Risks of Epidural Anesthesia in Normal Vaginal Delivery Outweighs the Benefits
Impact of Epidural Anesthesia on the Health/Medical State of Mother
Impact of Epidural Anesthesia on the Health State of Baby
Impact of Epidural Anesthesia on the Psychological Well-being of Mothers
Social Disadvantages of Epidural Anesthesia for Mothers and Babaies
Anesthesia is a part of general medicinal practices that are commonly employed in present times. Its vital purpose is to reduce the pain/discomfort during surgery or any pain inflicting procedure under medical scenario. Furthermore, Epidural anesthesia is one of the most familiar types of anesthesia that are being performed currently. It plays a significant role in reducing pain experienced by women during labor and childbirth; however, it encompasses several risks that cannot be disregarded at any cost. Usage of epidural in normal vaginal delivery is one of the current controversies in the field of medicine. The aim of this paper is to discuss and debate over this controversy by highlighting the potential risks and benefits of Epidural Anesthesia when used for the purpose of normal labor and childbirth. Furthermore, my stance discussed and concluded in this research paper concerning the issue is that an epidural poses great risks to the overall health of mother and baby and fundamentally outweigh its benefits. Therefore, I disagree with its usage specifically in the process of normal delivery.
Since time immemorial, people have benefited largely by medicinal practices. The field of medicine has contributed immensely to improve the health conditions of people and to provide comfort by treating ailments and reducing pain. Furthermore, continuous research and advancements in this regard have begotten to newer techniques of treatment and cure. Anesthesia is one of these practices that are primarily and widely used to alleviate pain during medical processes such as surgery, getting stitches, and so forth. Additionally, it reduces shock/fear that commonly victimizes the patient during a painful process (Barash et al. 2012).
Anesthesia can be given in any part of the body; however, if it is given by administering anesthetic in a region around spinal cord known as epidural space, then it is termed as Epidural Anesthesia. It is generally categorized as local anesthesia because it makes a particular part of the body insensitive to any sort of feeling; thus, pain is also not experienced in that region (Orebaugh 2011). This practice finds its traces of discovery from long time ago and is indeed not a new practice in the field of medicine, which I will discuss in the following section of the paper. Nevertheless, it has obtained immense importance since it has been used for abating pain in labor and childbirth.
Amongst many of its applications, epidural anesthesia is commonly and chiefly administered to reduce the pain experienced during normal vaginal delivery by women. The tolerance capacity of every individual female differs from each other; therefore, in case of strong contractions that one may experience during labor and finds it unbearable, may be given epidural anesthesia. It inhibits the transmission of nerve impulses between uterus and spine; thus, causing numbness in the sections of reproductive system. During the process of epidural anesthesia, generally labor is not disturbed; rather, it continues to occur normally coupled to reduction in pain (Halpern and Douglas 2008). Nevertheless, researches tell that exceptions do exist, which are dangerous/risky for mother and baby. This controversy will be debated upon in the dissertation part. The topic under discussion is very important to look upon in detail as a controversial issue because the technologies related to childbirth are advancing and they are being implemented by doctors and midwifes greatly nowadays. It is necessary to study these technologies including epidural anesthesia for analyzing its benefits and potential risks to the health state of mother as well as baby.
Several benefits are associated with epidural anesthesia as argued by several experts; however, multiple risks and disadvantages are also incorporated with it. These aspects will be discussed and compared in the third section of the paper. The principal purpose of this research paper is to highlight that the risks of employing epidural in normal vaginal delivery are much severe and largely surpass its benefits. Furthermore, it imposes great risks to the health condition of mother as well as fetus; therefore, my stand in this regard is that epidural anesthesia should not be administered in normal vaginal delivery. My standpoint in the dissection part will portray that I disagree with administering epidural in normal delivery.
Epidural anesthesia was discovered by medical researchers more than a century ago during 1900s but its usage was limited at that time. The function of epidural space was first studied by Corning during the first year of twentieth century. This was followed by further researches that led to the general use of epidural anesthesia by the medical practitioners. Couple of decades after the work of Corning was published; Fiedal started using epidural as a mean of pain relief for his patients. Many experts then studied about this topic and gradually extended its usage in numerous fields in the years that followed until the present time (Middleton, 2006).
Furthermore, Middleton (2006) notifies that an obstetrician named Kreis had employed other drugs for relieving labor pain before the discovery of epidural anesthesia, which showed successful results. Nevertheless, it took more than four decades for epidural anesthesia after its discovery to be employed for the purpose of reducing pain during the process of labor and normal childbirth.
The era when people became immensely interested in knowing about different aspects of childbirth was the actual time when epidural anesthesia gained acknowledgment. Additionally, extensive knowledge from research work had enabled the obstetricians to deal with complexities associated with epidural with more specification and ease. As a result, this technique of anesthesia began to be employed widely in normal vaginal delivery by the specialist doctors for reducing pain in most of the developed countries (Middleton, 2006).
Middleton (2006) and White, Duncan and Baumle (2012) discuss that the procedure of administering epidural anesthesia couple of decades ago was critically different from what it is nowadays. It was difficult to perform; as the medicine was then injected further down the spine where inserting a needle was complex. Moreover, this way of giving anesthesia required larger quantities of medicines to attain the desirable effects. In addition to it, the position of insertion was such that it held a risk for fetus; since there was a chance that needle together with medicine may mistakenly get pierced into fetus’ skull. Considering this aspect, experts studied this technique further and concluded that it imposes less risk if the medicine is injected through lumbar region of the back.
The basic procedure of administering epidural anesthesia as discussed by White, Duncan and Baumle (2012) begins when labor pain is triggered.
Furthermore, before injecting the needle, the outer skin is cleaned using an antiseptic medicine in order to kill pathogens that may be present there and also to restrain the development of infections. This is followed by making a small region in the lumbar area insensitive by application of external anesthetic. This assuages the pain that otherwise would be immense when the needle along with a catheter is inserted through that numbed region into the epidural space (White, Duncan and Baumle 2012).
When the anesthesiologist supposes that the needle and catheter have reached the required part, he takes out the needle while catheter still remains inside. In order to assure that the catheter is at the correct position, a small test is performed in which a small quantity of anesthetic is inserted through catheter and heart beat of the patient is monitored closely. If the catheter is placed in correct position, it is secured to prevent it from dislocating (White, Duncan and Baumle 2012). The effects of anesthesia curb down and diminish after few hours of stopping the inflow of medicine.
Taylor (2003) explains that gestation stage is generally based on nine months with variation of few days; therefore, a child who is born after this time period through the birth canal or vagina of his/her mother is said to be delivered normally. Labor precedes the birth process in which biochemical changes are caused to the uterine layers that in turn generate contractions. Furthermore, the amniotic membrane becomes ruptured together with expansion of cervical region that allow the fetus to be delivered. All these events initiating from labor till the birth are majorly painful for mothers; hence, obstetricians use epidural anesthesia to relieve this pain.
The trend of using epidural anesthesia as described by Taylor (2003) has largely increased during couple of decades. Despite of the fact that this technique is expensive and most importantly have adverse impacts on the health of mother and baby, many obstetricians and women (patients) prefer this technique in majority of the developed countries.
Moreover, doctors or midwifes who perform the delivery often prefer administering the patient with epidural anesthesia especially in the case of untimely labor. Also, if the women experience excessive tension or anxiety prior to the labor or during the labor then obstetricians recommend this type of anesthesia to provide comfort to the mothers. However, before giving the medicine, anesthesiologist carefully examines the condition of the pregnant woman to whom anesthesia is to be given. Epidural anesthesia during labor and normal delivery does not cause unconsciousness; thus, patients do not lose their psychological alertness (Halpern and Douglas 2008).
According to (Orebaugh 2011), epidural anesthesia is commonly administered by injecting the medicine in the lumbar region of the back, specifically in the epidural region. The detailed procedure regarding the administration of epidural anesthesia has already been discussed in the previous section of the paper. However, the anesthetic drug injected in the epidural space interrupts the passage of nerve impulses that originate in reproductive organs and travel through nerves to lower spine and then to brain. This hinders the feeling of sensation/pain that is produced in the lower parts of the body.
The degree of insensitivity induced depends on few factors that include the quantity and the nature of medicine that has been injected. Large quantities will lead to greater loss of sensation for longer time. Moreover, these medicines may be injected together with other types of drugs that assist in obtaining required and desirable effects. Nevertheless, the induced numbness is temporary and the region subjected to it regains its ability to feel as soon as the effect of anesthesia fades away (Orebaugh 2011). Studies by Akbas and Akcan (2011) highlight that epidural anesthesia induce numbness not only in the lower section of the body. At instances, it may affect the upper parts such as chest and abdominal cavities in order to relieve pain.
According to Helpern and Douglas (2008), the technique of using anesthetics and analgesics in the obstetric practice began during 1847 by James Young Simpson. Many forms of anesthesia had been utilized until the epidural anesthesia came into practice. Middleton (2006) notifies that epidural anesthesia particularly gained attention when a tube like instrument catheter was used along with a needle to allow the insertion of anesthetic into the epidural space even after the removal of needle from the body.
Halpern and Douglas (2008) discuss that the field of anesthesia has gained colossal attention of the people and recently many are pursuing it as their career for which they take extensive training to become experts. Coupled to this, midwifes are also trained in this respect; therefore, this technique is now available in larger hospitals as well as in smaller obstetric clinics and is becoming more contentious for its usage in normal labor and delivery.
Using different forms of anesthesia including epidural in normal delivery have remained controversial, as all pose threats to the health of mother and baby. Numerous debates have been witnessed because despite of the significant role of epidural in pain relief, much severe risks are also connected to it, which raise concerns for professionals and patients. This aspect will be dealt with in the following discussion.
This section of the paper is based on the discussion of benefits and risks associated with epidural anesthesia in normal vaginal delivery. Moreover, arguments by different experts and authors together with personal stand regarding the controversy have been presented.
Impact of Epidural Anesthesia on the Health/Medical State of Mother
Akbas and Akcan (2011) discuss that epidural was initially used to relieve pain for those pregnant ladies who faced complications during normal delivery and had to undergo cesarean as an alternative. But nowadays the purpose has transformed and epidural anesthesia has started to be commonly used in normal vaginal delivery. However, in case of cesarean birth, severe pain experienced by the mothers can be assuaged by using this technique. Moreover, epidural in cesarean section is preferred over general anesthesia for an apparent reason that epidural does not cause the patient to become unconscious. As a result, mother can enjoy the precious moment of the birth of her child and can nurture the baby immediately after delivery.
On the contrary, (Baxley and Cline 2008) argue that in case of utilizing epidural in normal delivery, there exist potential dangers that can contribute largely in complicating a normal delivery case. This has increased the concern because a woman who can have normal delivery should go on with this ordeal without external interventions in the natural process of childbirth. My stand regarding this issue is that I disagree with the usage of epidural in normal delivery because it is pointless to disturb and complicate a process that can proceed normally. Additionally, medical principles clearly teach that no such measures should be used that pose threat to the life of patients (mothers in this case).
Some schools of thought discuss the health aspect of mothers and believe that epidural anesthesia assist in comforting the patients by reducing their labor pain, as they numb the nerves that carry messages for making the pain felt so it is beneficial (Green 2011). However, (Baxley and Cline 2008, Murray and Huelsmann 2009) argue that this is not always true because cases have been witnessed where labor contractions grew weaker under the effect of epidural anesthetics and have developed complications, which then required the progression of delivery by either cesarean or other techniques. Furthermore, pelvic muscles are adversely affected that cause restrictions of movement in mothers who then face difficulties during childbirth, as they cannot make appropriate movements to advance the procedure. Additionally, when pelvic muscles do not function properly, it creates problems for baby to be moved out of the womb, which necessitates the employment of other methods. These are very painful, as few entail the need for stitches that takes several days to heal.
I deem that when normal delivery is possible without administering epidural anesthetics then it should be avoided in order to prevent worsening of the state of mother and fetus. Moreover, it is useless to exercise a technique of pain reduction that, at instances, itself lead to application of more pain inflicting processes for mothers.
Moving onwards, experts discuss the medical aspect related to mothers who claim that epidural anesthesia is effective because the injected medicines do not make the mother feel lethargic and sleepy. Furthermore, she can retain her consciousness and remain relaxed till the time of delivery (Akbas and Akcan 2011, Green 2011). Conversely, (Orshan 2008) disagrees and states that the mother cannot get down from her bed when given epidural and is required to remain only in few particular positions throughout until the catheter is removed from her back.
I support the latter argument because the purpose of epidural is to provide relieve to mothers who are subjected to utter pain but this argument draws the attention to the fact that this practice is contributing to the discomfort of mothers (related to medical aspect). Thus, I disagree to the usage of epidural in normal delivery because it has potential capability to make that normal process complex.
A rare but complex risk of epidural associated to mother’s health condition is that while administering the anesthetic, the needle may get inserted into nearby blood vessel, which causes bleeding. Moreover, wrong site of insertion may beget to leakage of cerebro-spinal fluid which causes prolong headaches (Baxley and Cline 2008). My point-of-view related to this is that epidural disturbs the natural bond shared by mother and her baby, as headaches hinder the mother-child interaction after the birth. Therefore, I totally condemn the administration of epidural in normal delivery.
One more major risk related to medical/health aspect of mothers as explained by Epstein (2013) is that epidural may lead to neurological destruction in mothers as a result of neural puncture while injecting the medicine. Similarly, several forms of infections due to using infectious injections can develop in mothers including deadly forms of meningitis. Many practitioners are themselves unaware of these risks and even if they do know, they hesitate in telling this to mothers. I believe that mothers should be made aware of the risks associated with epidural beforehand, who will then certainly disagree with being administered with it as I do.
Where many research works favor the use of epidural; Wilson, Macarthur, and Shennan (2009:97-103) argue over another health risk of epidural for mothers which states that the medicine injected in epidural space may also anesthetize the bladder. This is explained by the anatomy of human body which illustrates the close positions of uterus and bladder. Numbing of bladder leads to difficulty in excreting urine (due to loss of sensation) which begets to connecting a catheter to the bladder. My viewpoint regarding this argument is that placement of catheter makes the patient uncomfortable and may be a source of awkwardness. Furthermore, epidural can turn a blissful time (as would have been the case in normal delivery without epidural) into a miserable time.
Another medical aspect of epidural is that it lowers the blood pressure and is beneficial for those mothers that suffer from hypertension (Wilson, Macarthur, and Shennan 2009:97-103); however, there remains a concern that not all mothers face this enormity. Consequently, mothers with normal blood pressure experience a rapid decline; therefore, they are needed to be monitored continuously and drips are normally administered. I feel that constant monitoring by medical staff members disturbs the privacy of mothers and can become a cause of disturbance while the mother would like to take rest. Consequently, administration of epidural is no more than a distracting factor for mothers; therefore, it should not be used where it is not needed (as in case of normal delivery).
Impact of Epidural Anesthesia on the Health State of Baby
The next argument is related to the health state of baby. Supporters of epidural anesthesia affirm that it does not cause considerable problems to the health conditions of baby (Green 2011). On the other hand, studies and records illustrate that anesthetics may enter into mother’s blood vessels when they are being injected into epidural space and can travel to the baby through placental membrane. One of the potential risks that it can impose on baby is that it can affect its respiratory system; thus, causing breathing difficulties. Furthermore, there is a possibility that baby suffers from low blood glucose level under the effects of epidural drugs. In human body, toxic substances are removed by liver but babies do not have a well-formed liver; therefore, it takes quite a long time for removing harmful chemicals (Lewis 2010). My outlook regarding this aspect is that medical practices are aimed to solve health-related issues rather than boost them. I totally disagree with the use of epidural, as it is posing threats to the well-being of newly born baby.
It has been discussed in the studies presented by Wilson, Macarthur, and Shennan (2009:97-103) that mothers often experience the lowering of blood pressure. This results in adverse impacts on the health state of baby, as baby may be depleted from the supply of essential substances such as nutrients and oxygen that it usually receives through maternal circulatory system and death can occur (Orshan 2008 and Lewis 2010). In this respect, I disagree with the usage of epidural in normal delivery because a normal process that is healthy for both mother and baby becomes a serious matter of life and death.
Impact of Epidural Anesthesia on the Psychological Well-being of Mothers
(Orshan 2008) also argues about the psychological disadvantages that are experienced by mothers. As it has been mentioned that mothers cannot move around due to the placement of catheter; therefore, she has to take assistance from medical staff for every basic need. This makes her feel uncomfortable, since she becomes irritated staying in bed for several hours without doing things for herself. My stance regarding this point is that a medical practice that tortures mothers instead of comforting them is useless to be used and promoted in cases of normal delivery, which could otherwise be fairly simple and psychologically peaceful.
Social Disadvantages of Epidural Anesthesia for Mothers and Babaies
Orshan (2008) argues over the social aspect linked to the practice of epidural anesthesia that constant presence of nurse can cause disturbance for the patient when she probably would like to spend precious time with her husband who can console and support her together with sharing a valuable bond. Furthermore, (Baxley and Cline 2008) also talk about the social aspect. They deem that prolonged headaches do not allow the mother and child to spend time together (they are unable to socialize normally) that spoils the significance of the moments after childbirth. Therefore, I stand against this practice, as epidural ruins the treasured moments that nature has blessed women with.
Although the practice of epidural anesthesia is not a new one; however, it has gained recognition globally during the past few decades. Furthermore, there are several disadvantages related to medical, psychological, and social aspects that are faced by mothers when administered with epidural. Moreover, health risks for the babies also remain high when epidural is given in normal delivery.
Epidural anesthesia has remained a medical as well as social controversy over many years and I possess a stance that disagrees with the implementation of this practice. Since it has been employed by obstetricians in abating labor pain during normal delivery, it has brought about benefits together with potential health risks for mother and baby. It cannot be ignored that the risks of obstetric epidural largely outweigh the benefits as debated above. Therefore, I disagree with the usage of Epidural Anesthesia during normal labor. I believe that when normal labor can proceed with no complications and external interventions, patients and doctors should not opt for epidural.
Medical specialist cannot shut their eyes to the fact that multiple risks (although minute sometimes) do exist for using epidural anesthesia in normal vaginal delivery and so they should not employ it, as the positive results are not certain. It is the responsibility of the doctors and nurses to provide secure and safe delivery to patients rather than using practices that messes up normal process. Furthermore, experts should study the hazards linked to epidural in detail and should work out feasible solutions to cope up with the current risks. Meanwhile, this practice should be strictly curbed down in order to control the complications resulting from it.
Every life is precious; therefore, before new medical technologies and researches are being implemented, they should be studied deeply to eliminate the related risks. Moreover, it is recommended that people should be provided with information regarding all possible threats, which are associated with practices that are employed under sensitive conditions such as childbirth.
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