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By Amanda Miller Demystifying Epidurals 7 Common Questions Answered
or variation. Some people have what’s called spina bifida where their spinal cord during early development didn’t fuse properly, and so the anatomy is a little off, which might make it more risky to have an epidural placed as well. 3 Can it be “too late” to receive an epidural? Dr. Montgomery: Yes, in the sense that if you are close to complete. There are three different stages of labor. The first two the epidural helps with in stage one is when you’re going through the thinning of the cervix, and you’re going from a closed cervix to a dilated or a 10-centimeter dilated cervix at stage one. Stage two is from the 10-centimeter dilated cervix to the delivery of your baby. The epidural really helps more effectively at stage one, with the whole process of the contractions that are developing with the thinning of the cervix, and then getting to the point where you’re complete and ready to help push and deliver your baby. Some people do come in, and they’re already eight or nine centimeters. I have heard some say that that’s too late to do it, and I still feel if this is your first time in labor and delivery, we can still place an epidural even if you’re eight or nine centimeters, and you can still get some benefit from that for the second stage of labor till the delivery of your baby. Part of the epidural is effective and helpful if there is any repair or anything that needs to be managed after your delivery. The epidural can also help with that as well. I’ve had some patients who’ve come in and they’re at 10 centimeters, and we try everything we can to get it in as quickly as possible, but they probably get very minimal effect from the second
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W hen it comes to putting in an epidural. For those moms who are still undecided and want to learn more about epidurals, Dr. Matthew Montgomery, an anesthesiologist who has been practicing at Rose Hospital since 2006 and has been the Director of OB Anesthesia since 2012, provides insight into common questions and concerns when it comes to epidurals. 1 What does an epidural do? Dr. Matthew Montgomery: It’s a chemical block of nerve signal, both to and from the brain to the lower half of your body. What an epidural does is with injecting medicine into this epidural space, it affects and blocks the nerves, so that the signal back to your head blocks the pain receptors. It also goes the other direction, too. It does block motor function and pressure functions to the lower extremities into the abdomen to some extent. It helps with the whole labor process to help with pain control as well. 2 Can anyone receive an epidural? Dr. Montgomery: There are a few contraindications to receiving an together a birth plan, many moms-to-be opt to factor
epidural. One is a patient’s inability or refusal. If someone is extremely nervous about having a needle in their back, and they don’t want it there, we’re not going to force anyone to have an epidural placed. In terms of actual contraindications, one is different hematologic regions, or blood issues. Someone who has any disorders that don’t allow them to form blood clots very easily. Whether they have low amounts of platelets or their platelet function doesn’t work very well, that would be an indication or a concern that we would have for placement of an epidural. There are certain guidelines that we utilize to say if someone’s platelets are at a certain level below, it’s not really safe to have an epidural placed. The other thing would be an infection. If someone has an infection in their blood system, that infection would potentially limit our ability to place something because we would not want to spread that infection. If someone has had prior surgery, if they had spinal fusion, or they’ve had any other instrumentation in the lower back, that might prohibit us from getting into the epidural space. Another thing would be some sort of anatomical abnormality
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PINK&BLUE | SPRING 2024
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