The patient is placed on her left side with her thighs and trunk flexed. The position of the spines of the lumbar are marked.
	The epidural needle is inserted between the vertebral spin of L-3 and L-4 after infiltration of the skin with local anesthesia.
	The resistance to the injection of a small amount of air is felt to make sure that the tip of the needle is in the epidural space.
	The epidural catheter is inserted through the needle and the needle is then removed.
	Epidural "top ups" are performed by injecting local anesthesia through a self-sealing valve.

Nearly every woman giving birth in a hospital will receive a drug at some point during her stay.

(I discovered with my third hospital birth after receiving the hospital records that my "natural birth" was anything BUT natural. I was so involved with my labor I had no idea that I was given the drugs until I received the paperwork. This was my last hospital birth and my next two babies were born at home, non-medicated and totally natural!)

Pitocin is frequently used to induce or augment labor. Because it causes abnormally strong contractions, many women receive a pain-relieving drug such as a narcotic. Unfortunately, narcotics also are received by the baby and can affect the condition of the baby at birth and for years after. Some of these side effects are respiratory problems, impaired muscular, visual and neural development in the first week of life and in the following years, lower reading and spelling scores, difficulty in solving problems or performing tasks when they pose a challenge.

The new drug of choice at many hospitals is the epidural. It must be administered by an anesthesiologist and requires the mother to remain in bed afterward. She must be flushed with an IV fluid prior to getting it to keep her blood pressure up. A needle is inserted into the woman's back and small catheter is left in place where the medication is injected. It numbs the woman's body from the ribs to the toes. Many women ask for this drug because they do not want to deal with the pain of childbirth and believe it is safe for themselves and their babies because the physician who administered it, their obstetrician and the labor and delivery nurses all encourage the use of it and give no or very limited information regarding side effects.

The known complications are many ranging from requiring EFM (external fetal monitor), IV, immobility, urinary catheterization. An epidural also may allow no sensation of labor or the pushing urge, lower blood pressure, abnormally relax the pelvic muscles which may encourage the baby to adopt malpositions of the head, may decrease the production of oxytocin at critical times, and increase the need for forceps and cesarean section. Epidurals cause some serious complications such as heart attack, spinal damage, and spinal headache. After the birth, chronic backache is a common complaint as well as backache.

The baby may be exposed to narcotic drugs given to enhance the effect of the epidural and which if given alone can compromise the baby's respiratory efforts as well as require the newborn to metabolize the drugs. We do not know the short or long term effects of the epidural or other drugs on the baby. Some claim that the baby is unaffected unless the mother becomes hypotensive.

Some non-interventionist birth attendants recognize that occasionally epidurals may be useful for certain situations. Some examples when an epidural may permit a normal birth are for maternal exhaustion, severe back labor, certain malpresentations or psychological dystocia.

Although the FDA approves drugs as safe or unsafe, they have no definition of "safe" and do not guarantee safety of drugs. Many who work with brain damaged children, wonder if the disability is due to obstetric drug use. They also question if women would make the drug choice if they were given complete information about side effects. The American Academy of Pediatricians discourages the routine use of obstetric drugs.

Epidural Anesthesia - Obstetric Myths VS Research Realities Chapter 13 - By Henci Goer

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