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The Truth About Epidurals · Fit As A Fiddle

0:00
SPEAKER_00: So, epidurals can be titrated based on a patient's needs.
0:04
SPEAKER_00: It can be the dose of medication, the type of medication that we give, or the method of delivery.
0:10
SPEAKER_00: So most of the time you'll get either a continuous infusion through the pump, where you're getting a steady amount of medication delivered through the catheter, or the pump can also give you a big bolus at a set interval, say every 45 minutes or every hour.
0:27
SPEAKER_01: Hello everyone.
0:29
SPEAKER_01: I'm your host, Dr.
0:30
SPEAKER_01: Sneha Gazi, a physical therapist, course creator, and mom.
0:34
SPEAKER_01: I own Sneha Physical Therapy, a private practice in New York City, and created the course Master Your Pelvic Floor to help you transform the way you think about and move your body.
0:45
SPEAKER_01: Use discount code FIT20 for a special 20% discount exclusively for my listeners at the link in all show notes.
0:53
SPEAKER_01: Each episode brings phenomenal guests in the health and wellness space who share inspiring tips and tangible advice.
1:00
SPEAKER_01: All things health and wellness starts right here.
1:04
SPEAKER_01: Welcome to this week's episode on Fit as a Fiddle.
1:08
SPEAKER_01: Our guest today is Dr.
1:09
SPEAKER_01: Tiffany Lynn.
1:11
SPEAKER_01: Dr.
1:11
SPEAKER_01: Tiffany Lynn is a board-certified anesthesiologist and a pain medicine specialist at Wild Cornell Medicine and New York Presbyterian Hospital.
1:20
SPEAKER_01: She actively does outpatient and inpatient interventional pain management.
1:25
SPEAKER_01: She treats patients for acute and chronic pain.
1:28
SPEAKER_01: She does general anesthesia.
1:29
SPEAKER_01: And then why we're here today is because she does obstetric anesthesia too.
1:34
SPEAKER_01: So we're going to be talking a lot about what that means and everything you need to know about epigerols.
1:40
SPEAKER_01: Dr.
1:40
SPEAKER_01: Lynn is also, you know, has published a lot of articles and research.
1:44
SPEAKER_01: She teaches, she speaks at conferences, and overall, just a very knowledgeable person in this field and has a lot of passion for what she does.
1:52
SPEAKER_01: So welcome to the episode, Dr.
1:54
SPEAKER_01: Lynn.
1:55
SPEAKER_00: Thank you for having me.
1:56
SPEAKER_00: Happy to share any insights I may have for you.
1:59
SPEAKER_00: Yeah.
2:00
SPEAKER_01: So first, we just want to get to know you a little bit.
2:04
SPEAKER_01: What brought you into this space and what interests you the most about the work that you do?
2:09
SPEAKER_00: Uh sure.
2:10
SPEAKER_00: Um, as you um talked about, I am um board certified in both anesthesia and pain medicine.
2:16
SPEAKER_00: And um really what um uh got me interested in pain management is that um it's a very uh immediate gratification.
2:26
SPEAKER_00: You can do a nerve block, an epidural steroid injection, and the patient goes from you know 10 out of 10 pain to uh more than in chronic pain, we say more than 50% pain relief is significant.
2:38
SPEAKER_00: But patients will tell you, oh, I have no pain now.
2:41
SPEAKER_00: Um and you know it's a very um gratified experience.
2:46
SPEAKER_00: And that also translates to regional anesthesia and epistetric anesthesia because we are providing um nerve blocks, epidurals as means of pain relief for someone uh who is going through surgery or labor and delivery, uh, which can be one of the most painful events in a mother's life.
3:05
SPEAKER_00: And a lot of times you see the patient going from uh having excruciating pain to smiling with a sigh of relief.
3:13
SPEAKER_00: And that is such a you know good experience for you and the patient.
3:18
SPEAKER_00: Um, and you know, really for me, that is kind of you know what I see my role is uh as a provider.
3:26
SPEAKER_01: I love that.
3:27
SPEAKER_01: So what we really want to know today, um, and just to set the stage for everybody here, um, we're coming from this approach today of awareness and understanding and just being educated on all of your options, right?
3:41
SPEAKER_01: So um we have a lot of really amazing things out there in medicine, life-changing, life-saving, um, you know, wonderful things that science and research has given us.
3:50
SPEAKER_01: And so I think what's really important is for people to just be aware of all of their options.
3:55
SPEAKER_01: So for the people who are listening who may be thinking, you know, if you're a newer expecting parent and you're like, oh, you know, I am thinking about giving birth in a hospital, I want to learn more about an epidural and what its effects are.
4:08
SPEAKER_01: This is where you are, where you should be.
4:10
SPEAKER_01: But if you're also like, hey, I want a very natural home birth or in a birth center, this is also good information for you because no matter what, which way, it's not like epidurals are good or bad.
4:21
SPEAKER_01: I know that sometimes people think about it like, oh, if you have an epidural, you kind of um you failed or you didn't like sack it up.
4:29
SPEAKER_01: But you know, we don't really, as as patients, but especially as mothers and women, we tend to do this like white knuckle through all these things.
4:38
SPEAKER_01: And we experience as women lots of different physical changes on a daily basis, on a monthly basis with our menstrual cycles and just hormonally through our entire um lifespan, right?
4:49
SPEAKER_01: So that's something that's unique to us and understanding our options, being aware of what they are, I think is like the most important thing.
4:56
SPEAKER_01: So, and also just from a personal note, I went into my birth two years ago, almost exactly two years ago now, thinking, you know, I'm gonna really try my best to not have any pain management and see what happens.
5:08
SPEAKER_01: And that's I'm really happy I started out that way because I needed that experience.
5:12
SPEAKER_01: It was part of my journey, it was part of my story.
5:14
SPEAKER_01: And then eventually, by the time I got to the hospital and was laboring for 36 hours, having not having slept, not having eaten anything, the epidural was the reason why I think I had a physiological vaginal birth that I wanted.
5:27
SPEAKER_01: I feel like had I not done that, I wouldn't have been able to push effectively or done what I needed to for the baby to turn and move and you know effectively exit and come out of my body.
5:38
SPEAKER_01: I probably would have ended up having more interventions, right?
5:41
SPEAKER_01: So for me personally, the epidural was awesome and exactly what I needed in that particular moment.
5:48
SPEAKER_01: But again, everybody's story is different.
5:50
SPEAKER_01: And so today, Dr.
5:51
SPEAKER_01: Lynn is gonna talk to us about everything that you need to know from an anesthesiologist who is the person in the hospital if you're going in for birth, who's going to be administering your anesthesia through the epidural.
6:03
SPEAKER_01: So, having said that, Dr.
6:05
SPEAKER_01: Lynn, can you first and foremost walk us through what is an epidural?
6:11
SPEAKER_00: Sure.
6:11
SPEAKER_00: Um, so when we talk about epidural, it's really um the epidural space.
6:16
SPEAKER_00: So uh epidural space is a potential space that sits right outside of your spine, um right outside of the stack that involves your spinal core.
6:25
SPEAKER_00: And this space uh contains blood vessels, fab, and also spinal nerve roots that exit the spinal core and go you know in over your body.
6:34
SPEAKER_00: And so when we talk about an epidural, it's a procedure uh where we access the epidural space and deliver some kind of medication to the space.
6:43
SPEAKER_00: Most often it's a local anesthetic, a numbing medication, but it can also be combined with opioid uh or steroid for different indications.
6:52
SPEAKER_00: So when you deliver a numbing medication into epidural space, how it works is that it numbs the nerve roots that are in the area, and also some of the medication can also diffuse into the um spinal fluid, um, where it also exerts some um effect as well.
7:10
SPEAKER_00: So essentially the end result is that you get this um sensory nerve block and also motor nerve block in the area that you're targeting.
7:20
SPEAKER_00: Um, so that you know causes numbness and pain relief in your targeted region.
7:25
SPEAKER_00: Um the way that a badrill works is that um it uh the different effect depends on where you inject the medication and also the type and amount of medication that you're using.
7:36
SPEAKER_00: Um so initially it can first block your sympathetic fibers, which are the ones that regulate blood supply and also kind of your fight response.
7:46
SPEAKER_00: And then with a higher dose, it starts blocking your sensory fibers, which can uh be the ones that control the pain sensation, also temperature sensation.
7:55
SPEAKER_00: And then at a higher dose, it starts blocking your motor fibers, which can you know um cause uh weakness and um inability to move your low extremities.
8:06
SPEAKER_00: Um so that's kind of like a gist of how the drills work.
8:09
SPEAKER_00: Yeah.
8:09
SPEAKER_01: And so for people who are listening and are like, what do all of those words mean?
8:13
SPEAKER_01: Um, Dr.
8:14
SPEAKER_01: Lynn broke it down.
8:15
SPEAKER_01: But just to clarify, there's different types of things, like tracks in our spinal cord that have different effects in our body.
8:23
SPEAKER_01: So she was talking about a sympathetic track, a sensory track, and a motor track.
8:27
SPEAKER_01: And in order of how intense your dosage of medication needs to be in order to affect that track.
8:34
SPEAKER_01: So the first one, which is a sympathetic track, she said is like the fight or flight response, right?
8:39
SPEAKER_01: The second and third one were are the sensory and the motor.
8:42
SPEAKER_01: So sensation, right?
8:44
SPEAKER_01: So, like if you get an epidural, you may not feel from that spot of the epidural.
8:50
SPEAKER_01: By the way, Dr.
8:50
SPEAKER_01: Minton, correct me if I'm wrong.
8:52
SPEAKER_01: From that part of the epidural down, you will not have sensation.
8:55
SPEAKER_01: So if somebody touched the skin overlaying that area, they would be like, I can't feel that compared to, you know, somewhere in their shoulder or somewhere on their face.
9:05
SPEAKER_01: And then the motor component is your ability to move.
9:08
SPEAKER_01: So motor meaning, you know, like motion.
9:10
SPEAKER_01: So it will give you like basically an inability or a decreased ability, depending on the dosage, to move your body parts and move your muscles.
9:20
SPEAKER_01: So, how do we move, right?
9:21
SPEAKER_01: By contracting muscles in our body.
9:23
SPEAKER_01: That's how those are the skeletal muscles in our body that help us navigate through the world and do everything we need to do.
9:29
SPEAKER_01: So this kind of ties in to the next piece that I wanted to ask you, Dr.
9:33
SPEAKER_01: Lynn, about positions during labor, because a lot of people go into birth being like, well, you know, I want some pain relief, but I still want to be able to move around as much as possible.
9:45
SPEAKER_01: Because we know through the literature, through the science, and through just the history of childbirth that's way beyond medical science, right?
9:53
SPEAKER_01: Since the beginning of human time, that moving your body helps move the pelvic bones, helps move the baby down the birth canal, and helps the baby exit.
10:01
SPEAKER_01: This is for uh vaginal birth.
10:03
SPEAKER_01: So for people who are like, hey, I want some pain relief, but I want to be able to move, what would you do in that situation?
10:11
SPEAKER_00: Yes.
10:12
SPEAKER_00: So I think um historically, uh patients would think about um an epidural as that you're kind of bedbound.
10:21
SPEAKER_00: You're not able to move or uh you're completely uh paralyzed in the sense that you know your legs can't move anymore, you can't reposition.
10:30
SPEAKER_00: Um, but that's uh when we in the old days used to use much higher concentration of vocal anesthetics.
10:36
SPEAKER_00: So uh to put into comparison, it used to be at 0.2 or 0.25% of bupivacaine.
10:44
SPEAKER_00: Uh nowadays, um, the epidurals are much more dilute.
10:48
SPEAKER_00: Um, they can range from 0.0625% to 0.1%.
10:53
SPEAKER_00: So a fraction of a dose that used to be.
10:55
SPEAKER_00: So with a lower dose of concentration of the local anesthetics, uh patients can still move their legs around, they can still reposition in bed, they can still get into positions to help facilitate um the um the uh positioning of the neonate of the fetus.
11:15
SPEAKER_00: Um there are um some facilities that allow uh moms to uh walk uh with that dose of the epidural.
11:26
SPEAKER_00: However, it does have some um uh safety guardrails around it.
11:32
SPEAKER_00: Um so with epidurals, it can potentially lower your blood pressure.
11:36
SPEAKER_00: So they need to make sure your blood pressure is stable even with you sitting or standing up.
11:41
SPEAKER_00: Uh, they need to make sure that your legs are not too numb or too weak where you can't feel yourself when you're walking around.
11:48
SPEAKER_00: And they require that a staff is always with you uh when you're um, you know, attempting to walk.
11:55
SPEAKER_00: So it might not be feasible in some hospitals just because of their hospital policy uh and institutional um like uh protocol.
12:04
SPEAKER_00: Um, but um technically uh you are able to move and um you know walk with the very low dose of uh local anesthetics.
12:13
SPEAKER_00: Um, you know, but most of the time um the uh hospital will require to stay in bed just for a liability reason.
12:21
SPEAKER_00: But when you're on the bed, you can still kind of move around um and to reposition yourself.
12:26
SPEAKER_00: Yes.
12:27
SPEAKER_01: And so like Dr.
12:28
SPEAKER_01: Lynn just said, it's very hospital specific.
12:31
SPEAKER_01: And so these are questions during your um OB visits that you go to on a monthly basis or a weekly basis.
12:38
SPEAKER_01: You might want to ask some questions like, hey, what are the hospital protocols in the place that I'll be giving birth at?
12:45
SPEAKER_01: If it's not maybe directly connected to the hospital, but you might ask whoever is your care provider, what are some of my options?
12:52
SPEAKER_01: And then they might be able to let you know or at least pass you off to somebody else with like a phone number or somebody that you can call to ask about these options.
13:00
SPEAKER_01: Because going in knowing really helps because then you can advocate for yourself and say, hey, you know, at this point, this is what I'm looking for.
13:08
SPEAKER_01: And things change, right?
13:09
SPEAKER_01: Like the way that the birth goes can be completely different than how you imagined it in your head.
13:14
SPEAKER_01: In fact, I think it always goes differently than you imagined it in your head.
13:17
SPEAKER_01: Because birth, again, I always say like birth and death are like, you never know how it's gonna go, how it's gonna start, how it's gonna end.
13:24
SPEAKER_01: That's just a mystery to us, right?
13:26
SPEAKER_01: Um, so having said that, what are can you dive a little bit into um with the titration of the epidurals?
13:36
SPEAKER_01: How can a patient in that room um control that?
13:40
SPEAKER_01: So I know in the past we you and I have talked about the patient control button versus asking them how how do patients navigate if they have the medication already in their epidural space, managing how much and what kind of medication is going in.
13:54
SPEAKER_00: Exactly.
13:55
SPEAKER_00: So epidurals can be titrated based on a patient's needs.
13:59
SPEAKER_00: Uh, it can be the dose of medication, the type of medication that we give, uh, or the method of delivery.
14:06
SPEAKER_00: So um, most of the time you'll get either a continuous infusion uh through the pump where you're getting a steady amount of medication delivered uh through the catheter, or the pump can also give you a big bolus at a set interval, say every 45 minutes or every hour.
14:23
SPEAKER_00: So that's kind of like your maintenance um uh delivery.
14:28
SPEAKER_00: On top of that, you can also get what's called PCEA or patient-controlled epidural analgesia, uh, where you have a button where you can push to give yourself extra doses if you need to.
14:40
SPEAKER_00: So for example, as your labor progresses, you might be having more and more pain later on, and the background infusion is no longer covering your pain.
14:51
SPEAKER_00: You can self-administer extra doses within the CD limit.
14:55
SPEAKER_00: And there is a CD lockout on the uh pump, so you're not going to overdose yourself.
15:00
SPEAKER_00: So we always encourage patients, go ahead and push it as often as you need to.
15:05
SPEAKER_00: Um, it does take a little bit of time for the medication to kick in.
15:08
SPEAKER_00: So don't wait until the pain is excruciating because it'll be plain catch-up at that point.
15:14
SPEAKER_00: Um, so you know, if a patient says, Oh, I feel like I'm getting too numb now, I don't like this feeling, I can't really feel my contractions, or I can't really uh feel my perineum appropriately to know how to push, then we can also just stop the epidural.
15:30
SPEAKER_00: Uh, it'll wear out from maybe 30 minutes to an hour.
15:33
SPEAKER_00: Um, so you can, you know, feel more uh and know how to push more appropriately.
15:38
SPEAKER_00: So everything is titratable.
15:41
SPEAKER_00: We can stop it, we can give you extra doses if we need to.
15:44
SPEAKER_01: Yeah.
15:45
SPEAKER_01: And so for people who are listening who haven't gone through the experience of having an epidural, um, it there's there's different, there's a difference between feeling pain and feeling pressure.
15:55
SPEAKER_01: And so what I always tell my patients when they're going in to give birth and they're asking me it for advice is you want to be able to take out as much pain and discomfort as you can in order to be able to focus and concentrate if you choose to get the epidural.
16:09
SPEAKER_01: Again, this is not for people who are like, hey, I don't want any pain intervention.
16:13
SPEAKER_01: Awesome.
16:13
SPEAKER_01: But people who do want pain intervention of any kind and they choose the epidural, I always recommend that they feel pressure.
16:20
SPEAKER_01: And so that's why we do all the pelvic floor exercises of gaining motor control and muscle memory, like weeks and weeks and weeks ahead of time before they even give birth.
16:29
SPEAKER_01: Because when they're actually there and they're actually giving birth, they know exactly what to do because they practice it enough times.
16:35
SPEAKER_01: So when you're feeling the contractions of your uterus, you might just feel like a pressurized sensation where it just feels like somebody's kind of like squeezing you in different areas.
16:44
SPEAKER_01: Um, and it might come with some discomfort, but it will be in the absence of true unbearable pain, so that you can focus and then you can do the correct pushing techniques to help the baby come out.
16:56
SPEAKER_01: And so we can talk a little bit about the pushing techniques on another episode.
16:59
SPEAKER_01: But um, but in general, when you feel the pressure and you time your um pushes with the actual uterine contractions, that's how the baby comes out more effectively.
17:09
SPEAKER_01: And if you are experiencing less pain, you can probably focus on it a little bit more.
17:13
SPEAKER_01: These are some of the pros of having an epidural, right?
17:15
SPEAKER_01: Is being able to be relaxed, being able to concentrate, being able to feel safe and connected because pain is kind of the antithesis of in some situations, right?
17:25
SPEAKER_01: Pain can almost be the direct opposite of love and comfort for some people.
17:30
SPEAKER_01: This is not in every situation, but for a lot of people, when they feel pain, their response is in to build oxytocin, which is the hormone needed to help with uterine contractions and help with labor and delivery.
17:41
SPEAKER_01: They instead feel the cortisol and they feel tightening of their bodies and constricting.
17:45
SPEAKER_01: And the way that I describe to my patients is if you are trying to have a vaginal birth, this is not, this is not for a cesarean birth, but if you're trying to have a vaginal birth, you need to open so that the baby comes out, right?
17:57
SPEAKER_01: I say the pelvic floor is like the door.
17:59
SPEAKER_01: And if you open the door, the baby comes out.
18:01
SPEAKER_01: But when we have a stress response, maybe because of pain, discomfort, and just feeling stressed out in the situation, not feeling safe and comfortable.
18:10
SPEAKER_01: Our tendency is to actually contract and tighten, which is the opposite of what we need to do.
18:15
SPEAKER_01: So the abidural in that case can be very beneficial because it helps you to create that, you know, that, like you said, Dr.
18:21
SPEAKER_01: Lynn, that beautiful smile, that calmness.
18:24
SPEAKER_01: I remember my husband looked at me and he and he goes, You just went from going crazy looking to being like, hey guys, what's up?
18:32
SPEAKER_01: Normal speedha mode.
18:34
SPEAKER_01: And he's like, See that all the time.
18:35
SPEAKER_01: Wild the difference from when you walked in that room to after the anesthesiologist had left the room.
18:41
SPEAKER_01: And I was like, I know, because I felt great.
18:43
SPEAKER_01: I was joking around.
18:44
SPEAKER_01: The medical students and I were having a good laugh.
18:47
SPEAKER_01: Everyone was having a great time.
18:48
SPEAKER_01: And then after that is when my labor progressed and um my water broke and I was able to give breadth.
18:53
SPEAKER_01: So, again, so many beautiful benefits and so many misconceptions, right?
18:58
SPEAKER_01: People think they can't move, they can't do anything.
19:00
SPEAKER_01: And again, everything is very hospital-specific, but epidurals have come a long way and people can titrate it.
19:07
SPEAKER_01: They can out, they can figure out exactly how much of what they want and what its effects should be.
19:12
SPEAKER_01: And they can change that during the course of labor and delivery, which can take quite a bit of time, right?
19:17
SPEAKER_01: Um, so having said that, can we jump into some of the risks?
19:21
SPEAKER_01: Like, why would somebody not want an epidural?
19:23
SPEAKER_01: Or why would we, you know, think about it and like, hey, we need to have a conversation because maybe this is not the right fit for you?
19:31
SPEAKER_00: Okay, so um, I guess in terms of, you know, serious risk of epidural uh that will prevent us from putting epidural in someone is one, uh, do they have infection at the site uh where we're gonna place epidural because you could potentially um seed uh the infection into the uh spinal canal, uh causing like meningitis.
19:54
SPEAKER_00: Uh, it could cause like an epidural abscess.
19:57
SPEAKER_00: Those are obviously the complications that we don't want.
20:00
SPEAKER_00: Um, if someone has like a bleeding disorder, like a blood clotting disorder, uh, it can also prevent them from getting an epidural, uh, just because you could cause bleeding in the spinal cord that can um potentially cause paralysis uh if the um bleeding is not um evacuated uh in a timely manner.
20:20
SPEAKER_00: Um so these are kind of like a strong contraindications uh for an epidural.
20:26
SPEAKER_00: Um, or if someone has some kind of like neurologic condition that uh causes higher intracranial pressure, like higher pressure in their brain, um, that will also preclude them from um getting an epidural.
20:38
SPEAKER_00: Uh, or they're just um clinically unstable, like they're they have low blood pressure, they have they're severely dehydrated.
20:46
SPEAKER_00: Um, as a lepidural can dilate your blood vessel and cause uh lower blood pressure, that will also be a contraindication.
20:54
SPEAKER_00: But in the you know, regular population, um that's these are not really like issues that we have to consider.
21:01
SPEAKER_00: So some of the fat infects that are common, uh, it's more medication related.
21:06
SPEAKER_00: So like we talked about earlier, the local anesthetic can cause lower blood pressure.
21:12
SPEAKER_00: Um, so usually um prior to a pedural placement will give you like a fluid bolus uh to kind of uh fill up the tank, as you may say.
21:20
SPEAKER_00: Um, and uh we can also give you medication to help uh raise your blood pressure if you do have low blood pressure after the epidural placement.
21:28
SPEAKER_00: Usually that's just uh you know in the initiation phase.
21:32
SPEAKER_00: Um other medications like uh opioid that can be included in your epidural solution can cause itching, can cause nausea.
21:40
SPEAKER_00: Um, some people can also have urinary tension.
21:43
SPEAKER_00: Uh, so we always put in a fully catheter after an epidural placement.
21:49
SPEAKER_00: Uh, and we also talked about motor weakness from the local anesthetic effect.
21:54
SPEAKER_00: Um, there are some people that um they don't have enough um pain relief from the And that could be because the catheter wasn't optimally placed, or maybe it has migrated, and that could necessitate us replacing the epidural.
22:11
SPEAKER_00: So that's also a side effect that we counsel our patients beforehand that is a it is a possibility that it might not work and we have to do it again.
22:20
SPEAKER_00: And other side effects include headache.
22:25
SPEAKER_00: So that is a pretty rare side effect, and that's more procedurally related.
22:30
SPEAKER_00: That you know, we um our needle accidentally goes too far, causing leakage of the spinal fluid, which causes headache.
22:39
SPEAKER_00: Normally this results within one or two weeks if you don't do anything about it.
22:43
SPEAKER_00: Um, you know, it's difficult for you to take care of a newborn when you have a splitting headache and you have to lay in bed all day.
22:52
SPEAKER_00: So, you know, there are um treatments for that, including hydration, bed rest, uh, drinking lots of coffee, some pain medications.
23:01
SPEAKER_00: If those don't help, we also um perform a procedure called epidural blood patch.
23:06
SPEAKER_00: Uh, essentially performing the epidural procedure again, but instead of injecting other medications, we inject your own blood uh to kind of help patch the whole to prevent the fluid from keep uh leaking, uh from continuing to leak.
23:21
SPEAKER_00: Uh so these are you know kind of the more common side effects that we see from the epidural.
23:26
SPEAKER_00: Got it.
23:27
SPEAKER_00: Um and when you say common, how common to not scare people?
23:31
SPEAKER_00: Well, so the headache is very, very rare.
23:34
SPEAKER_00: We say less than one in a thousand procedures.
23:37
SPEAKER_00: Um, and the medication side effects are a little bit more likely.
23:42
SPEAKER_00: Um, you know, the itching, I would say maybe one in a hundred patients.
23:47
SPEAKER_00: And the other, like urinary retention, uh, motor weakness, oh, those are expected uh from the medication side effects.
23:55
SPEAKER_01: Yeah.
23:55
SPEAKER_00: So when you say urinary retention, do you feel like that's because of a catheter that's been placed?
24:01
SPEAKER_00: Um no, it's because that the local anesthetics uh can um basically prevent you.
24:08
SPEAKER_00: So it it blocks the sensation of the bladder, so you're not able to urinate on your own.
24:13
SPEAKER_00: Uh so they always place a fully catheter after we place epidural.
24:17
SPEAKER_00: Yeah.
24:18
SPEAKER_01: And for everyone listening, and again, correct me if I'm wrong, Dr.
24:22
SPEAKER_01: Lynn, but um, for a patient who has gotten an epidural in the hospital before their discharge, one of their discharge requirements is to have past urine on their own.
24:32
SPEAKER_01: Is that right?
24:33
SPEAKER_01: Yeah.
24:34
SPEAKER_01: Yeah.
24:34
SPEAKER_01: So usually in the um postpartum room or like the recovery room after giving birth, when you're transferred out, um, the there will be nurses who are like constantly monitoring.
24:44
SPEAKER_01: It's like, did you pee?
24:46
SPEAKER_01: Did you pee?
24:46
SPEAKER_01: Did you pee?
24:47
SPEAKER_01: Uh, how much did you pee?
24:48
SPEAKER_01: They usually have like a little um kind of like a hat that goes inside of the toilet seat to make sure they measure how much urine you passed um as like one of their check marks to say, okay, this person is safe or discharged because obviously we don't want to keep urine in our bladder for very long.
25:03
SPEAKER_01: We don't want to get uh get an infection, we don't want to have any other complications from the pressure.
25:08
SPEAKER_01: So um cool.
25:10
SPEAKER_01: All right.
25:10
SPEAKER_01: What else should we what else should the general population know about epidurals?
25:16
SPEAKER_01: Are there any other misconceptions or anything that we need to correct for people to understand more about the science, the purpose, and the reasons to to do it?
25:26
SPEAKER_00: Yeah, so I would say a lot of misconceptions that I hear just from talking to patients, is that one, they have this idea that getting an epidural later is better than getting it earlier.
25:39
SPEAKER_00: Like some places will say, oh, you have to be four centimeters dilated before you can get an epidural.
25:44
SPEAKER_00: Um, that is no longer true.
25:46
SPEAKER_00: Uh, you can get an epidural whenever you like.
25:49
SPEAKER_00: The neurostudies have not found any association between uh leper epidural and also increased prolonged labor or also increased risk of uh forcep or cesarean delivery.
26:00
SPEAKER_00: I want patients to feel comfortable getting it because you know that is no longer a problem that we see.
26:07
SPEAKER_00: That's good to know.
26:08
SPEAKER_01: Yeah, I I guess I kind of vaguely remember the timing of the epidural being like a thing, but it's good to know that it's not anymore.
26:16
SPEAKER_01: Um anything else that you can think of that you want to dispel myths about or missing?
26:21
SPEAKER_00: Yeah, uh one thing I hear a lot is um, you know, a patient will also say, I heard from someone that someone got paralyzed from the epidural.
26:31
SPEAKER_00: Um, which um, you know, it's extremely, extremely rare, uh, less than one in 500,000 cases.
26:40
SPEAKER_00: Um, the location of the spinal cord and much higher than where we place the epidural.
26:47
SPEAKER_00: So there's a very far-seeking margin from where we're putting our needle to where the spinal cord would be.
26:53
SPEAKER_00: Um, so it's very unlikely that we would cause any spinal cord injury uh with an epidural.
26:59
SPEAKER_00: Um, there are um some cases of nerve irritation um from placing epidural, but that's usually self-resolving uh in days to weeks, and it sometimes just causes some numbness and tingling uh in your legs, but it goes away on its own.
27:14
SPEAKER_00: Um, so that's also one kind of myth that I want to debunk about epidural.
27:21
SPEAKER_00: Cool.
27:22
SPEAKER_00: Anything else you got?
27:24
SPEAKER_00: Uh let's see, what else is there?
27:27
SPEAKER_00: I think uh that's mostly it.
27:30
SPEAKER_00: Um yeah.
27:32
SPEAKER_00: Um, do you have any other questions about you know lid repidural or just epidural in general?
27:38
SPEAKER_01: I'm trying to think if we have any other questions.
27:41
SPEAKER_01: I'm trying to like pretend like I'm the audience listening to you and going into their brain and trying to navigate and see if there's there might be any other questions here.
27:49
SPEAKER_01: But I think you've covered pretty much everything.
27:51
SPEAKER_01: It's like what exactly is it?
27:53
SPEAKER_01: What is the medication?
27:54
SPEAKER_01: What types of you know tracks does it target?
27:57
SPEAKER_01: The fact that we can control it, the fact that we can move in it, the fact that it's also hospital dependent on exactly what the protocols are, some of the really great uses of it, some of the reasons why we have contraindications or precautions, some of the myths out there.
28:14
SPEAKER_01: I think we've covered everything.
28:16
SPEAKER_01: I hope the audience really got everything that they needed.
28:19
SPEAKER_01: I'll just say one more thing here at the end because I am, as a person who's in the birth space and talks to a lot of birth workers, I think that sometimes interventions get a bad rap in hospitals.
28:35
SPEAKER_01: And there are definitely like just like there's uh pros and cons to every, I guess, medical field or medical practice.
28:43
SPEAKER_01: You know, there's good physical therapists, there's awful physical therapists.
28:46
SPEAKER_01: There's good chiropractors, there's awful chiropractors, there are good OBGYNs, there's there are terrible OBGYANs.
28:52
SPEAKER_01: Just like every practitioner is a little bit different.
28:54
SPEAKER_01: But when it comes to the overarching theme of birth and intervention, I know that it's become a lot more interventionalized over the last couple of decades and uh, you know, last couple of like several, several, several years.
29:08
SPEAKER_01: Um, and I know that people are moving more into the space of how do we have more natural physiological words?
29:13
SPEAKER_01: How do we do it with less intervention?
29:15
SPEAKER_01: And there is, and and I'm all for that.
29:18
SPEAKER_01: And I think that there's totally a time and place for it.
29:20
SPEAKER_01: And there are people who can do that, and that's amazing.
29:23
SPEAKER_01: And for people who are like, I just want to keep my options open because we have tools, we have medicine, we have science.
29:30
SPEAKER_01: And so let me keep my options open.
29:33
SPEAKER_01: That's also great.
29:34
SPEAKER_01: And for the people who are like just got their pregnancies confirmed and are like, here is my induction date, and I'm getting an epidural and I'm doing this, and this is extremely, you know, it's planned C sections or whatever it is, that's also great.
29:49
SPEAKER_01: I feel like one thing that's really important in this conversation is the way that the person wants to give birth is a very individualized, very multifactorial decision.
29:59
SPEAKER_01: It has so many factors that go into what ends up happening.
30:03
SPEAKER_01: I hope that that person actually has a lot of choice.
30:07
SPEAKER_01: I hope that they are not either pressured or there's, you know, there's something that they feel like, you know, didn't go the way that they that they didn't have control in, you know, because oftentimes birth is not exactly the way that you imagined it, like I said.
30:20
SPEAKER_01: But at least if you have an option of ideas of, okay, here's what we're giving birth, here's what we're doing, here are my options, understanding what is medically necessary versus medically suggested.
30:32
SPEAKER_01: What does that even mean?
30:34
SPEAKER_01: We have a whole podcast episode from I think it's the last season or the season before about that exactly, like medical necessity versus medically suggested.
30:41
SPEAKER_01: There's a big difference between that.
30:43
SPEAKER_01: But learning and knowing is the most important thing.
30:46
SPEAKER_01: So saying things like, I never want an epidural, I don't want to talk about it.
30:49
SPEAKER_01: That's for people who are wimps, that's not a good way to approach it.
30:52
SPEAKER_01: And it's also not a good way to approach it to be like, I don't care, I just want it, I don't want to deal with anything.
30:58
SPEAKER_01: Nothing is right or wrong, but to keep your mind and eyes open, to be educated, to understand what's actually out there.
31:05
SPEAKER_01: Not Instagram, not Dr.
31:07
SPEAKER_01: Google and Dr.
31:08
SPEAKER_01: Instagram, but learning and understanding the science behind everything, I feel like is the the best way that somebody who is going into birth and labor should view the whole thing.
31:18
SPEAKER_01: And I know if you have any thoughts on that, Dr.
31:20
SPEAKER_01: Lynn, that's kind of just where I am right now in my career and in my life and being a mother.
31:25
SPEAKER_01: Do you have any thoughts?
31:26
SPEAKER_00: No, I totally agree.
31:28
SPEAKER_00: So I think number one, it's very important to educate yourself, knowing what your options are, the risks and benefits before you even, you know, step into the labor unit.
31:38
SPEAKER_00: Um, it's good to have a um birth plan coming in, um, just so you can kind of communicate your preferences uh regarding, you know, what kind of pain relief you would like, what kind of interventions that you like.
31:50
SPEAKER_00: Um, you know, look for providers and institutions that are able to execute your birth plan if they're you know uh more specific.
32:00
SPEAKER_00: Um, but also just like don't hesitate to ask questions about why something is being suggested and what alternatives there are.
32:08
SPEAKER_00: Um, but also I would uh like to encourage uh mothers just to be flexible.
32:13
SPEAKER_00: Uh, as you said, labor can be very unpredictable.
32:16
SPEAKER_00: Uh, even if you come on the bird plan uh where you want natural birth without any interventions, sometimes you know, things can happen where there is a higher risk of needing like cesarean delivery.
32:28
SPEAKER_00: And I always talk to patients.
32:29
SPEAKER_00: I know you know this is not what you originally intended, but in a case of emergency, it's always much safer to have an epidural in place just so we can use that uh if we do need to, you know, uh convert into a cesarean delivery, um, because we don't want to run to a situation where it's an emergent uh surgery and we don't have an epidural in place, and you'll have to go under general anesthesia with a breathing tube placement, which is a lot more traumatic for you, for the baby, and you won't be able to be awake uh when the baby comes.
33:07
SPEAKER_00: Um, so um I think very just detailed communication uh with your provider and what the expectations are, it's really important.
33:15
SPEAKER_00: Absolutely.
33:16
SPEAKER_01: Open communication, no, understand your options, risks, benefits, and alternatives.
33:22
SPEAKER_01: Go in.
33:22
SPEAKER_01: Of course, there's there, I feel like there are also cons to knowing too much and going in with life overly, overly researched.
33:31
SPEAKER_01: Uh but I still think that it's better to be more researched than under-researched on what your options are, because we have so many options now, right?
33:38
SPEAKER_01: We do have in our current um world, we can give, we you can give birth at home with a midwife and a doula, you can give birth in a birth center, you can give birth in a hospital.
33:48
SPEAKER_01: Again, depends on where you live in this country and where you live in this world.
33:52
SPEAKER_01: But there are options to to do different things.
33:55
SPEAKER_01: And so depending on which direction you want to go, I just recommend everyone learn about all of them.
34:00
SPEAKER_01: Learn and understand every piece of it.
34:03
SPEAKER_01: Because again, just like Dr.
34:05
SPEAKER_01: Linda and I said earlier too, we never know.
34:08
SPEAKER_01: You never know how it's gonna go.
34:10
SPEAKER_00: Yeah.
34:10
SPEAKER_01: So thank you so much, Dr.
34:12
SPEAKER_01: Lynn.
34:13
SPEAKER_01: This was amazing.
34:14
SPEAKER_01: I'm so glad that you were able to do this episode with us.
34:17
SPEAKER_01: Um, do you have any final thoughts or anything else that you want to add before we close out today?
34:21
SPEAKER_00: Uh no, and feel free to reach out uh if anyone has any more questions about labor material or just any kind of main pain management options uh in the prairie pardon period.
34:31
SPEAKER_00: I'm happy to answer them.
34:33
SPEAKER_00: Wonderful.
34:33
SPEAKER_01: And we'll put all of Dr.
34:34
SPEAKER_01: Len's information in the um show links below so everyone can take a look at that.
34:39
SPEAKER_01: Thank you so much, everybody.
34:41
SPEAKER_01: See you next time.
34:42
SPEAKER_01: Thank you all for tuning in and investing in yourself and your well-being.
34:46
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34:52
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34:55
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35:05
SPEAKER_01: See you again next week with an exciting new guest and topic.