It's not unusual for women to have back pain during pregnancy, during delivery, and after the baby is born.
Not a few women, however, experience even worse back pain after getting an epidural for pain during delivery.
For those who don't know, an epidural is an injection (in this case, of an anesthetic) in to the space around a nerve in the spine. The doctor inserts a thin tube called a canula to deliver the pain killing medication into the space between a vertebra and the spinal fluid, after first applying a local anesthetic to kill the pain of inserting the canula. It takes about 15 minutes for the injection to begin to work. A spinal isn't the same as an epidural. In this procedure, the doctor injects anesthetic directly into the spinal fluid. A spinal yields pain relief in about 5 minutes. Doctors may use epidurals or spinals or both to manage pain during delivery. Combining an epidural with a spinal allows less medication to be used, so there is less numbness after the procedure.
The needle used to insert the canula is large but it's only in place for a minute or two. The canula itself is about the width of a human hair. The insertion needle is withdrawn once the canula is in place, and then the canula is used to deliver continuous anesthesia during delivery. You feel a pinch with the first injection to numb the injection site for the needle used to deliver the epidural or spinal, and then pressure, but not pain, as the medication is pumped in. The sensation of pressure continues as long as the canula is in use.
A tiny percentage of the anesthetic from the epidural or spinal reaches the baby. More medication reaches the soon-to-be-born child through an epidural than through a spinal.
Both epidurals and spinals can cause a variety of side effects, some mild and very common, and some more serious and quite rare.
- Up to 50 percent of women receiving epidural or spinal injections experience itching at the injection site. This usually goes away in a few hours.
- Up to 30 percent of women receiving epidural or spinal injections develop nausea. This goes away when the medication is stopped, after the baby is delivered.
- About 5 percent of women receiving an epidural injection don't get pain relief. This is usually because the dose of anesthetic is just too low. It can also happen when the woman has to stay in the same position too long, so that the anesthetic does not flow around the nerve. Some hospitals deal with this problem with patient-controlled epidural analgesia (PCEA), allowing the woman to use as much pain reliever as she wishes.
- If the canula is left in place for more than six hours (this most commonly happens the first time a woman gives birth), the mother can develop a fever. Since the doctor can't know quickly whether the fever is due to the anesthesia or an infection, the mother and baby usually both get broad-spectrum antibiotics.
- About 1 percent of women receiving an epidural or spinal injection develop a "spinal headache." This can be quite severe and last for several days.
When women have problems with back pain that go on and on after delivery, for weeks, months, or years, the problem is usually due to a combination of factors of which the injection is just a part. Here are some ways to relieve it:
- Start movement from your knees when you are picking up your baby.
- Keep your spine straight when you are talking to or feeding your baby. Don't hunch over your infant.
- Take a nice, warm bath in a clean, well-scrubbed tub. If you have had a Caesarean, your OB-GYN will tell you when it is safe to take a bath. Or let a shower head give you a warm water massage.
- Try not to stand too long. Place one foot on a low stool to relieve stress on your lower back if you have to stand in one place for household tasks.
- Get a massage. Most massage therapists are knowledgeable about post-partum pain management.
Fractures of the lower back are more common after delivery than most women realize. If nothing works for pain relief, you may need to have orthopedic treatment for this problem that is more common than nerve injury from epidurals.
Don't be afraid to tell your doctor your concerns about epidurals and back pain. Know what you will need to do during delivery to ensure there are no complications from the procedure to block your pain.
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