October 5, 2023 • 31 mins
Congratulations! You're having a baby! As your due date approaches, you may be wondering how you want to deliver..."naturally" or with some form of pain control. The good news is that you have MANY options! Get the facts straight in this informative episode with us, Harvard-trained anesthesiologists Dr. Maleeha Mohiuddin and Dr. Dionne Ibekie. We're pulling back the curtain on epidurals, debunking myths, and discussing what exactly anesthesiologists do during delivery.
This episode is packed with practical tips and insights. So, tune in and let's cover the pros and cons of all the options!
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Episode Transcript
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Maleeha (00:00):
Now, as your due date approaches, you may be thinking
about how you want to deliveryour baby naturally or with the
help of an epidural for pain,and everyone has an opinion
based on their own experiences,and usually they are very strong
opinions.
Yes, yeah.
(00:22):
But did you know thatanesthesiologists are often
involved in your delivery, evenif you never meet us?
Yeah, we actually work closelywith your obstetrician when
you're in the hospital to helpmake sure your labor is safe and
you're comfortable.
Dionne (00:41):
We are here to tell you that there are so many options
out there and there are a lot ofmisconceptions about epidurals.
So, before you try to create abirth plan, leah and I are here
to dispel those myths and layout all the options because,
contrary to popular belief, youhave options.
On this episode, we are goingto give you the essential quick
(01:02):
and dirty rundown of youroptions so that your birth plan
is flexible and well-informed.
Luckily, leah and I trained atthe best hospital in the country
where we did a lot ofobstetrics.
Yeah, you know, we got abragging of it.
Maleeha (01:17):
That's right.
Basically, we delivered a wholelot of babies at night.
Dionne (01:22):
Yes, we did so.
We have seen a lot in trainingand even in private practice.
Our own friends ask us foradvice all the time, so we
figured we'd share some of thatinformation with you all today.
Maleeha (01:38):
This is the IVY Drip, a podcast designed to give you
the dish on health topics youneed to know but didn't know to
ask.
We are your hosts, Dr.
M Mohiuddin and
Dionne (01:50):
Dr.
Dionne Ibekie.
We're both Harvard-trainedanesthesiologists and besties.
Join us as we explore hottopics that are rarely discussed
but can have a huge impact onyour life.
Maleeha (02:02):
So before we begin, Dionne, I have to ask did you
have a birth plan?
Dionne (02:07):
I did.
It was very simple.
What about you, Maleeha?
Did you have a birth plan?
Maleeha (02:12):
I did.
I did indeed.
It also was verystraightforward and simple.
Dionne (02:19):
I think you and I are very like-minded.
It's get to the hospital, havean obstetrician and
anesthesiologist deliver safelyand go home safely with their
baby.
Maleeha (02:32):
Absolutely, which is our goal number one deliver a
baby safely and keep mom safeand healthy.
That is the main big pictureand if we can do that it's a
success.
Dionne (02:50):
The other thing I would say Maleeha, that was a huge
part of my plan because I'm awimp was managing my pain, labor
pain.
Maleeha (03:00):
I have to agree with you.
I think that, given that I hadwitnessed enough deliveries
before having my own baby, thatdefinitely informed my
decision-making.
You learn through observation.
So, yeah, I got my epidural in,but that's not the right choice
(03:22):
for everybody.
So let's talk about this.
First off, I think we shoulddefine what is labor pain, what
actually is it?
Go ahead, Dionne.
Dionne (03:32):
What is it?
Maleeha?
Maleeha (03:33):
Yeah, go for it.
Dionne (03:33):
Oh, you want me to do it .
Okay, I'll take it.
I'll take it for once, okay.
So pain during labor is causedby contractions of the muscles
of the uterus and by pressure onthe cervix.
This pain can be felt like astrong cramping in the abdomen
groin and your back, and you canalso have just like an achy
feeling as well.
When you're in true labor.
(03:54):
Your contractions last about 30to 70 seconds and they can come
every five to 10 minutes, sothe intensity kind of goes up as
you progress.
They can be so strong that youcan't walk, you can't really
talk, you're focused on yourbreathing and you're just trying
to keep it together becausethey just keep coming in waves.
You know those movies whereyou're like don't talk to me
(04:17):
Right.
That's what we're talking abouthere, right?
Maleeha (04:21):
And it's really that uterine contraction, it's like a
really bad period pain thatextends across your abdomen and
it gets tighter and it getslonger and as the baby moves
down the birth canal, itactually gives a lot of people
the feeling of having to poop.
I will say you know, that's oneof the first things I noticed
(04:43):
as a med student, is womensaying, oh, I really have to
poop and it's actually thepressure from the baby's head in
that pelvic floor and in thebowels Okay?
Dionne (04:52):
Especially when you progress further in your labor
Exactly.
Maleeha (04:55):
Exactly that.
Pain changes Right.
So I want to be really clear,though.
Everyone's pain is different.
Your pain can range from mildto severe, and it's really
impossible to know in advancehow you're going to feel.
So please don't compare yourpain to someone else's.
Like your sisters or yoursister-in-laws or your friends,
(05:17):
everyone has differentexperience.
In fact, some women have acompletely different experience
with each of their owndeliveries.
Dionne (05:25):
You know, I have people who have said my first delivery
was easy.
Maleeha (05:28):
My second delivery was took a lot longer.
So every experience isdifferent.
Don't get caught up in the gameof comparison.
That's right, okay.
Dionne (05:38):
So let's dive in Maleeha , let's dive into the questions
that we commonly receive fromfriends and family and our
patients.
Really, this question is are myoptions basically going natural
, as in no medication or gettingan epidural?
That's a big one.
Maleeha (05:55):
That's a huge one, and I would say the short answer to
that is no.
There are more options to helpyou control your pain during
labor than just an epidural, butthe epidural is the most widely
used and highly effectiveoption.
But before we drill downspecifically on epidurals,
(06:16):
dionne, I think let's justdiscuss some of these other
options people have available tothem.
Dionne (06:21):
Yeah, that's right.
So one of the first one is IVmedications.
When you get into the hospitalyou're going to get an IV, so
it's one of our first line forpain control, especially if you
are someone who wants to delayan epidural or may not want an
epidural.
So it makes it really fast andeasy because, again, when you
(06:44):
come in you get an epidural oryou get an IV, which is that
intravenous catheter that fluidsgo through and medications go
through.
The most common IV drug that weadminister for labor pain are
opioids, like fentanyl is acommon one and it's very
effective.
They rapidly curve the pain,but they make you feel drowsy
(07:05):
and nauseated, maybe a littlehigh.
So it's gonna be a weirdfeeling.
And we also don't like to givea lot of pain medications
because they cross the placentaand can be passed on to the baby
, which can make the baby drowsyand slow their breathing down.
So there are limitations withopioids.
So we have to be very mindfulof that because we don't wanna
(07:29):
give medications that can beharmful to your child.
Maleeha (07:33):
Absolutely.
But you're right, I considerthat to be first line because
it's easy once you have an IVand it can delay that epidural.
If you wanna just wait and see,I would say number two another
option that's becoming morepopular, but it's not everywhere
is nitrous oxide, also known aslaughing gas.
(07:55):
Now, laughing gas is often usedin dental offices I think
that's how people mostly hearabout it, so maybe you've had
some experience with it there.
It's a mix of oxygen andnitrous oxide, which is a gas
that you inhale through a smallmask.
It does not eliminate all thispain, but it kinda makes you
forget about it, so you justdon't care as much anymore.
(08:18):
It doesn't target thecontraction pain specifically.
You'll feel a little relaxed,maybe a bit drowsy.
The other benefit is that itwears off really quickly once
you stop inhaling it.
But again, I would say that itisn't offered everywhere, so
check it out to see if it's anoption at your birthing facility
(08:38):
.
Dionne (08:38):
Yeah, that's a good one.
We had that in residency.
Maleeha (08:41):
Yes, we did.
Dionne (08:42):
And I think we started to see it more and more as we
progressed in our like, as weadvanced in our residency.
We started to see it more andmore.
But you're right, it's notreadily available.
The third bucket is all thenon-medicinal interventions.
We would list them underrelaxation techniques.
(09:02):
These techniques can helpdistract from the pain and relax
your body.
They might includevisualizations, meditation,
guided imagery, music,hypnobirthing, hydrotherapy,
breathing techniques or using abirthing ball.
I've seen it all.
The pros to non-medicalinterventions are it promotes
(09:26):
relaxation.
They're personalized to yourspecific needs.
And then I would say the consthey require practice and focus.
Maleeha (09:35):
Sure, and all the things that we just listed.
Often they can be used togetherto some extent.
Dionne (09:42):
That's right, so you can combine.
Maleeha (09:44):
People will wanna walk around, wanna use those birthing
balls.
They have a doula, they have amidwife or they have a coach of
some kind and as their painprogresses they might start to
feel uncomfortable and maybe wecan try a little bit nitrous,
because they're not ready forthe epidural, they wanna try a
little bit longer.
So those are all possibilitiesof ways to use these together.
Dionne (10:06):
And as labor progresses and the contractions start
getting stronger and closertogether, it may not be enough.
So just have that in mind.
Maleeha (10:16):
Now let's get to the main event.
The most widely used for painlabor is the epidural.
I think we should again startwith first what is an epidural,
because there are a lot ofmisconceptions about this
procedure, that's right, yeah,it's a procedure that basically
creates a band of numbness fromyour belly button to your legs,
(10:39):
so it targets the contractionpain very specifically.
It allows you to be awake andalert throughout labor as well
as feel the pressure of eachcontraction.
The goal is to take the edgeoff the contraction pain so that
they become manageable, notcompletely eliminate all feeling
(11:00):
so that you're totally numbfrom the waist out, because when
it's time to push, you need tofeel that pressure from the
contractions in order to pusheffectively.
And I tell that to all mypatients before I place an
epidural so they know what toexpect.
Dionne (11:19):
Yep, setting expectations.
It's a procedure done by us,your anesthesiologist, and we
place a thin, flexible catheterin your lower back, along your
spine.
Maleeha (11:32):
Right, and the catheter is about the size.
It's so tiny and thin it's likea fishing line.
Dionne (11:37):
Yeah, that's right.
Maleeha (11:39):
Right, and that's what's being threaded into your
lower back area.
Dionne (11:42):
That's right.
The catheter is taped securelyto your back and then connected
to a programmable pump devicethat is going to continuously
give you that numbing medication.
The pump pumps the medicationinto something called the
epidural space for the entireduration of your labor.
(12:03):
So, one, there's nothing sharpleft in your back.
We don't leave the needle inthere, and that's a big fear of
all the patients that we do thisto.
So we make sure to emphasizethat.
And two, an epidural is not aone-time shot, because again,
you're gonna have that catheterthat's attached to the pump, so
you're getting continuousmedication and it's not gonna
(12:27):
wear off because of that.
It won't wear off when you needit the most, which is when it's
time to push.
So once you get medication, youcan keep getting that
medication as long as you needit for your labor.
Once you've delivered, the pumpis turned off and we'll pull
that catheter right out.
So it's easy.
Maleeha (12:47):
Yeah, very easy.
Usually doesn't take very longto place for us either.
Dionne (12:51):
If it's straightforward.
Maleeha (12:53):
It usually takes 10 minutes, I would say.
The pros are again.
They're really fast to put in,they provide pretty immediate
relief within minutes and theytarget the contractions.
The other major pro is that youcan adjust the dose on the
device, the pump, throughoutyour labor.
So I really like that.
So you can stop the medicineentirely at some point.
(13:15):
I can lower the dose if I needto lower the dose.
I can even increase the dose asthe contractions get stronger
and as your labor progresses,because the baby's moving down
the birth canal, and I like that.
It's customizable to yourspecific needs.
And because you're only numbfrom the waist down, you're
awake and alert and fullypresent for the delivery.
(13:37):
So you're participating.
I would say.
The other big, big pro forgetting an epidural this is the
one that you just do not hearvery often is that if, for any
reason, you would need to get aC-section and this happens, you
try to deliver vaginally andthen something happens and you
(14:01):
need to get a C-section, theythink it's the best thing for
the baby and for you.
We can actually just use theexisting epidural to get you
completely numb for the surgery.
You wouldn't need to put youcompletely to sleep or to place
a spinal, which we can talkabout a little bit later.
It's a different procedure, butthat's another big pro about
(14:22):
having an epidural in place.
Dionne (14:24):
That's a huge pro.
That's a huge pro Maleeha,because that's an insider gem
right there.
Oh yeah, oh yeah, because thingsrapidly change with labor.
You have a plan, but just knowthat you have to be flexible.
Having that epidural allowsthat flexibility.
(14:46):
So you're absolutely right.
But to the cons which are minorI would say, but they need to be
mentioned because you need tobe informed about your decisions
it can cause a drop in bloodpressure which basically stems
from the fact that the epiduralisn't just targeting the muscles
of your abdomen and your backand your legs, but it also
(15:06):
dilates the blood vessels andthat will drop your blood
pressure.
But it emphasizes why we placean IV as soon as you get there,
because we load you up withfluid and we have medication at
the bedside to treat those lowblood pressures as soon as we
see it.
So we're monitoring you veryclosely because we anticipate
this happening.
The other thing is that theepidural can cause weakness in
(15:29):
your legs so you won't be ableto walk around and it's a weird
feeling.
So what we do, or what thenurse does, we'll place a fully
catheter so that you can urinatebecause you won't be able to
walk to the bathroom.
So that might be a weirdfeeling for some people, feeling
used loosely, because you'reactually not going to feel that
fully catheter at all, becauseyou'll have an epidural in place
(15:53):
, and then there's a small riskof a specific headache called
post-ural puncture headache orPDPH.
That is treatable.
The risk of this happening isabout one in a hundred, and the
other complications that we willmention are infection and
bleeding, which are about one ina hundred thousand.
Maleeha (16:13):
Right.
Incredibly incredibly rare.
Dionne (16:15):
Yeah, for sure.
Maleeha (16:17):
And so it's important to remember that, while these
risks exist, the vast majorityof epidurals are administered
without any complications.
Your anesthesiologist will takeall the necessary precautions
to minimize these risks.
Please discuss any concernsthat you have, though, with your
team.
Absolutely ask questions andthink things through and have
(16:37):
that conversation.
Dionne (16:38):
That's right.
Okay, now let's answer somecommon questions we get
specifically about epidurals.
The first question would be doepidurals increase your risk of
a C-section Maleeha?
Maleeha (16:51):
Yeah, I think this one is major question.
I always get asked and theshort answer is no.
The American College ofObstetrics and Gynecology I'm
going to state this right offtheir site r"andomized trials
and systematic reviews includingthousands of patients have
shown that the initiation ofepidural analgesia at any stage
(17:15):
during labor does not increasethe risk of cesarean delivery.
They have looked at thousandsof these cases.
I think most people are nervous, right, Dionne?
Dionne (17:27):
Mm-hmm, mm-hmm.
I think most people are nervousto get an epidural because
they're afraid it will lead to aC-section or that they'll be in
labor forever because they aretoo numb.
In fact, though, I thinkepidurals help a lot of mothers
relax and sleep, which is soimportant to conserve your
energy.
It relaxes the pelvic floor and, like I just mentioned again
(17:50):
conserving your energy, becauseyou're going to need a lot.
You don't know how long you'regoing to be pushing for, so it's
good to have when that timecomes.
Maleeha (17:58):
Right.
Next question when should I getan epidural?
Is there a time when I can'tget one?
Yes, great question.
Dionne (18:08):
So most women choose to get an epidural when
contractions become too painfulto handle, often around four to
five centimeters dilated.
However, it can be administeredearlier or later.
It's generally ideal to get itbefore you're about eight to
nine centimeters.
One so that it can be effectiveand useful, and two because
(18:29):
there is a time where it can betoo late, such as when your
labor is progressing superrapidly or you're not able to
sit still, which is what we needfor the procedure.
When you're too dilated,sometimes you're in a lot of
pain and we're using a needle,so it can get dangerous if
you're moving around too much.
(18:49):
What do you think?
Maleeha (18:51):
Yeah, I think that's a great question and you answered
it spot on.
Really, If nothing else isgoing on medically with you, I
would say you got to be able tosit still to have the epidural
placed, just even for a shortamount of time.
And if you're in too much painand you can't do that, it's too
dangerous to use a needle inyour back.
So that would be an issue wherewe wouldn't be able to place it
(19:15):
.
And along that lines people askI want to try a natural birth,
but then I might change my mind.
Is it too late to change my mind?
And you just kind of touched onthat, deanna.
It's great to try.
That's fine.
I think if you're thinkingabout a natural birth but are
open to pain relief options,just communicate that to your
(19:36):
nurse so they're aware thatyou're flexible.
It's important to know whatoptions you have at that
hospital or facility.
The nurses, obstetricians, theanesthesiologists we all
communicate a lot while you'rein the hospital.
Even you might not be aware ofit, but in the back rooms we're
talking because labor isunpredictable and an unexpected
(19:57):
change of mind for you orprolonged labor can just change
how you feel and that's totallynormal.
So, even if you're committed tothe natural birth, it's good to
be flexible and we're there tohelp you.
And the goal is again healthymama and baby.
And in this way the nurse ishelpful in saying you know what?
(20:18):
If you're really uncomfortable,now is the time to maybe
consider getting an epidural,and I can call the
anesthesiologists because it'lltake them a few minutes to get
here and get all set up, okay.
Dionne (20:29):
That's right.
Listen to the nurse, that's agood point.
Listen to them.
They have the experience andthey do really help you through
Right.
Maleeha (20:37):
Right.
Dionne (20:38):
And the next one would there be a reason why I can't
get an epidural?
And yeah, I mean there arecertain people if you are out
there listening who should makean appointment with an
anesthesiologist before theirday of delivery and you can ask
your OB to help you set that up.
It's easy on their end to getthat situated, but here are some
(21:02):
conditions that you shouldthink about that would make you
want to prompt that appointment.
So one history of a bleedingdisorder.
Maleeha (21:12):
Yes, listen to our earlier episode on the Mandy
Moore episode in labor analgesia.
Dionne (21:19):
Okay, that's a great episode she had.
Maleeha (21:22):
ITP, which we can explain later.
But it's also a bleedingdisorder and it explains.
We drill down on ITP, yeah, andhow you can still get an
epidural if you want one with ableeding disorder.
But go ahead, Dionne.
Dionne (21:38):
Right, yeah.
So other conditions that youshould think about are
hemophilia, If you have heartproblems like aortic stenosis or
an arrhythmia.
If you have back issues likescoliosis or prior back surgery
or even a rash, and some peoplehave had you know, back to the
point on back surgery verycomplex back surgery.
(21:59):
So you really want to thinkabout making an appointment.
If you are someone who dealswith chronic pain and may have a
spinal cord stimulator, that'sa good reason to get an
appointment.
Or if you have a history ofspina bifida.
So these are conditions tothink about.
Mention it to your OB so thatthey can set an appointment with
the anesthesiologist, Becausewe can develop a plan well in
(22:22):
advance so that we're preparedwhen it's time to deliver.
Maleeha (22:26):
That's a great point.
I think you know most OBs do areally good job about flagging
these patients and sending themour way in advance of their due
date, so we're well equipped tocarry out a plan.
(22:46):
It's not like a scramble theday up.
That's right, that's what wedon't want.
Dionne (22:52):
We don't want that stress.
You don't want that stress, Idon't.
Maleeha (22:56):
Yeah, nobody wants that stress, Okay, okay.
Next question Can you beparalyzed from an epidural?
Gosh, this is a really commonquestion.
The risk of paralysis from anepidural is extremely low.
To put a number on it, I wouldsay the odds are estimated to be
around 1 in 100 to 200,000people.
(23:18):
So it's very rare and typicallyit's associated with a more
complex procedures than astandard epidural.
Like I said earlier, epiduralsare pretty straightforward on
the normal anatomy of a person.
If there's a complication, it'soften due because patients have
very complex anatomy.
And again, incredibly rare.
(23:40):
What a common question.
Dionne (23:42):
Yeah, and another common question on that same vein are
can you suffer permanent nervedamage?
Permanent nerve damage from anepidural is also very rare,
about 1 in 10,000 to 1 in100,000.
So again, very rare.
And a lot of times you regainyour function of those nerves if
(24:03):
you do have some sort of injurywithin weeks to months.
So thankfully it tends to bemore temporary than permanent.
Maleeha (24:10):
Right, Well, I'll piggyback that.
The other question you get iscan an epidural cause permanent
back pain?
Dionne (24:17):
Oh, my goodness.
Maleeha (24:18):
Right.
Dionne (24:19):
Big big, big, big big.
Maleeha (24:20):
As for permanent back pain, there isn't a direct
correlation between epidural useand long-term back pain.
Okay, however, there isn't aninitial soreness at the site of
where the epidural was placedbecause there was a needle
insertion there.
Usually that results within afew days.
Also, a lot of people have backdiscomfort that's related to
(24:42):
other factors, such as thestrain of pregnancy and birth,
and not the epidural and stealth.
And I tell that to a lot ofpatients because when they are
pushing and if you've ever, ifyou haven't experienced it or
you've watched something orwatching the movies it's a
position Okay, your legs arepulled back, you are forcefully
pushing and it is putting a lotof pressure on your back and in
(25:06):
that moment, with all theadrenaline coursing through your
body, you do not feel any ofthis pain, especially if you
have an epidural.
You're just not focused on it inthe same way.
Then later, of course, you'regoing to feel sore and of course
it hurts really badly, and sosometimes those things get kind
of confused and you hear peoplesay, oh well, it's the epidural.
(25:29):
That's why I have back pain.
It's like maybe, but mostlikely it's because you just
pushed out a baby and put yourwhole back into it.
Dionne (25:38):
If you want, that's right, that's right.
Our epidurals are so good thatthey forget they just pushed a
seven or eight pound baby out oftheir pelvis Right.
Maleeha (25:48):
And you can take ibuprofen, sure, and Tylenol,
and there is pain medicationthat's given to kind of get you
through that immediate soreness.
Dionne (25:57):
That's right, okay, so kind of going a different
direction here.
Can you get an epidural if youhave a tattoo on your back?
That's a common question thatwe get.
Maleeha (26:07):
Yeah, isn't that interesting.
Dionne (26:09):
And you know there was a period in time where a lot of
people had those tattoos ontheir lower back.
We won't use the word, it's notthe best.
Maleeha (26:18):
Oh yeah.
Dionne (26:19):
Yes, that's right, that's right, so that was really
common.
Maleeha (26:23):
Yeah.
Dionne (26:23):
It was extremely common.
And don't worry ladies, this isnot a contraindication to
getting an epidural.
There is no specific statisticsfor an association between a
tattoo and an anesthesiologist'sability to place an epidural.
But if we're worried maybethere's a rash there or we see
(26:45):
something we may find a clearspot within the tattoo to insert
the needle to minimize any riskof infection.
But the tattoo itself is not acontraindication to an epidural.
Maleeha (26:56):
Yeah, and contraindication is a fancy word
that we use in medicine,meaning a medical reason not to
do it.
Okay, yes.
Yeah, okay, moving to adifferent line of questioning,
what if my OB tells me I need tohave a C-section?
What are my options?
All right, great question.
(27:16):
A C-section is different.
It is a surgical procedure andit requires a different kind of
pain control, one where you'recompletely numb.
The most common option here is aspinal, which is similar to an
epidural, but not quite the samething, and often they are
confused, understandably.
(27:36):
Okay, for a spinal, just likean epidural, the medicine goes
into your lower back.
But the difference here is thatit's just one dose of a strong
numbing medication that'sinjected into the spinal fluid
for rapid pain relief.
It usually lasts about two tothree hours and it eventually
wears off.
So there's no catheter herewith a spinal.
(27:58):
It's kind of a one-shot deal,and we often use that for
scheduled C-sections, meaningyou have an appointment and you
have a day where you're comingin to get a section.
Okay.
The major benefits of that arethat it's fast acting and you
have complete pain control andyou are awake for the delivery
of your baby, even in theoperating room.
Dionne (28:21):
A huge plus because the mom can still be a part of the
process and witness that momentof her child being born, unlike
our other option, which we wouldcall plan B I think me and
Maleeha would call it plan Z, tobe honest and that's general
anesthesia, where we put ourpatients completely to sleep and
(28:45):
we have to place a breathingtube.
It's used much less frequently,typically only when there's an
emergency.
It's safe as well, but the bigdownside is that you'll be
unconscious, so you won't havethat moment of witnessing your
child being born.
And again, we typically justreserve this for emergency
situations.
And you know, at the end of theday, we just want, just like
(29:09):
you do, for you to be able tocome into the hospital and leave
with you being healthy and yourbaby being healthy.
That's it.
So that's why we're you know.
That's what this episode is allabout, and I think we covered a
lot today and I hope itprovided some clarity.
This is a personal decisionwhere there is no right or wrong
(29:30):
answer.
Okay, we want you to beinformed and we want you to be
comfortable.
So that ends today's segment.
For more IVY drip, head to ourwebsite at theivdrip.
co or follow us on Instagram@theivdrip_ podcast.
Email us with your labor,epidural questions and comments
at info@ theivdrip.
(29:50):
co, or send us a DM.
We love hearing from you all,so share with us your experience
.
Most importantly, don't forgetto subscribe to our podcast.
You can find it on allstreaming platforms.
Leave a review and spread thelove.
Now for the tip of the day,take it away, Maleeha.
Maleeha (30:09):
Okay.
So my tip is a very practicaltip.
Even if you want a naturalbirth and you never want to see
anybody in scrubs for your wholeexperience, get an IV.
Dionne (30:22):
Yes.
Maleeha (30:22):
Okay, get an IV and that IV, it doesn't have to be
connected to a catheter withfluids running, it's just a
little access into your IV thatthey can tape off, because at
least it allows us or the nurseto give you medication quickly
if something happens, and it'seasily removed as well.
(30:46):
So allow the anesthesiologistto visit with you just for a few
minutes when you get in.
It allows us opportunity.
Just do a quick assessment.
You're in our brains, we'rewatching what happens because
sometimes, like we mentionedearlier, natural births get
converted into C sections andit's good to be prepared, it's
(31:10):
good for us to be prepared.
So that's my tip.
Dionne (31:16):
Yeah, I think that's a fantastic way to end the episode
, because I think we'veemphasized that childbirth is
unpredictable.
So you want to just walk outwith a healthy baby, so just be
malleable, be feeling to changeyour plan for the ultimate
outcome of walking out of thathospital with you and your baby
(31:36):
intact.
So great, certainly, huh.
Now, as your due date approaches, you may be thinking
about how you want to deliveryour baby naturally or with the
help of an epidural for pain,and everyone has an opinion
based on their own experiences,and usually they are very strong
opinions.
Yes, yeah.
(00:22):
But did you know thatanesthesiologists are often
involved in your delivery, evenif you never meet us?
Yeah, we actually work closelywith your obstetrician when
you're in the hospital to helpmake sure your labor is safe and
you're comfortable.
Dionne (00:41):
We are here to tell you that there are so many options
out there and there are a lot ofmisconceptions about epidurals.
So, before you try to create abirth plan, leah and I are here
to dispel those myths and layout all the options because,
contrary to popular belief, youhave options.
On this episode, we are goingto give you the essential quick
(01:02):
and dirty rundown of youroptions so that your birth plan
is flexible and well-informed.
Luckily, leah and I trained atthe best hospital in the country
where we did a lot ofobstetrics.
Yeah, you know, we got abragging of it.
Maleeha (01:17):
That's right.
Basically, we delivered a wholelot of babies at night.
Dionne (01:22):
Yes, we did so.
We have seen a lot in trainingand even in private practice.
Our own friends ask us foradvice all the time, so we
figured we'd share some of thatinformation with you all today.
Maleeha (01:38):
This is the IVY Drip, a podcast designed to give you
the dish on health topics youneed to know but didn't know to
ask.
We are your hosts, Dr.
M Mohiuddin and
Dionne (01:50):
Dr.
Dionne Ibekie.
We're both Harvard-trainedanesthesiologists and besties.
Join us as we explore hottopics that are rarely discussed
but can have a huge impact onyour life.
Maleeha (02:02):
So before we begin, Dionne, I have to ask did you
have a birth plan?
Dionne (02:07):
I did.
It was very simple.
What about you, Maleeha?
Did you have a birth plan?
Maleeha (02:12):
I did.
I did indeed.
It also was verystraightforward and simple.
Dionne (02:19):
I think you and I are very like-minded.
It's get to the hospital, havean obstetrician and
anesthesiologist deliver safelyand go home safely with their
baby.
Maleeha (02:32):
Absolutely, which is our goal number one deliver a
baby safely and keep mom safeand healthy.
That is the main big pictureand if we can do that it's a
success.
Dionne (02:50):
The other thing I would say Maleeha, that was a huge
part of my plan because I'm awimp was managing my pain, labor
pain.
Maleeha (03:00):
I have to agree with you.
I think that, given that I hadwitnessed enough deliveries
before having my own baby, thatdefinitely informed my
decision-making.
You learn through observation.
So, yeah, I got my epidural in,but that's not the right choice
(03:22):
for everybody.
So let's talk about this.
First off, I think we shoulddefine what is labor pain, what
actually is it?
Go ahead, Dionne.
Dionne (03:32):
What is it?
Maleeha?
Maleeha (03:33):
Yeah, go for it.
Dionne (03:33):
Oh, you want me to do it .
Okay, I'll take it.
I'll take it for once, okay.
So pain during labor is causedby contractions of the muscles
of the uterus and by pressure onthe cervix.
This pain can be felt like astrong cramping in the abdomen
groin and your back, and you canalso have just like an achy
feeling as well.
When you're in true labor.
(03:54):
Your contractions last about 30to 70 seconds and they can come
every five to 10 minutes, sothe intensity kind of goes up as
you progress.
They can be so strong that youcan't walk, you can't really
talk, you're focused on yourbreathing and you're just trying
to keep it together becausethey just keep coming in waves.
You know those movies whereyou're like don't talk to me
(04:17):
Right.
That's what we're talking abouthere, right?
Maleeha (04:21):
And it's really that uterine contraction, it's like a
really bad period pain thatextends across your abdomen and
it gets tighter and it getslonger and as the baby moves
down the birth canal, itactually gives a lot of people
the feeling of having to poop.
I will say you know, that's oneof the first things I noticed
(04:43):
as a med student, is womensaying, oh, I really have to
poop and it's actually thepressure from the baby's head in
that pelvic floor and in thebowels Okay?
Dionne (04:52):
Especially when you progress further in your labor
Exactly.
Maleeha (04:55):
Exactly that.
Pain changes Right.
So I want to be really clear,though.
Everyone's pain is different.
Your pain can range from mildto severe, and it's really
impossible to know in advancehow you're going to feel.
So please don't compare yourpain to someone else's.
Like your sisters or yoursister-in-laws or your friends,
(05:17):
everyone has differentexperience.
In fact, some women have acompletely different experience
with each of their owndeliveries.
Dionne (05:25):
You know, I have people who have said my first delivery
was easy.
Maleeha (05:28):
My second delivery was took a lot longer.
So every experience isdifferent.
Don't get caught up in the gameof comparison.
That's right, okay.
Dionne (05:38):
So let's dive in Maleeha , let's dive into the questions
that we commonly receive fromfriends and family and our
patients.
Really, this question is are myoptions basically going natural
, as in no medication or gettingan epidural?
That's a big one.
Maleeha (05:55):
That's a huge one, and I would say the short answer to
that is no.
There are more options to helpyou control your pain during
labor than just an epidural, butthe epidural is the most widely
used and highly effectiveoption.
But before we drill downspecifically on epidurals,
(06:16):
dionne, I think let's justdiscuss some of these other
options people have available tothem.
Dionne (06:21):
Yeah, that's right.
So one of the first one is IVmedications.
When you get into the hospitalyou're going to get an IV, so
it's one of our first line forpain control, especially if you
are someone who wants to delayan epidural or may not want an
epidural.
So it makes it really fast andeasy because, again, when you
(06:44):
come in you get an epidural oryou get an IV, which is that
intravenous catheter that fluidsgo through and medications go
through.
The most common IV drug that weadminister for labor pain are
opioids, like fentanyl is acommon one and it's very
effective.
They rapidly curve the pain,but they make you feel drowsy
(07:05):
and nauseated, maybe a littlehigh.
So it's gonna be a weirdfeeling.
And we also don't like to givea lot of pain medications
because they cross the placentaand can be passed on to the baby
, which can make the baby drowsyand slow their breathing down.
So there are limitations withopioids.
So we have to be very mindfulof that because we don't wanna
(07:29):
give medications that can beharmful to your child.
Maleeha (07:33):
Absolutely.
But you're right, I considerthat to be first line because
it's easy once you have an IVand it can delay that epidural.
If you wanna just wait and see,I would say number two another
option that's becoming morepopular, but it's not everywhere
is nitrous oxide, also known aslaughing gas.
(07:55):
Now, laughing gas is often usedin dental offices I think
that's how people mostly hearabout it, so maybe you've had
some experience with it there.
It's a mix of oxygen andnitrous oxide, which is a gas
that you inhale through a smallmask.
It does not eliminate all thispain, but it kinda makes you
forget about it, so you justdon't care as much anymore.
(08:18):
It doesn't target thecontraction pain specifically.
You'll feel a little relaxed,maybe a bit drowsy.
The other benefit is that itwears off really quickly once
you stop inhaling it.
But again, I would say that itisn't offered everywhere, so
check it out to see if it's anoption at your birthing facility
(08:38):
.
Dionne (08:38):
Yeah, that's a good one.
We had that in residency.
Maleeha (08:41):
Yes, we did.
Dionne (08:42):
And I think we started to see it more and more as we
progressed in our like, as weadvanced in our residency.
We started to see it more andmore.
But you're right, it's notreadily available.
The third bucket is all thenon-medicinal interventions.
We would list them underrelaxation techniques.
(09:02):
These techniques can helpdistract from the pain and relax
your body.
They might includevisualizations, meditation,
guided imagery, music,hypnobirthing, hydrotherapy,
breathing techniques or using abirthing ball.
I've seen it all.
The pros to non-medicalinterventions are it promotes
(09:26):
relaxation.
They're personalized to yourspecific needs.
And then I would say the consthey require practice and focus.
Maleeha (09:35):
Sure, and all the things that we just listed.
Often they can be used togetherto some extent.
Dionne (09:42):
That's right, so you can combine.
Maleeha (09:44):
People will wanna walk around, wanna use those birthing
balls.
They have a doula, they have amidwife or they have a coach of
some kind and as their painprogresses they might start to
feel uncomfortable and maybe wecan try a little bit nitrous,
because they're not ready forthe epidural, they wanna try a
little bit longer.
So those are all possibilitiesof ways to use these together.
Dionne (10:06):
And as labor progresses and the contractions start
getting stronger and closertogether, it may not be enough.
So just have that in mind.
Maleeha (10:16):
Now let's get to the main event.
The most widely used for painlabor is the epidural.
I think we should again startwith first what is an epidural,
because there are a lot ofmisconceptions about this
procedure, that's right, yeah,it's a procedure that basically
creates a band of numbness fromyour belly button to your legs,
(10:39):
so it targets the contractionpain very specifically.
It allows you to be awake andalert throughout labor as well
as feel the pressure of eachcontraction.
The goal is to take the edgeoff the contraction pain so that
they become manageable, notcompletely eliminate all feeling
(11:00):
so that you're totally numbfrom the waist out, because when
it's time to push, you need tofeel that pressure from the
contractions in order to pusheffectively.
And I tell that to all mypatients before I place an
epidural so they know what toexpect.
Dionne (11:19):
Yep, setting expectations.
It's a procedure done by us,your anesthesiologist, and we
place a thin, flexible catheterin your lower back, along your
spine.
Maleeha (11:32):
Right, and the catheter is about the size.
It's so tiny and thin it's likea fishing line.
Dionne (11:37):
Yeah, that's right.
Maleeha (11:39):
Right, and that's what's being threaded into your
lower back area.
Dionne (11:42):
That's right.
The catheter is taped securelyto your back and then connected
to a programmable pump devicethat is going to continuously
give you that numbing medication.
The pump pumps the medicationinto something called the
epidural space for the entireduration of your labor.
(12:03):
So, one, there's nothing sharpleft in your back.
We don't leave the needle inthere, and that's a big fear of
all the patients that we do thisto.
So we make sure to emphasizethat.
And two, an epidural is not aone-time shot, because again,
you're gonna have that catheterthat's attached to the pump, so
you're getting continuousmedication and it's not gonna
(12:27):
wear off because of that.
It won't wear off when you needit the most, which is when it's
time to push.
So once you get medication, youcan keep getting that
medication as long as you needit for your labor.
Once you've delivered, the pumpis turned off and we'll pull
that catheter right out.
So it's easy.
Maleeha (12:47):
Yeah, very easy.
Usually doesn't take very longto place for us either.
Dionne (12:51):
If it's straightforward.
Maleeha (12:53):
It usually takes 10 minutes, I would say.
The pros are again.
They're really fast to put in,they provide pretty immediate
relief within minutes and theytarget the contractions.
The other major pro is that youcan adjust the dose on the
device, the pump, throughoutyour labor.
So I really like that.
So you can stop the medicineentirely at some point.
(13:15):
I can lower the dose if I needto lower the dose.
I can even increase the dose asthe contractions get stronger
and as your labor progresses,because the baby's moving down
the birth canal, and I like that.
It's customizable to yourspecific needs.
And because you're only numbfrom the waist down, you're
awake and alert and fullypresent for the delivery.
(13:37):
So you're participating.
I would say.
The other big, big pro forgetting an epidural this is the
one that you just do not hearvery often is that if, for any
reason, you would need to get aC-section and this happens, you
try to deliver vaginally andthen something happens and you
(14:01):
need to get a C-section, theythink it's the best thing for
the baby and for you.
We can actually just use theexisting epidural to get you
completely numb for the surgery.
You wouldn't need to put youcompletely to sleep or to place
a spinal, which we can talkabout a little bit later.
It's a different procedure, butthat's another big pro about
(14:22):
having an epidural in place.
Dionne (14:24):
That's a huge pro.
That's a huge pro Maleeha,because that's an insider gem
right there.
Oh yeah, oh yeah, because thingsrapidly change with labor.
You have a plan, but just knowthat you have to be flexible.
Having that epidural allowsthat flexibility.
(14:46):
So you're absolutely right.
But to the cons which are minorI would say, but they need to be
mentioned because you need tobe informed about your decisions
it can cause a drop in bloodpressure which basically stems
from the fact that the epiduralisn't just targeting the muscles
of your abdomen and your backand your legs, but it also
(15:06):
dilates the blood vessels andthat will drop your blood
pressure.
But it emphasizes why we placean IV as soon as you get there,
because we load you up withfluid and we have medication at
the bedside to treat those lowblood pressures as soon as we
see it.
So we're monitoring you veryclosely because we anticipate
this happening.
The other thing is that theepidural can cause weakness in
(15:29):
your legs so you won't be ableto walk around and it's a weird
feeling.
So what we do, or what thenurse does, we'll place a fully
catheter so that you can urinatebecause you won't be able to
walk to the bathroom.
So that might be a weirdfeeling for some people, feeling
used loosely, because you'reactually not going to feel that
fully catheter at all, becauseyou'll have an epidural in place
(15:53):
, and then there's a small riskof a specific headache called
post-ural puncture headache orPDPH.
That is treatable.
The risk of this happening isabout one in a hundred, and the
other complications that we willmention are infection and
bleeding, which are about one ina hundred thousand.
Maleeha (16:13):
Right.
Incredibly incredibly rare.
Dionne (16:15):
Yeah, for sure.
Maleeha (16:17):
And so it's important to remember that, while these
risks exist, the vast majorityof epidurals are administered
without any complications.
Your anesthesiologist will takeall the necessary precautions
to minimize these risks.
Please discuss any concernsthat you have, though, with your
team.
Absolutely ask questions andthink things through and have
(16:37):
that conversation.
Dionne (16:38):
That's right.
Okay, now let's answer somecommon questions we get
specifically about epidurals.
The first question would be doepidurals increase your risk of
a C-section Maleeha?
Maleeha (16:51):
Yeah, I think this one is major question.
I always get asked and theshort answer is no.
The American College ofObstetrics and Gynecology I'm
going to state this right offtheir site r"andomized trials
and systematic reviews includingthousands of patients have
shown that the initiation ofepidural analgesia at any stage
(17:15):
during labor does not increasethe risk of cesarean delivery.
They have looked at thousandsof these cases.
I think most people are nervous, right, Dionne?
Dionne (17:27):
Mm-hmm, mm-hmm.
I think most people are nervousto get an epidural because
they're afraid it will lead to aC-section or that they'll be in
labor forever because they aretoo numb.
In fact, though, I thinkepidurals help a lot of mothers
relax and sleep, which is soimportant to conserve your
energy.
It relaxes the pelvic floor and, like I just mentioned again
(17:50):
conserving your energy, becauseyou're going to need a lot.
You don't know how long you'regoing to be pushing for, so it's
good to have when that timecomes.
Maleeha (17:58):
Right.
Next question when should I getan epidural?
Is there a time when I can'tget one?
Yes, great question.
Dionne (18:08):
So most women choose to get an epidural when
contractions become too painfulto handle, often around four to
five centimeters dilated.
However, it can be administeredearlier or later.
It's generally ideal to get itbefore you're about eight to
nine centimeters.
One so that it can be effectiveand useful, and two because
(18:29):
there is a time where it can betoo late, such as when your
labor is progressing superrapidly or you're not able to
sit still, which is what we needfor the procedure.
When you're too dilated,sometimes you're in a lot of
pain and we're using a needle,so it can get dangerous if
you're moving around too much.
(18:49):
What do you think?
Maleeha (18:51):
Yeah, I think that's a great question and you answered
it spot on.
Really, If nothing else isgoing on medically with you, I
would say you got to be able tosit still to have the epidural
placed, just even for a shortamount of time.
And if you're in too much painand you can't do that, it's too
dangerous to use a needle inyour back.
So that would be an issue wherewe wouldn't be able to place it
(19:15):
.
And along that lines people askI want to try a natural birth,
but then I might change my mind.
Is it too late to change my mind?
And you just kind of touched onthat, deanna.
It's great to try.
That's fine.
I think if you're thinkingabout a natural birth but are
open to pain relief options,just communicate that to your
(19:36):
nurse so they're aware thatyou're flexible.
It's important to know whatoptions you have at that
hospital or facility.
The nurses, obstetricians, theanesthesiologists we all
communicate a lot while you'rein the hospital.
Even you might not be aware ofit, but in the back rooms we're
talking because labor isunpredictable and an unexpected
(19:57):
change of mind for you orprolonged labor can just change
how you feel and that's totallynormal.
So, even if you're committed tothe natural birth, it's good to
be flexible and we're there tohelp you.
And the goal is again healthymama and baby.
And in this way the nurse ishelpful in saying you know what?
(20:18):
If you're really uncomfortable,now is the time to maybe
consider getting an epidural,and I can call the
anesthesiologists because it'lltake them a few minutes to get
here and get all set up, okay.
Dionne (20:29):
That's right.
Listen to the nurse, that's agood point.
Listen to them.
They have the experience andthey do really help you through
Right.
Maleeha (20:37):
Right.
Dionne (20:38):
And the next one would there be a reason why I can't
get an epidural?
And yeah, I mean there arecertain people if you are out
there listening who should makean appointment with an
anesthesiologist before theirday of delivery and you can ask
your OB to help you set that up.
It's easy on their end to getthat situated, but here are some
(21:02):
conditions that you shouldthink about that would make you
want to prompt that appointment.
So one history of a bleedingdisorder.
Maleeha (21:12):
Yes, listen to our earlier episode on the Mandy
Moore episode in labor analgesia.
Dionne (21:19):
Okay, that's a great episode she had.
Maleeha (21:22):
ITP, which we can explain later.
But it's also a bleedingdisorder and it explains.
We drill down on ITP, yeah, andhow you can still get an
epidural if you want one with ableeding disorder.
But go ahead, Dionne.
Dionne (21:38):
Right, yeah.
So other conditions that youshould think about are
hemophilia, If you have heartproblems like aortic stenosis or
an arrhythmia.
If you have back issues likescoliosis or prior back surgery
or even a rash, and some peoplehave had you know, back to the
point on back surgery verycomplex back surgery.
(21:59):
So you really want to thinkabout making an appointment.
If you are someone who dealswith chronic pain and may have a
spinal cord stimulator, that'sa good reason to get an
appointment.
Or if you have a history ofspina bifida.
So these are conditions tothink about.
Mention it to your OB so thatthey can set an appointment with
the anesthesiologist, Becausewe can develop a plan well in
(22:22):
advance so that we're preparedwhen it's time to deliver.
Maleeha (22:26):
That's a great point.
I think you know most OBs do areally good job about flagging
these patients and sending themour way in advance of their due
date, so we're well equipped tocarry out a plan.
(22:46):
It's not like a scramble theday up.
That's right, that's what wedon't want.
Dionne (22:52):
We don't want that stress.
You don't want that stress, Idon't.
Maleeha (22:56):
Yeah, nobody wants that stress, Okay, okay.
Next question Can you beparalyzed from an epidural?
Gosh, this is a really commonquestion.
The risk of paralysis from anepidural is extremely low.
To put a number on it, I wouldsay the odds are estimated to be
around 1 in 100 to 200,000people.
(23:18):
So it's very rare and typicallyit's associated with a more
complex procedures than astandard epidural.
Like I said earlier, epiduralsare pretty straightforward on
the normal anatomy of a person.
If there's a complication, it'soften due because patients have
very complex anatomy.
And again, incredibly rare.
(23:40):
What a common question.
Dionne (23:42):
Yeah, and another common question on that same vein are
can you suffer permanent nervedamage?
Permanent nerve damage from anepidural is also very rare,
about 1 in 10,000 to 1 in100,000.
So again, very rare.
And a lot of times you regainyour function of those nerves if
(24:03):
you do have some sort of injurywithin weeks to months.
So thankfully it tends to bemore temporary than permanent.
Maleeha (24:10):
Right, Well, I'll piggyback that.
The other question you get iscan an epidural cause permanent
back pain?
Dionne (24:17):
Oh, my goodness.
Maleeha (24:18):
Right.
Dionne (24:19):
Big big, big, big big.
Maleeha (24:20):
As for permanent back pain, there isn't a direct
correlation between epidural useand long-term back pain.
Okay, however, there isn't aninitial soreness at the site of
where the epidural was placedbecause there was a needle
insertion there.
Usually that results within afew days.
Also, a lot of people have backdiscomfort that's related to
(24:42):
other factors, such as thestrain of pregnancy and birth,
and not the epidural and stealth.
And I tell that to a lot ofpatients because when they are
pushing and if you've ever, ifyou haven't experienced it or
you've watched something orwatching the movies it's a
position Okay, your legs arepulled back, you are forcefully
pushing and it is putting a lotof pressure on your back and in
(25:06):
that moment, with all theadrenaline coursing through your
body, you do not feel any ofthis pain, especially if you
have an epidural.
You're just not focused on it inthe same way.
Then later, of course, you'regoing to feel sore and of course
it hurts really badly, and sosometimes those things get kind
of confused and you hear peoplesay, oh well, it's the epidural.
(25:29):
That's why I have back pain.
It's like maybe, but mostlikely it's because you just
pushed out a baby and put yourwhole back into it.
Dionne (25:38):
If you want, that's right, that's right.
Our epidurals are so good thatthey forget they just pushed a
seven or eight pound baby out oftheir pelvis Right.
Maleeha (25:48):
And you can take ibuprofen, sure, and Tylenol,
and there is pain medicationthat's given to kind of get you
through that immediate soreness.
Dionne (25:57):
That's right, okay, so kind of going a different
direction here.
Can you get an epidural if youhave a tattoo on your back?
That's a common question thatwe get.
Maleeha (26:07):
Yeah, isn't that interesting.
Dionne (26:09):
And you know there was a period in time where a lot of
people had those tattoos ontheir lower back.
We won't use the word, it's notthe best.
Maleeha (26:18):
Oh yeah.
Dionne (26:19):
Yes, that's right, that's right, so that was really
common.
Maleeha (26:23):
Yeah.
Dionne (26:23):
It was extremely common.
And don't worry ladies, this isnot a contraindication to
getting an epidural.
There is no specific statisticsfor an association between a
tattoo and an anesthesiologist'sability to place an epidural.
But if we're worried maybethere's a rash there or we see
(26:45):
something we may find a clearspot within the tattoo to insert
the needle to minimize any riskof infection.
But the tattoo itself is not acontraindication to an epidural.
Maleeha (26:56):
Yeah, and contraindication is a fancy word
that we use in medicine,meaning a medical reason not to
do it.
Okay, yes.
Yeah, okay, moving to adifferent line of questioning,
what if my OB tells me I need tohave a C-section?
What are my options?
All right, great question.
(27:16):
A C-section is different.
It is a surgical procedure andit requires a different kind of
pain control, one where you'recompletely numb.
The most common option here is aspinal, which is similar to an
epidural, but not quite the samething, and often they are
confused, understandably.
(27:36):
Okay, for a spinal, just likean epidural, the medicine goes
into your lower back.
But the difference here is thatit's just one dose of a strong
numbing medication that'sinjected into the spinal fluid
for rapid pain relief.
It usually lasts about two tothree hours and it eventually
wears off.
So there's no catheter herewith a spinal.
(27:58):
It's kind of a one-shot deal,and we often use that for
scheduled C-sections, meaningyou have an appointment and you
have a day where you're comingin to get a section.
Okay.
The major benefits of that arethat it's fast acting and you
have complete pain control andyou are awake for the delivery
of your baby, even in theoperating room.
Dionne (28:21):
A huge plus because the mom can still be a part of the
process and witness that momentof her child being born, unlike
our other option, which we wouldcall plan B I think me and
Maleeha would call it plan Z, tobe honest and that's general
anesthesia, where we put ourpatients completely to sleep and
(28:45):
we have to place a breathingtube.
It's used much less frequently,typically only when there's an
emergency.
It's safe as well, but the bigdownside is that you'll be
unconscious, so you won't havethat moment of witnessing your
child being born.
And again, we typically justreserve this for emergency
situations.
And you know, at the end of theday, we just want, just like
(29:09):
you do, for you to be able tocome into the hospital and leave
with you being healthy and yourbaby being healthy.
That's it.
So that's why we're you know.
That's what this episode is allabout, and I think we covered a
lot today and I hope itprovided some clarity.
This is a personal decisionwhere there is no right or wrong
(29:30):
answer.
Okay, we want you to beinformed and we want you to be
comfortable.
So that ends today's segment.
For more IVY drip, head to ourwebsite at theivdrip.
co or follow us on Instagram@theivdrip_ podcast.
Email us with your labor,epidural questions and comments
at info@ theivdrip.
(29:50):
co, or send us a DM.
We love hearing from you all,so share with us your experience
.
Most importantly, don't forgetto subscribe to our podcast.
You can find it on allstreaming platforms.
Leave a review and spread thelove.
Now for the tip of the day,take it away, Maleeha.
Maleeha (30:09):
Okay.
So my tip is a very practicaltip.
Even if you want a naturalbirth and you never want to see
anybody in scrubs for your wholeexperience, get an IV.
Dionne (30:22):
Yes.
Maleeha (30:22):
Okay, get an IV and that IV, it doesn't have to be
connected to a catheter withfluids running, it's just a
little access into your IV thatthey can tape off, because at
least it allows us or the nurseto give you medication quickly
if something happens, and it'seasily removed as well.
(30:46):
So allow the anesthesiologistto visit with you just for a few
minutes when you get in.
It allows us opportunity.
Just do a quick assessment.
You're in our brains, we'rewatching what happens because
sometimes, like we mentionedearlier, natural births get
converted into C sections andit's good to be prepared, it's
(31:10):
good for us to be prepared.
So that's my tip.
Dionne (31:16):
Yeah, I think that's a fantastic way to end the episode
, because I think we'veemphasized that childbirth is
unpredictable.
So you want to just walk outwith a healthy baby, so just be
malleable, be feeling to changeyour plan for the ultimate
outcome of walking out of thathospital with you and your baby
(31:36):
intact.
So great, certainly, huh.
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