- The Washington Times - Saturday, August 23, 2003

Researchers are continuously refining the epidural, the nation’s predominant form of pain relief for women in labor, focusing on refining drugs used for the procedure as well as the method of providing them.

More than 60 percent of women nationwide receive an epidural or spinal block for pain relief during labor.

“I think women are a lot more satisfied with it now,” says Dr. John Larsen, chairman of George Washington University Hospital’s Department of Obstetrics and Gynecology. “Since the late ‘60s, early ‘70s, when epidurals came on the scene, research has been refining technique, dosages and newer drugs that work a little better.”

In the past 20 years, anesthesiologists have altered their philosophy toward pain relief for women in labor, moving away from trying to eliminate a woman’s senses in the lower half of her body to providing pain relief without a loss of motor functions, says Dr. David Birnbach, a professor and executive vice chairman of the Department of Anesthesiology at the University of Miami.

By infusing the anesthetic into the epidural space instead of injecting it, doctors found they could cut the dosage. This allowed a woman to maintain her motor function, including some use of her legs, which helps her push the baby through the birth canal.

“Many studies show that women feel more empowered that they can participate more,” Dr. Birnbach says.

Many women receive a combined spinal epidural (CSE), in which a thin spinal needle is placed through the epidural needle and anesthetic is injected into the spinal fluid, Dr. Birnbach says. Then the spinal needle is removed and replaced with an epidural catheter, a tube through which local anesthetic is pumped into the epidural space, the space just outside the spinal cord.

This method can be used to administer a “walking epidural,” which provides patients instant pain relief with little motor block, he says.

Researchers have developed a spinal needle shaped like a pencil point, which has lowered the patient’s risk of getting a spinal headache — a severe, often long-lasting headache caused by a puncture of the sack containing spinal fluid — to about one or two out of every 100 who receive the procedure, Dr. Birnbach says.

“Ten years ago, you had a chance of a huge risk,” he says. “It’s a dramatically safer thing.”

Researchers also are developing a catheter tiny enough to be placed in the spinal space that would require smaller doses of medicine, making the procedure safer and more effective, Dr. Birnbach says.

He says he expects researchers to finish developing the catheter within the next two years, upon which it would need FDA approval.

Anesthesiologists also are using new drugs to improve epidurals, says Dr. Stephen Martin, chairman of anesthesiology at Shady Grove Adventist Hospital.

Within the past year, anesthesiologists there began using a new local anesthetic called Chirocaine at the start of an epidural, when the largest dose of medicine is given and a patient is most at risk for complications, Dr. Martin says.

Although it is more expensive than other local anesthetics, this drug has a lower rate of cardiac toxicity, which can cause arrhythmias.

More info:

Books —

• “Birthing From Within: An Extra-Ordinary Guide to Childbirth Preparation,” by Pam England and Rob Horowitz, Partera Press, 1998. This book provides several techniques for coping with labor pain without medication, describing giving birth as a rite of passage, not a medical emergency.

• “Having a Baby, Naturally,” by Peggy O’Mara, Atria Books, 2003. This book advises parents on having a natural childbirth, offering tips from the first trimester of pregnancy through the first months of child care.

Associations —

• The American College of Obstetricians and Gynecologists, 409 12th St. SW, PO Box 96920, Washington DC 20090-6920. Web site: www.acog.org. Click on “Patient Information” to order up to five free pamphlets.

Online —

• Waterbirth International is a project sponsored by the nonprofit Global Maternal/Child Health Association. Its Web site (www.waterbirth.org) offers information about water birth and pool sales and rentals as well as tips for evaluating hospital tubs.

• Childbirth.org (www.childbirth.org) is a site that offers a collection of articles from doulas, childbirth educators and medical professionals. The labor section offers information about drug-free pain relief and medicated pain relief for women in labor. There also is a helpful description of different types of childbirth classes.

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