Pain relief for childbirth has run the gamut over the ages. And the battle is still being fought today. Should a woman have medications or not during birth is not a question that I anticipate an answer for anytime soon. However, some women will choose medication and some will require it for surgical deliveries and complications. Let's just all be thankful that we are no longer buried alive for accepting pain relief in labor as was done in the middle ages.
This article will actually focus on a particular aspect of pain relief in labor, the ultra low dose epidural, frequently called the walking epidural. It is done in two parts. I will be answering common questions from women and their partners concerning the benefits and risk, while Dr. Paul Ting, anesthesiologist, focuses on the actual procedures.
Q. What is the difference between the walking epidural and the regular epidural?
A. The differences lie in both the procedure and the medications used. The walking epidural is a combination of spinal and epidural analgesia. While the medications, often referred to as a cocktail, are a narcotic, a local anesthetic and epinephrine, used in smaller amounts than the regular Epidurals.
Q. If I can walk, what can I feel?
A. The walking epidural is not designed to make you feel deadened. It is designed to provide enough pain relief that you are comfortable and yet still aware of the contractions. So it will not mask extraordinary pain that you and your practioner would need to be aware of.
Q. Can I really walk?
A. This really depends, women receiving the walking epidural will not be able to walk for the following reasons: woman refuses (15-25%), leg weakness (often described as not feeling normal), and maternal hypotension (low blood pressure).
I would also add that some facilities do not allow you to walk with this type of medication for fear of legal ramifications. I do want to point out that if you were 90 years old and had just had hip replacement surgery and this type of medication it would be required for you to walk.
Q. Why would I want to walk in labor?
A. Ambulation and mobility promote contractions and therefore labor, decrease pain, shorten labor, and increase the vaginal delivery rate. I would also point out that having the ability to move is very important to the emotional and mental health of the woman in labor. This type of medication will actually give her more control over her body as opposed to the classic epidural.
Q. Do I have to walk?
A. No, you do not have to walk. However, there are still advantages even if you do not walk. You are still able to move around better in the bed, or get up to the bathroom or chair. This is especially useful in the second stage of labor (pushing) where adopting more upright or squatting positions can help in the birth of your baby.
Q. What about extra interventions or complications from the walking epidural?
A. Every medication that you take will reach the baby and have potential side effects on you, labor and your baby. However, these are actually lessened with the walking epidural compared to the classic epidural. Because you are able to move around we are not finding the increase in cesarean rates that we have previously found with the classic Epidurals.
Q. What if I need more medication or a cesarean birth?
A. The catheter is left in place in your back so that additional medication could be administered for either additional pain relief or a surgical birth. This is the same as the continuous classic epidural.
Q. How commonplace are the walking epidurals? Can I get one in my rural town?
A. This is definitely one to ask your anesthesia department. It may depend on the anesthesiologist on call. You may be able to get them to try the ultra low dose combination if you talk to them before hand and let them do their research as well.
Q. Can my partner or someone stay with me?
A. This is really a matter of hospital policy and/or the anesthesiologist. If it is very important to you, make sure that you discuss this prenatally with the anesthesia department. Also preparing your partner for the procedure would be a good idea.