Epidurals: The Good, The Bad, and The Ugly

I’m pleased to host anesthesiologist and suspense author, H.S. Clark, as he discusses his thoughts on epidurals. Very informative post. I hope you’ll check out his medical thriller Secret Thoughts available on Amazon. 

On the morning on April 7, 1853, a little known innovative physician, Dr. John Snow, was called to Buckingham Palace to administer Chloroform anesthesia to Queen Victoria for the birth of her fourth child, Prince Leopold. The Prince was healthy, and the Queen did not feel the pain of childbirth. That was the beginning of the end for “natural” childbirth, and the dawn of modern anesthesia for labor and delivery.

Buckingham Palace
Now, 25% of mothers give birth by Caesarian section, and 75% of the remaining vaginal births receive either a spinal or epidural anesthetic, so that leaves less than 20% to experience “natural” childbirth. We know now that the designation “natural” does not mean medically superior. The pain and stress of labor and delivery raises maternal blood pressure, increases circulating adrenaline, impairs breathing, and interferes with muscle control and fetal descent, all to the detriment of both mom and her unborn baby. Pain also leads to expulsive deliveries that increase the occurrence and severity of pelvic lacerations.

We’ve now progressed from Chloroform to the use of epidural anesthesia. Small amounts of local anesthetic placed in the lower back near the spinal nerves set up a regional block of the bottom half of the body. It’s like two cops stopping all the highway traffic with a roadblock. Modern epidural anesthesia reduces stress for mom and baby, which is especially helpful if the baby is medically compromised. Epidurals are used not just for pain control, but also as an active tool to manage labor and delivery, and to provide flexible options, safety, and control that is not possible during “natural” childbirth. Unlike the early days of epidural anesthesia, modern epidural methods do not slow labor, have minimal effects on the unborn child, and often help to speed labor and fetal descent.

But in medicine, there is always a down side. Epidurals are wonderful, when they work. Even in the most skilled of hands, epidurals are highly technical, difficult to place and maintain, sometimes marginally effective, and frequently fail. They are best placed after the labor is well established, usually at 3 to 5 cm of cervical dilation. If labor is rapid, there may not be adequate time to place an epidural. Minor complications include a 1% chance of a migraine-like headache that may require treatment, and the rare possibility of nerve damage, seizures, infection, or other life threatening problems. Techniques, drugs, equipment, and monitoring used during an epidural anesthetic are all geared toward preventing complications.

Epidurals are usually an elective choice, but not always. There are labor situations in which epidurals may be mandatory for the safety of both mom and baby. Anesthesia for childbirth is unique because the anesthesiologist must treat two patients at once, each one with very special needs. Epidurals are used by default, because other methods of pain control have unacceptable effects on mom or her unborn child. The delicate balance between pain control and safety during labor and delivery is like a tightrope walk. I wonder if Dr. John Snow realized what he started on that foggy April morning in London.
Secret Thoughts Book Trailer:

H.S. Clark is a mystery writer, physician, anesthesiologist, and the author of Secret Thoughts: a Medical Thriller, set in Seattle. His thrillers are ultimately about the interface of ethics and medicine, and the human struggle for health and wellness. The technology he writes about is 99% cutting edge fact mixed with a 1% glimpse into the future. He showcases the abuses of medicine in order to focus attention on the wonders of medical achievement. Mostly, he wants the reader to enjoy the journey. You can connect with H.S. at his website at:
Secret Thoughts: a Medical Thriller is available for immediate download from Kindle, and in paperback from Amazon http://goo.gl/UWLVR  

Western Medicine Circa 1890: Part 3/4

Lacy continues her four part Friday series today on western medicine. I think her posts have been quite thought provoking! Don’t forget, she’s running a great contest for a chance to win four historical novels so be sure to leave a comment and check out full contest details as posted on June 30th. I echo Lacy’s thankfullness at giving birth with today’s medical techniques.

When I was getting to know my heroine, I met a really tough, independent woman. She has to be, to be able to do her job as town marshal. But what most of the other townspeople don’t know is that she does have a softer side… and she desperately wants a family of her own. Her best friend is pregnant and Danna ends up having to help during the delivery… and it is a really poignant moment for her because of her secret desire for a family of her own.
Also, as a mom who gave birth in a lovely hospital with several nurses and my obstetrician attending, I was still plenty scared. Imagining what it would have been like to deliver a baby back in the 1890s makes me shudder…
During the 1890s, most women gave birth at home. Hospitals existed in the East, but in the West there weren’t a lot of towns big enough to support one. So the best most women could expect was for a doctor to be present. More common was a midwife or even a neighbor to be present. Or sometimes it was just the husband (my husband pretended to be calm during my first delivery but I later found out it was all an act—I can’t imagine what he would have been like if he had been the only person in that room with me…)
According to Bleed, Blister and Purge (2005) a lot of women could have a normal delivery at home with very minimal help. The problems came when there were complications. Because doctors were often far away, sometimes the mother and/or child would suffer or even die because the doctor couldn’t get there in time. Luckily for my heroine, her best friend was a second-time mom and didn’t suffer any complications.
Here’s an excerpt from Marrying Miss Marshal chapter 13:
“I’m here!” Rushing to her friend’s side, Danna saw the face creased in pain, the sweat on Corrine’s brow, the marks where she’d obviously clutched the sheets in her fists. “What can I do?”
Corrine let out a long breath, muscles easing. “Nothing yet. I think we have a bit to go, even though the pains have been coming all day.”
“Should I get the doctor?”
“He’s tied up at his office. The young man from the robbery took a turn for the worse. He’s in surgery.”
That wasn’t good. The “young man” was quite possibly the only lead Danna had to find out anything about where the outlaws were going with the bank’s money.
“What about your neighbor…” And why had she rushed out like that?
Corrine clasped Danna’s hand as another pain came. Her lips pinched white. “She doesn’t…she thinks…Brent killed…your husband.” The words came out in spurts and gasps as Corrine panted through the contraction.
Danna found a clean cloth on the end of the bed—someone had prepared things at least—and dabbed at her friend’s forehead. “Ssh. Ssh. It’s okay.”
The contraction eased and Corrine relaxed again. “I don’t suppose there’s any news…?”
Danna wished she had something positive to tell her friend, but there was nothing. “I’m sorry.”
“And Mrs. Burnett,” the preacher’s wife, “is visiting her sister out of town,” Corrine spoke as if the question about her husband hadn’t been asked. “So I sent the neighbor boy to fetch you. Will you stay with me? Help me labor this baby?”
Tears sparkled in Corrine’s eyes.
A lump of responding tears formed in Danna’s throat. “You don’t even have to ask,” she told her dearest friend.
Copyright © 2011 by Lacy Williams. Permission to reproduce text granted by Harlequin Books.
The Modern Family Physician (1915) is available in the public domain on Googlebooks.
Volume 1 (Childbirth information starts page 370):
Bleed, Blister and Purge by Volney Steele, M.D. (2005)
As a child, Lacy Williams wanted to become a veterinarian “when she grew up”. However, the sight of blood often made her squeamish so she gave up that dream before her teen years. As a college student, Lacy was a physical therapy major for approximately two weeks—until she found out she’d have to take a cadaver lab to complete that degree plan. As a writer, Lacy has finally found a way she can handle blood and gore—fictionally.
A wife and mom from Oklahoma, Lacy is a member of the American Christian Fiction Writers and is active in her local chapter, including a mentorship program she helped to start. She writes to give her readers and mostly reads the end of the book first. You can find out more about Lacy at her website http://www.lacywilliams.net/. She is also active on Facebook (www.facebook.com/lacywilliamsbooks) and Twitter (www.twitter.com/lacy_williams).