:12:29.645 --> 00:12:35.162
So let them see if you have the full strength back in your feet and your legs and if you're ready to stand up.
00:12:35.162 --> 00:12:50.041
I mean, for a lot of women it wears off much faster than that, but it can take up to that long and a lot of times you may think or feel like you're strong enough to stand up, but you're actually not strong enough to stand up unassisted and you don't want to injure yourself immediately postpartum because who's going?
00:12:50.061 --> 00:12:52.077
to help you take care of your baby Very important points.
00:12:52.077 --> 00:13:02.860
So say, we have an epidural and we were planning on having a vaginal delivery, but then some stuff went down and now we need a C-section.
00:13:02.860 --> 00:13:06.820
What can we do if we have the epidural in and we need to get a C-section?
00:13:07.121 --> 00:13:10.000
So this is another talking point.
00:13:10.000 --> 00:13:18.602
Occasionally, you know, women are not sure if they want to have an epidural and they may be trying to have a vaginal birth after cesarean.
00:13:18.602 --> 00:13:24.740
Or maybe they have a large baby and they've been told, you know, this delivery may be difficult or not work.
00:13:24.740 --> 00:13:27.740
So they kind of have a little bit of knowledge beforehand.
00:13:27.740 --> 00:13:34.466
Some women don't know when they come in and they are having a nice normal labor and they immediately have to go to the operating room because something changes during labor.
00:13:34.466 --> 00:13:51.779
If you have an epidural in place and you're any of the above patients, then you significantly increase the chances that we can just give you a different and stronger medication through your epidural so that you can have your C-section awake and be present for the delivery of your baby.
00:13:51.779 --> 00:14:03.980
If you do not have an epidural in place, more than likely in any sort of emergency situation emergency C-section or labor that turns emergent we would have to put you to sleep under general anesthesia.
00:14:03.980 --> 00:14:17.038
That means we would take you to the operating room, we would put a breathing tube in, put you on a ventilator and we would wake you up once everything was completed with the delivery and your body was completely repaired and all of your dressings are on.
00:14:17.038 --> 00:14:28.139
There's nothing wrong if you have to be asleep for your delivery because that's the safest way to bring your child into the world and to keep you alive and healthy for that process, then you go to sleep for your delivery.
00:14:28.139 --> 00:14:41.620
But if you have the option to have the epidural, not to have to have a general anesthetic and potentially be present and be less groggy and awake post delivery, then you want to consider having that epidural in place.
00:14:41.620 --> 00:14:43.427
Which option is generally safer?
00:14:43.427 --> 00:14:44.924
Yes, thank you, I was gonna get there.
00:14:44.945 --> 00:14:52.533
But yes, in addition to wanting to just be present for the delivery, general anesthesia in pregnant women is never an ideal scenario.
00:14:52.533 --> 00:15:07.679
There have been historically cases of pregnant women being much more difficult to place breathing tubes in which can turn a situation from something that we do routinely to something that is much more urgent, emergent and dangerous.
00:15:07.679 --> 00:15:11.179
So we try to be prepared for all scenarios.
00:15:11.179 --> 00:15:22.972
I would definitely recommend especially a woman who maybe is trying a vaginal after Cesarian are a higher risk for ending up in the operating room to strongly consider placing an epidural prior to needing one emergently.
00:15:22.972 --> 00:15:25.155
That's the other thing If we get into an emergency situation.
00:15:25.155 --> 00:15:29.620
Most emergencies don't leave any time for us to put in an epidural at the last minute.
00:15:29.620 --> 00:15:44.708
So this is a procedure that standardly would take, you know, anywhere from 15 to 45 minutes, depending on the patient's anatomy and just how difficult it is or easy it is to place the epidural, so you don't have 45 minutes in the emergency.
00:15:44.961 --> 00:15:54.881
So then, if you are in a C-section, that you'd have to dose the epidural, what is the difference between the recovery for that versus the recovery from general anesthesia?
00:15:54.922 --> 00:16:02.840
Another really wonderful reason to have an epidural in place is the medication that we can give you through your epidural and the way that medication impacts you.
00:16:02.840 --> 00:16:15.620
So if we're using an epidural for your delivery, we basically make you extremely numb up to about your nipple area so that the obstetrician can perform the surgery and you don't feel it.
00:16:15.620 --> 00:16:28.750
We also can give you some strong narcotics through the epidural, so when the medication goes to the epidural you don't get the same type of sedative effects to your brain that you would get if we gave it through your IV.
00:16:28.750 --> 00:16:32.452
We have a really strong pain medicine that we use a lot of times in labor and delivery.
00:16:32.452 --> 00:16:38.527
That lasts about 24 hours and gives you a nice kind of baseline pain control.
00:16:38.527 --> 00:16:57.139
A lot of women don't have to take much more than Tylenol in addition to that, so it really makes for a faster and more awake and present postpartum period General anesthesia we do have to give you everything through the IV typically, so that means you would be a lot more groggy when you wake up.
00:16:57.360 --> 00:17:27.579
We can't give you that long-acting epidural pain medicine that lasts for 24 hours when you're asleep under general anesthesia, so then when you wake up you're having to take much more pain medicine, iv pain medicine, oral pain medicine Again, it's not a bad thing, but when you're dealing with a non-sleeping baby and you just had surgery, the less medicine, the less opiates that you need to take, the better, because opiates can cause constipation, itching, nausea and being constipated after just having a baby.
00:17:27.579 --> 00:17:30.838
It's just if we can avoid these things, it would be ideal.
00:17:30.838 --> 00:17:40.640
So, while you're making your birth plan and thinking about things, I know that the epidurals can be scary or an intimidating option, but there's more to the epidural than just the immediate pain relief of labor.
00:17:42.130 --> 00:17:43.720
And then, what's the difference between an epidural and a spinal?
00:17:43.720 --> 00:17:45.118
Another fun one.
00:17:46.484 --> 00:17:50.018
So the epidural is what we use for labor and delivery.
00:17:50.018 --> 00:18:00.930
It's a larger needle that we used to put it in honestly and it sits into a part of your body anatomically called the epidural space.
00:18:00.930 --> 00:18:03.799
There's no way I could describe that to you in an audio.
00:18:03.799 --> 00:18:08.279
I would encourage Google to see where the epidural space is.
00:18:08.279 --> 00:18:09.111
That's where an epidural is.
00:18:09.111 --> 00:18:18.279
A spinal goes into a layer a little bit deeper and works much faster and much more intensely.
00:18:18.279 --> 00:18:25.240
So you get very numb very quickly with a spinal and that enables us to do surgery.
00:18:25.240 --> 00:18:28.920
We usually will use a spinal when we know for a fact we're going to the operating room.
00:18:28.920 --> 00:18:32.391
So a woman with a scheduled C-section.
00:18:32.391 --> 00:18:35.339
We also do spinals frequently for joint replacements, hips and knees.
00:18:35.339 --> 00:18:43.048
If your grandma or mom whomever maybe had a hip or knee replacement, they probably got a spinal, at least in America.
00:18:45.932 --> 00:19:04.737
The another interesting difference between epigirls and spinals because the spinal needle is much smaller, you have a lower risk of getting what we call a spinal headache, which kind of is confusing, because I'm talking about a spinal not causing a spinal headache, but it's really just semantics, it's the language.
00:19:04.737 --> 00:19:09.480
So one thing that we didn't talk about when I was discussing epigirls were the risks.
00:19:09.480 --> 00:19:12.049
I reassured you that you would not get paralyzed.
00:19:12.049 --> 00:19:13.556
I didn't really say why.
00:19:13.556 --> 00:19:18.662
So when we put an epigirl in, we put it below the spinal cord.
00:19:18.662 --> 00:19:25.173
So there's a part of your spinal cord it starts out as kind of a thick cord and then at the very bottom it turns into like spaghetti.
00:19:25.173 --> 00:19:26.855
We call that the cauda equina.
00:19:26.855 --> 00:19:39.220
If you've ever taken like a skewer and tried to spear spaghetti noodles in a pot of boiling water, you'd notice that you can't really hit any of those noodles.
00:19:39.220 --> 00:19:41.875
You're kind of floating and moving around.
00:19:41.875 --> 00:19:43.840
The same applies to your cauda equina.
00:19:43.840 --> 00:19:50.477
If you're putting a needle down there, it's very difficult and basically impossible to hit any of those nerves down there.
00:19:50.477 --> 00:19:54.200
So you're not going to damage the spinal cord by placing an epidural.
00:19:54.200 --> 00:19:55.952
That's why you don't get paralyzed.
00:19:57.170 --> 00:20:01.880
As far as the spinal headache, how that occurs is when we're placing an epidural.
00:20:01.880 --> 00:20:05.317
If it goes, we're supposed to put the epidural in the epidural space.
00:20:05.317 --> 00:20:20.357
Okay, if an epidural needle goes beyond the epidural space, to where a spinal needle could go, it can cause you to lose some of your spinal fluid and that changes the pressure in your head and can cause a severe headache called a spinal headache.
00:20:20.357 --> 00:20:24.500
Spinal headaches are probably the biggest risk of getting an epidural.
00:20:24.500 --> 00:20:30.221
The biggest real risk of getting an epidural would be potentially landing yourself a spinal headache.
00:20:30.221 --> 00:20:32.455
If you get a spinal headache, what does that mean?
00:20:32.455 --> 00:20:37.653
That means you're going to be sort of miserable for the first few days while the headache is present.
00:20:38.490 --> 00:20:41.298
Most women have what we call photophobia.
00:20:41.298 --> 00:20:42.513
You can't stand light.
00:20:42.513 --> 00:20:47.921
You're unable to sit straight up in the bed without your head feeling like it's going to explode.
00:20:47.921 --> 00:20:49.512
You need to lay flat.
00:20:49.512 --> 00:20:58.875
It's a very specific, very easily identifiable headache that comes after an epidural that's been placed a little bit too deeply.
00:20:59.250 --> 00:21:01.557
I stand and we tell patients things you can do to avoid it.
00:21:01.557 --> 00:21:04.277
Try to stay really still when they're placing the epidural.
00:21:04.277 --> 00:21:08.681
You can breathe, but don't make any major movements.
00:21:08.681 --> 00:21:09.791
Don't jump off the bed.
00:21:09.791 --> 00:21:10.855
Don't scream, don't howl.
00:21:10.855 --> 00:21:12.377
Just get into the zone.
00:21:12.377 --> 00:21:14.833
Focus, stay as still as you can.
00:21:14.833 --> 00:21:15.695
Do your best.
00:21:15.695 --> 00:21:17.695
That's what you can do on the patient side.
00:21:18.450 --> 00:21:22.441
Sometimes everyone does everything perfectly and the spinal headaches still happen.
00:21:22.441 --> 00:21:28.459
Sometimes the patient is perfectly still, the anesthesiologist is highly skilled and does everything exactly.
00:21:28.459 --> 00:21:38.256
Due to anatomic reasons or it's usually anatomic reasons, anatomic reasons the spinal headache still happens.
00:21:38.256 --> 00:21:41.637
If it does happen, there is a treatment for it.
00:21:41.637 --> 00:21:42.914
A few different things.
00:21:42.914 --> 00:21:45.316
One you could do absolutely nothing and just wait it out.
00:21:45.316 --> 00:21:46.800
Do not recommend.
00:00:00.261 --> 00:00:02.347
00:00:02.347 --> 00:00:05.288
00:00:05.288 --> 00:00:11.692
00:00:11.692 --> 00:00:27.568
00:00:27.568 --> 00:00:30.167
00:00:30.167 --> 00:00:35.031
00:00:35.031 --> 00:00:43.091
00:00:43.091 --> 00:00:44.865
00:00:45.079 --> 00:00:45.661
00:00:45.661 --> 00:00:48.170
00:00:48.170 --> 00:00:50.479
00:00:50.479 --> 00:00:50.981
00:00:50.981 --> 00:00:52.067
00:00:52.067 --> 00:00:59.048
00:00:59.048 --> 00:01:00.786
00:01:00.786 --> 00:01:03.427
00:01:03.427 --> 00:01:04.411
00:01:04.540 --> 00:01:08.712
00:01:08.819 --> 00:01:17.725
00:01:17.725 --> 00:01:21.108
00:01:21.108 --> 00:01:23.227
00:01:23.227 --> 00:01:24.906
00:01:24.906 --> 00:01:27.528
00:01:27.659 --> 00:01:31.331
00:01:31.331 --> 00:01:39.310
00:01:39.310 --> 00:01:42.066
00:01:42.066 --> 00:01:47.289
00:01:47.289 --> 00:01:51.349
00:01:51.349 --> 00:01:53.808
00:01:53.808 --> 00:01:56.248
00:01:56.248 --> 00:01:58.046
00:01:58.046 --> 00:01:59.605
00:01:59.605 --> 00:02:05.170
00:02:05.170 --> 00:02:08.288
00:02:08.288 --> 00:02:10.948
00:02:10.948 --> 00:02:15.972
00:02:15.972 --> 00:02:21.164
00:02:21.164 --> 00:02:25.110
00:02:25.110 --> 00:02:34.868
00:02:34.868 --> 00:02:39.271
00:02:39.400 --> 00:02:42.550
00:02:42.550 --> 00:02:49.467
00:02:49.467 --> 00:02:51.967
00:02:51.967 --> 00:02:57.912
00:02:57.912 --> 00:03:12.008
00:03:12.008 --> 00:03:23.729
00:03:24.180 --> 00:03:42.283
00:03:42.283 --> 00:03:48.278
00:03:48.278 --> 00:04:06.824
00:04:06.824 --> 00:04:07.687
00:04:07.687 --> 00:04:09.936
00:04:10.377 --> 00:04:15.425
00:04:15.425 --> 00:04:24.370
00:04:24.370 --> 00:04:27.117
00:04:27.117 --> 00:04:30.045
00:04:30.045 --> 00:04:37.560
00:04:37.560 --> 00:04:42.685
00:04:43.125 --> 00:04:44.108
00:04:44.108 --> 00:04:45.370
00:04:45.370 --> 00:04:46.173
00:04:46.173 --> 00:04:47.576
00:04:47.576 --> 00:05:01.928
00:05:01.928 --> 00:05:05.543
00:05:05.543 --> 00:05:10.613
00:05:10.613 --> 00:05:13.338
00:05:13.338 --> 00:05:17.295
00:05:17.745 --> 00:05:19.750
00:05:19.750 --> 00:05:21.374
00:05:21.374 --> 00:05:23.158
00:05:23.158 --> 00:05:35.786
00:05:35.786 --> 00:05:39.964
00:05:39.964 --> 00:05:40.990
00:05:40.990 --> 00:05:43.444
00:05:43.444 --> 00:05:44.865
00:05:44.865 --> 00:05:56.964
00:05:56.964 --> 00:05:58.651
00:05:58.771 --> 00:06:04.713
00:06:04.713 --> 00:06:05.776
00:06:05.776 --> 00:06:10.692
00:06:10.692 --> 00:06:16.692
00:06:16.692 --> 00:06:20.843
00:06:20.843 --> 00:06:25.704
00:06:25.704 --> 00:06:26.125
00:06:26.125 --> 00:06:27.149
00:06:27.149 --> 00:06:31.384
00:06:31.384 --> 00:06:36.757
00:06:37.065 --> 00:06:46.692
00:06:46.692 --> 00:06:49.788
00:06:49.788 --> 00:06:57.918
00:06:57.918 --> 00:07:03.076
00:07:03.076 --> 00:07:07.471
00:07:07.471 --> 00:07:15.865
00:07:15.865 --> 00:07:21.610
00:07:21.610 --> 00:07:28.345
00:07:28.345 --> 00:07:37.740
00:07:37.920 --> 00:07:43.925
00:07:43.925 --> 00:07:56.415
00:07:56.415 --> 00:08:07.125
00:08:07.125 --> 00:08:11.805
00:08:11.805 --> 00:08:16.064
00:08:16.625 --> 00:08:23.605
00:08:23.605 --> 00:08:36.408
00:08:36.408 --> 00:08:46.264
00:08:46.264 --> 00:08:53.804
00:08:54.125 --> 00:08:55.371
00:08:55.371 --> 00:09:01.431
00:09:01.431 --> 00:09:03.114
00:09:04.297 --> 00:09:04.538
00:09:04.538 --> 00:09:07.350
00:09:07.350 --> 00:09:20.323
00:09:20.323 --> 00:09:26.059
00:09:26.059 --> 00:09:31.427
00:09:31.427 --> 00:09:35.464
00:09:35.464 --> 00:09:36.486
00:09:36.486 --> 00:09:39.985
00:09:39.985 --> 00:09:48.462
00:09:49.695 --> 00:09:58.722
00:09:58.923 --> 00:10:03.956
00:10:03.995 --> 00:10:07.645
00:10:07.645 --> 00:10:16.826
00:10:16.826 --> 00:10:22.703
00:10:22.703 --> 00:10:29.503
00:10:29.503 --> 00:10:34.826
00:10:34.826 --> 00:10:37.640
00:10:37.640 --> 00:10:39.145
00:10:39.145 --> 00:10:48.163
00:10:48.163 --> 00:10:51.945
00:10:52.875 --> 00:10:56.004
00:10:56.004 --> 00:10:58.863
00:10:59.443 --> 00:11:00.125
00:11:00.125 --> 00:11:03.784
00:11:03.784 --> 00:11:12.085
00:11:12.085 --> 00:11:13.760
00:11:13.760 --> 00:11:19.427
00:11:19.427 --> 00:11:21.902
00:11:21.902 --> 00:11:29.804
00:11:29.804 --> 00:11:31.740
00:11:31.740 --> 00:11:34.682
00:11:34.682 --> 00:11:37.643
00:11:37.643 --> 00:11:39.902
00:11:39.902 --> 00:11:42.482
00:11:42.482 --> 00:11:52.323
00:11:53.616 --> 00:11:55.062
00:11:55.062 --> 00:11:59.946
00:11:59.946 --> 00:12:05.927
00:12:07.736 --> 00:12:14.802
00:12:14.802 --> 00:12:20.320
00:12:20.320 --> 00:12:21.624
00:12:21.624 --> 00:12:25.605
00:12:25.605 --> 00:12:29.645
00:12:29.645 --> 00:12:35.162
00:12:35.162 --> 00:12:50.041
00:12:50.061 --> 00:12:52.077
00:12:52.077 --> 00:13:02.860
00:13:02.860 --> 00:13:06.820
00:13:07.121 --> 00:13:10.000
00:13:10.000 --> 00:13:18.602
00:13:18.602 --> 00:13:24.740
00:13:24.740 --> 00:13:27.740
00:13:27.740 --> 00:13:34.466
00:13:34.466 --> 00:13:51.779
00:13:51.779 --> 00:14:03.980
00:14:03.980 --> 00:14:17.038
00:14:17.038 --> 00:14:28.139
00:14:28.139 --> 00:14:41.620
00:14:41.620 --> 00:14:43.427
00:14:43.427 --> 00:14:44.924
00:14:44.945 --> 00:14:52.533
00:14:52.533 --> 00:15:07.679
00:15:07.679 --> 00:15:11.179
00:15:11.179 --> 00:15:22.972
00:15:22.972 --> 00:15:25.155
00:15:25.155 --> 00:15:29.620
00:15:29.620 --> 00:15:44.708
00:15:44.961 --> 00:15:54.881
00:15:54.922 --> 00:16:02.840
00:16:02.840 --> 00:16:15.620
00:16:15.620 --> 00:16:28.750
00:16:28.750 --> 00:16:32.452
00:16:32.452 --> 00:16:38.527
00:16:38.527 --> 00:16:57.139
00:16:57.360 --> 00:17:27.579
00:17:27.579 --> 00:17:30.838
00:17:30.838 --> 00:17:40.640
00:17:42.130 --> 00:17:43.720
00:17:43.720 --> 00:17:45.118
00:17:46.484 --> 00:17:50.018
00:17:50.018 --> 00:18:00.930
00:18:00.930 --> 00:18:03.799
00:18:03.799 --> 00:18:08.279
00:18:08.279 --> 00:18:09.111
00:18:09.111 --> 00:18:18.279
00:18:18.279 --> 00:18:25.240
00:18:25.240 --> 00:18:28.920
00:18:28.920 --> 00:18:32.391
00:18:32.391 --> 00:18:35.339
00:18:35.339 --> 00:18:43.048
00:18:45.932 --> 00:19:04.737
00:19:04.737 --> 00:19:09.480
00:19:09.480 --> 00:19:12.049
00:19:12.049 --> 00:19:13.556
00:19:13.556 --> 00:19:18.662
00:19:18.662 --> 00:19:25.173
00:19:25.173 --> 00:19:26.855
00:19:26.855 --> 00:19:39.220
00:19:39.220 --> 00:19:41.875
00:19:41.875 --> 00:19:43.840
00:19:43.840 --> 00:19:50.477
00:19:50.477 --> 00:19:54.200
00:19:54.200 --> 00:19:55.952
00:19:57.170 --> 00:20:01.880
00:20:01.880 --> 00:20:05.317
00:20:05.317 --> 00:20:20.357
00:20:20.357 --> 00:20:24.500
00:20:24.500 --> 00:20:30.221
00:20:30.221 --> 00:20:32.455
00:20:32.455 --> 00:20:37.653
00:20:38.490 --> 00:20:41.298
00:20:41.298 --> 00:20:42.513
00:20:42.513 --> 00:20:47.921
00:20:47.921 --> 00:20:49.512
00:20:49.512 --> 00:20:58.875
00:20:59.250 --> 00:21:01.557
00:21:01.557 --> 00:21:04.277
00:21:04.277 --> 00:21:08.681
00:21:08.681 --> 00:21:09.791
00:21:09.791 --> 00:21:10.855
00:21:10.855 --> 00:21:12.377
00:21:12.377 --> 00:21:14.833
00:21:14.833 --> 00:21:15.695
00:21:15.695 --> 00:21:17.695
00:21:18.450 --> 00:21:22.441
00:21:22.441 --> 00:21:28.459
00:21:28.459 --> 00:21:38.256
00:21:38.256 --> 00:21:41.637
00:21:41.637 --> 00:21:42.914
00:21:42.914 --> 00:21:45.316
00:21:45.316 --> 00:21:46.800