Walking Epidurals : Why You Might Want To Consider An Intrathecal

What Is a Walking Epidural

Before I got pregnant with my second child, I had never heard the term "walking epidural" before. While taking a tour of one of the possible hospitals I might be delivering in I inquired about pain management. This was a concern for me because I had a history of fast labor, and the nearest hospital to my house was over 30 minutes away. I had a natural birth with my first, and was vehement that I wanted an epidural this time. The exchange between the nurse and myself went something like this:

Me: I have a history of fast labor. If I preregister, how long will I have to wait for an epidural?

Nurse: Oh we don't do epidurals here. We only do intrathecals.

Me: Huh? What is that?

Nurse: Basically the anesthesiologist injects a narcotic into the spinal area to reduce pain, but it only lasts 3 hours, and you can still walk afterwards. They call it a "walking epidural."

Me: .... cool....

Honestly, this left me with more questions than answers. What is this procedure, and why haven't I ever heard of it before? This was not my first child. This option had never even been presented to me before, and now someone was telling me that if I chose to deliver in their hospital it was my only option!

So here's the rundown. What was described to me as a "walking epidural" is not actually an epidural at all. A true "walking epidural" is actually a combination of an epidural and an intrathecal. In a walking epidural the anesthesiologst administers an initial dose of narcotic into the intrathecal area, then pulls the needle back and threads a catheter into the epidural space. This allows the woman to request an epidural at any time during her labor, if she feels that the intrathecal injection wasn't enough.

Okay Then, What Is An Intrathecal?

The term intrathecal actually refers to the administration of a narcotic (usually morphine) into the intrathecal space, or fluid surrounding the spinal cord, to provide analgesia or anesthesia. Anesthesia means lack of feeling, and is what you get with a traditional epidural. Numbness combined with the need to constantly be monitored, and being hooked up to a drip machine, means you aren't going anywhere on your own for a while. With the intrathecal, a small amount of narcotic is administered, which provides only analgesia to reduce pain, while retaining sensation. This is considered by some to be an advantage over a traditional epidural because the woman can still feel her contractions as well as the urge to push. This is thought to reduce the possibility of a c-section. Another advantage of an intrathecal is that instead of placing a catheter into the space, which will also have to be removed later, it is administered in a single injection that wears off in about 3 hours. The freedom to move around, also reduces the risk of c-section by promotion contractions, and contributing to the mental well-being of the woman in labor.

There are some drawbacks to the intrathecal though. You will not get the same amount of pain relief you could expect from an epidural. Also, due to the fact that the dura (membrane surrounding the spinal fluid) is punctured for the intrathecal, it carries the risk of a headache referred to ask a post-dural puncture headache, or spinal headache. Though the headache will eventually go away, you could essentially be trading one pain for another.

One last thing to consider is that unlike an epidural where you have a catheter placed, and a drip can be set up to provide continuous pain relief, the intrathecal only lasts an average of 3 hours. It could last longer or shorter depending on the person, but ideally you should wait until towards the end of labor to receive it. That means you may be terribly uncomfortable while you are waiting until you've progressed far enough to receive the intrathecal. It also means that if administered too early, you could end up with no pain relief at the end stages of labor. Neither of these sound particularly desirable for a woman who would like a pain-free delivery.

The Pros And Cons

Pros:

  • Ability to still receive the epidural, if the intrathecal isn't enough.
  • Being able to walk or move during labor, as well as the ability to feel contractions, reduces the risk of c-section
  • Side effects are less likely than with an epidural.
  • Less of a chance of a drop in blood pressure than with an epidural.
  • Medication takes effect faster than an epidural.

Cons:

  • Possibility of headache afterwards, as well as all other side effects associated with the narcotic used, as well as the epidural.
  • Might not be strong enough, requiring an epidural anyway.

What Kind Of Pain Management Did You Use For Your Delivery?

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