By , , Laura Geggel, Senior Writer
Published July 22, 2016
The modern epidural — a powerful combination of painkillers used to help women endure labor — is nothing like the painkillers of generations past.
These days, about two-thirds of women in the U.S. have epidurals during labor, said Dr. Aaron Caughey, professor and chair of the Department of Obstetrics and Gynecology at Oregon Health and Science University.
The procedure has undergone major changes since the earliest days of using drugs to help women in labor manage their pain. [8 Odd Changes That Happen During Pregnancy]
In the most recent change, made in the early 2000s, anesthesiologists greatly lowered the dose of the drugs used in an epidural, and they gave women a button they could press if they needed more pain relief.
"We're using less drug, and more of it is patient-controlled," said Dr. Stephen Halpern, an obstetric anesthesiologist at Sunnybrook Health Sciences Centre in Toronto. "Instead of me deciding on the dose, we give the patient a button to push, and if she needs more, she pushes it."
But women were not always given such control.
In 1900, at least one U.S. doctor used cocaine as an anesthetic during labor or, as he put it, a "cocainization of the spinal cord," according to a 2010 study published in the journal Local and Regional Anesthesia.
In the decades that followed, doctors began using flexible tubes called catheters to deliver the medicine. The end of the tube was inserted under the skin and was used to deliver the drug whenever it was needed, so doctors didn't have to continuously jab laboring women with needles. But these epidurals were still a long way off from those of today.
In the 1970s, anesthesiologists would insert a catheter tube and use it manually to deliver a dose of pain medicine every 2 hours, Halpern said.
This wasn't ideal, because if a woman was in labor for a long time — say 20 hours — she would need 10 doses. That many doses could make her lose all sensation below her waist and, in turn, make it difficult for her to push or feel feedback from the labor, experts told Live Science.
In the mid-1980s to early 1990s, doctors began delivering epidurals using a continuous infusion, meaning that the catheter would continuously deliver the drugs until the woman delivered the baby. But still, some women complained of "heavy legs," indicating that their doses were too high, Halpern said.
In today's epidurals, women are given about a quarter of the dose of drugs that they were given back then, Halpern said.
Epidurals may contain anesthetic agents, such as bupivacaine or ropivacaine, that numb the area.They may also be given narcotics, including fentanyl, that diminish — but do not eliminate — the pain. Or, they may get a mixture of anesthetics and narcotics, Halpern said.
The modern epidural is a continuous infusion of drugs, delivered through a catheter into an area called the epidural space, in the lower back, Caughey said.
The epidural is usually administered during the first stage of labor, when the woman's cervix has dilated to about 4 inches (10 centimeters), Caughey said. It takes about 15 minutes for the drugs to start working; and although the drug infusion may be turned off at some point, the catheter is kept in until after the delivery, so the infusion can be turned back on if the woman experiences more pain. For example, some women may need stitches or other treatments to repair lacerations that occurred during the birth, he said.
If the woman needs a Cesarean section, the doctors can use the epidural catheter during the procedure, Caughey said.
Most epidurals cost between $700 and $1,200, which includes the fee for the anesthesiologist and the hospital equipment, Caughey said.
The benefits of epidurals include:
Epidurals have several drawbacks, including the following:
Original article on Live Science.
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