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Subject:
From:
"C. Ione Sims CNM/MSN/IBCLC" <[log in to unmask]>
Reply To:
Lactation Information and Discussion <[log in to unmask]>
Date:
Tue, 5 Mar 1996 21:23:52 -0800
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For the person who asked what the difference was between epidurals and
intrathecals: the difference comes down to the medication used. Both are
done basically the same way, but epidurals usually utilize one of the
'caine drugs which means that it can act as local anesthesia and also,
depending on the amount and type of drug, can produce motor blockade --
hence the numbing effects that can interfere with pushing, for instance.
An intrathecal utilizes narcotics rather than anesthetics and can provide
excellent pain relief with very tiny amounts of morphine or fentanyl. An
intrathecal is the same as what you may have heard called a "walking
epidural".  It does not take away motor function and can be quite useful
for some women.  It also does not take away all sensation of pain. Common
side effects of intrathecals are itching (very common!), and urinary
retention.  Respiratory depression can be a problem which can occur
several hours after administration and because of this, some anesthesists
insist that the woman be on a pulse oximeter for the first 24 hours after
administration or at least on hourly checks of her respirations.

As far as effects on babies, I really don't know. For the woman, the
intrathecal can be a godsend (and I have labor sat my share of young moms
who begin losing it in early labor) especially for someone with a long,
difficult labor that isn't progressing especially well, and may be
preferable to systemic narcotics because the dosage is much less. I
suspect the effects on babies of most drugs or procedures that laboring
women are subjected to are much more subtle than many of us are led to
appreciate.  The intrathecal, at least, does have the advantage of
retaining the woman's mobility, doesn't require a large fluid bolus in
advance, and doesn't appear to interfere as much with pushing as the
epidural, though second stages appear to be longer with intrathecal's than
in unmedicated births.

Ione Sims, CNM, IBCLC

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