As a former labor and delivery nurse, part of the prep for getting an epidural is hydration of the patient to a level sufficient to prevent hypotension. When an epidural is administered, it causes relaxation of the blood vessels, which in turn lowers blood pressure. IV fluids help to sustain adequate blood pressures. Sometimes ephedrine is also given to increase tone of the blood vessels and raise a too low blood pressure. Once the epidural has worn off, the blood vessel tone increases, forcing the extra intravascular fluid out into the "third space." This is the root of the edema that occurs in normo-tensive patients. At our hospital, 93% of patients have epidurals. C-Section or vaginal delivery patients, same thing happens. Most of these moms get 3-4000 ml of IV fluids during labor. Some of the consequences include higher incidence of CHF and PE. Scary thing. Don't know if there is an increased incidence with higher proportions of fentanyl to marcaine. It would be an interesting study.
-----Original Message-----
From: Lactation Information and Discussion [mailto:[log in to unmask]] On Behalf Of Nikki Lee
Sent: Friday, May 19, 2006 5:51 PM
Subject: edema)
In a message dated 5/19/2006 6:18:16 P.M. Eastern Daylight Time,
[log in to unmask] writes:
Onset more than a day *after* delivery, increases in
severity for the next few days, then takes 2 or more weeks to resolve. What
puzzles me is that I don't think her exposure to pitocin was veryextensive,
and that's the only potential connection I know of so far.
Does anyone have any other ideas on what may be causing this postpartum
edema besides the pitocin theory? I'm interested in any insights from those
who notice and follow these things. There has GOT to be a connection here
somewhere. I just don't remember this happening like this to mothers a
decade ago.
Dear Friends:
I too am noticing this phenomenon, particularly with the onset way past
the delivery. I also agree with Lisa, that I didn't see this a decade ago; or
even a few years ago.
Could it be the aftermath of induction? Or, the type of drug used in the
epidural?
warmly,
Nikki Lee RN, MS, Mother of 2, IBCLC, RLC, CCE
craniosacral therapy practitioner
Faculty, Lactation Division Maternal-Infant Program, Union Institute
Film Reviews Editor, JHL
www.breastfeedingalwaysbest.com
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