Living'Walking epidural' or outpatient epidural: what is this type...

'Walking epidural' or outpatient epidural: what is this type of anesthesia administered during childbirth?

Anesthesia is the use of medications used to prevent the sensation of pain during surgery or a painful procedure. There are different types of anesthesia, but all are intended to block nerve impulses and, therefore, pain.

During childbirth, the most frequently used anesthesia is epidural , which consists of the reversible blockade of the nerve roots, avoiding pain in an entire region of the body.

But epidural anesthesia has a major drawback , and that is that it usually leaves the legs feeling tingly, heavy or even completely immobile, forcing the pregnant woman to lie down during the entire dilation process, which can sometimes last several hours. .

For this reason, there are women who decide to resort to ‘walking epidurals’ or itinerant epidurals . It is a variant of epidural anesthesia that blocks the pain of contractions and expulsion without blocking movement.

We tell you what exactly it consists of and what benefits and drawbacks it brings compared to the conventional epidural.

What is the ‘walking epidural’ and how is it applied?

The walking epidural first appeared in the early 1990s in an attempt to improve the freedom of movement of the pregnant woman while maintaining effective epidural analgesia.

The walking epidural is an anesthesia that manages to control the pain of the contractions but without leaving the woman paralyzed from the waist down , which allows her to have freedom of movement, walk and choose the position she wants to give birth to the baby, helping in this so that childbirth prospers.

It is applied in the same way as epidural anesthesia: first, the anesthesiologist places a local anesthetic in the woman’s lower back, and then, after she adopts a proper C-shaped posture, the anesthetic is injected. A catheter is left connected to a pump that administers the medications.

The difference between this anesthesia and the conventional epidural lies in the composition and in the combination of various drugs. This ensures that only the sensory fibers fall asleep , while those that control movement remain awake .

According to the words of Dr. Javier Cáceres Rico, head of the Anesthesiology service at Quirónsalud San José Hospital, this type of anesthesia would be indicated for those women who wish to have more participation and autonomy in their childbirth .

What are the advantages of the ‘walking epidural’ compared to the conventional epidural?

As it is a type of anesthesia that does not block movement, the main advantage is that the mother can stand, walk or do ball exercises during the entire labor . The movement, the opening of the pelvis and the effect of gravity favor the birth process.

In addition, according to this article from the Hospital Quirónsalud San José, the outpatient epidural or ‘walking epidural’ would also have the following advantages:

  • Contractions feel stronger and more effective, yet painless
  • Dilation time decreases thanks to the advantages of movement and standing
  • As a consequence, the woman remains more active and participatory during her delivery , increasing her satisfaction and sense of well-being.
  • The chances of instrumental delivery (forceps or the like) or of needing a urinary catheter are also reduced.

What are its main drawbacks

Like epidural anesthesia or any other drug, walking epidural anesthesia also has some drawbacks . Among them, the following would stand out:

  • It is not indicated in advanced deliveries, since higher concentrations of drugs that can cause motor block are required.
  • It is important to make sure that the mother can feel and move her legs correctly to avoid accidents and falls.
  • It usually has side effects very similar to the epidural, although itching occurs more frequently with the use of this anesthesia.
  • Not all hospitals offer it, since qualified personnel are required to care for pregnant women who receive it.

In which cases is it contraindicated?

Outpatient epidural is contraindicated in the same cases as epidural anesthesia.

Thus, according to this information sheet prepared by the University Hospital of Fuenlabrada (Madrid), it is not recommended in those patients who present infection at the puncture site, significant hypotension, intracranial hypertension, severe infectious syndrome, coagulation disorders and treatments anticoagulants.

It is also not recommended when the fetal heart rate is abnormal , when the mother has hemorrhage before delivery or in an unstable fetal situation or dystocia.

Alterations of the spine and obesity are not contraindications, but they can make the technique difficult and even prevent it.

What to keep in mind once this anesthesia is applied

As we read in this document on obstetric anesthesia, once the ambulatory epidural anesthesia has been administered, the woman should be evaluated by the doctor before starting to walk , making sure that she does not experience dizziness when moving from the sitting position to the standing position, which she feels feet completely and has motor power to perform certain actions.

If these criteria are met, the woman should be encouraged to walk around the room accompanied by someone or go to the bathroom with help, as well as avoid sitting for a long time (if she sits for more than 60 minutes, she should be evaluated again).

How can I request this type of epidural?

The outpatient epidural has been administered for more than a decade in some hospitals in our country, although it has only been in recent years that it has begun to gain popularity.

But not all hospitals offer it, so if you want to resort to the ‘walking epidural’ at the time of delivery, we recommend you talk to your doctor or midwife beforehand to find out if they offer this alternative at the clinic or hospital where you are going to give birth. light.

Likewise, it is necessary to speak with an anesthesiologist to clarify all the doubts you may have in this regard, as well as analyze the risks and benefits that the use of this type of anesthesia implies in your particular case.

Photos | iStock

Via | Childbirth is Ours, Hospital Quirón San José, Walking Epidural: living and feeling childbirth without pain, Elsevier

When Epidurals Don’t Work: Lateralization of Anesthesia, Analgesia in Labor: Pain Control Techniques Without Using Anesthesia, Why Labor Contractions Hurt

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