Do you ever wonder how much pain a woman is in when her baby is about to be born? Many at Greater Regional Medical Center have, and are soon going to offer labor epidurals to counteract that pain.
Currently, options include breathing techniques, IV medications and intrathecal injections, but during the spring, the labor epidurals will be available to mothers.
“We want our local moms-to-be to know that this is an option. We’re listening to them,” said LouAnn Snodgrass, Greater Regional executive director. “It’s something that’s been voiced as a concern, and we’re addressing it. We’ll have it in place in the very near future.”
Epidurals
Epidurals are nothing new to the certified registered nurse anesthetists (CRNA) at Greater Regional. Brian Gutmann, CRNA, said he and his coworkers do an average of 220 epidural steroid injections (ESIs) for chronic pain each year, a number that has increased dramatically in the past few years.
When labor epidurals will be available in the coming spring, the only difference between ESIs and labor epidurals are women in labor will have a catheter stay in their spine to give continuous medication, rather than only getting one shot.
“We don’t know an exact date yet,” Gutmann said. “We’re in the process of researching the equipment that’s going to be needed, the training that’ll be needed, the staff. We have a meeting set in early March to discuss it with all the medical staff, like all the policies and procedures, and to make sure we can do it in a safe and effective manner.”
A labor epidural is a pain management option for women who are in the throes of labor. A catheter is put in the spine in the epidural space outside the dura mater, a membrane to help protect the spinal cord. The catheter stays there and allows a continuous flow of pain medication to the birthing mother.
Labor epidurals were not offered in the past because of the amount of manpower it takes to create a safe environment for the birthing mother. However, anesthetists and obstetrical and gynecological staff have increased at Greater Regional.
Comparisons
Currently, the other two medicinal options are intravenous (IV) medications, which go into the bloodstream, and intrathecal services, which is similar to a labor epidural, but is pushed in past the dura mater, where the medication bathes the nerve roots.
The intrathecal procedure, however, only lasts about 2-4 hours. Currently, Greater Regional averages between 60 and 70 intrathecal procedures a year, and Gutmann expects that number to increase when labor epidurals will be available because, instead of waiting until their pain is at its worst, women will opt for the intrathecal earlier in labor and then opt for a labor epidural after.
“The epidural is probably the Cadillac or gold standard of labor analgesia,” Gutmann said. “And, the intrathecal’s a real good Chevy.”
Labor epidural kits at Greater Regional will include pumps, a catheter and tubing, and there is a chance a manual button will be available for women to dose themselves.
Other options
“It wouldn’t be the right choice for everybody,” Gutmann said. “But, we’ll have both options.”
Another possible option Gutmann and Snodgrass mentioned is the use of nitrous oxide, or laughing gas. Commonly used in Europe, nitrous oxide is becoming popular in the United States. There is no needle involved, it’s fast acting and the mother can give herself a dose if needed.
No matter which option a mother chooses, the most common safety concern at Greater Regional is the use of pain medication that will affect the baby.
“That’s one of the reasons epidural analgesia is better than IV analgesia in pregnancy, because that epidural medication does not cross the placenta and then make the baby sleepy,” Gutmann said.
When a mother has IV medications, the medications affect the baby because the baby is attached by the umbilical cord to the placenta, an organ that allows nutrients in, gas exchange and waste elimination via the mother’s blood supply.
However, neither an intrathecal nor labor epidural will affect the baby because they do not cross into the blood supply, and nitrous oxide also does not affect the baby because the mother and baby do not share an oxygen supply.
“Pain management for moms-to-be is individualized based on their risks and needs, as well as the baby’s risks and needs,” Snodgrass said.
Snodgrass and Gutmann both emphasized the choice for pain management is indidvidualized. A mother may not want any medication, while another mother may opt for both the intrathecal early in labor and an epidural when the intrathecal medication wears off.
“We’re exploring all options with our new OB/GYN (physician) coming. Once that provider gets here as part of our surgical team of professionals, they’re going to be looking at all opportunities because we want to deliver state of the art care,” Snodgrass said. “If you’re newly expecting or planning to become parents, check out Greater Regional for delivery of your baby because we’re going to have all options available.”