JEDDAH, 26 February 2003 — Most Saudi women would say no to an epidural during childbirth. Some want to experience the labor, others want a completely natural delivery process; but the main reason they reject the epidural is fear.
Horror stories of women who suffered paralysis as a result of the epidural are common.
Dr. Ashraf Ali Hasan, an anesthesiologist at Almutahidoon Hospital, said only 10 percent of the pregnant women who delivered at the hospital asked for an epidural, compared to 60-80 percent of the women in Western countries who routinely use it for childbirth.
“I think it’s mostly the older generation who are against it and they persuade their daughters not to take it, but almost everyone I know took the epidural especially once the pain increased,” said Arwa Julaidan who is expecting her first baby.
“I spoke with the anesthesiologist and feel comfortable about it, but my husband is still not convinced,” she said.
“There are many misconceptions and false information about the epidural,” said Dr. Hasan. “While it might be true that a long time ago mistakes happened in applying the epidural which caused some health problems for the women, this rarely happens now as medicine has become more advanced and the anesthesiologists are better trained,” he added.
The clear benefit of epidurals is that they can completely relieve the pain of labor. The procedure involves the insertion of a needle in the back near the spinal cord. Local anesthetics and sometimes narcotics can be instilled directly or, more commonly, a thin catheter or tube is left in place and medication is given as needed. Usually, the body from the middle of the abdomen down to the feet becomes numb. Use of an epidural is far safer than general anesthesia for both mother and baby, if caesarean section is indicated.
For certain women experiencing serious health problems, such as high blood pressure or heart problems, the epidural can potentially prevent further illness or death during labor. However, there are several drawbacks to this method of pain relief and there are some serious potential health risks for the mother and baby.
A commonly acknowledged problem with the epidural is that it can slow down and prolong labor, though sometimes it may actually speed it up.
Another problem is that a woman who receives an epidural may increase the risk of a caesarean section as much as five-fold. Also, epidurals may require other medical procedures (such as use of forceps) which add to the risk.
The most common, but still rare, side effect of epidural is a sudden drop in the woman’s blood pressure. This occurs on to two percent of the time and can be dangerous to a woman and her baby, but the medical staff present can usually correct the problem.
“Other side effects that might occur include backache, shivering, nausea and dizziness,” said Dr. Hasan, “but these are all treated while I’m monitoring the patient through the whole delivery process.”
A rare risk for a woman having an epidural is accidental puncture of the spinal cord coverings, which can cause a severe headache within 24 hours, and this is treatable too.
More serious but very rare side effects include permanent nerve damage, convulsions and heart and breathing difficulties attributable to the epidural. “It depends on the skill and experience of the medical staff, but these things rarely happen now,” asserted Dr. Hasan.
If the physician cannot easily locate the epidural space, it may not be possible to use epidural pain relief. This seldom happens. Most women can have an epidural, although women who have had back surgery, heart or blood disorders and those who have an allergy to “-caine” medications should discuss those problems with their physicians and anesthesiologists.
“I usually sit with the patient before her delivery to take her health history, explain everything about the epidural procedure and its possible side effects, answer her questions and try to comfort her as much as I can,” said Dr. Hasan.
“I wanted to know everything about it before I decided on using it,” said Kholood Qahtani who had her baby a few months ago and was very satisfied with her experience with the epidural.
