Walking Epidurals: Yuppie Trend Or Labor Relief?

Antoinette Olsen was nervous and scared as she walked through the hospital doors. The pain when she delivered her last baby had been horrible.Olsen had wanted to deliver that first baby naturally -- no drugs. But eventually the excruciating pain drove her to get an anesthetizing epidural that numbed her from the waist down."This time I was expecting the worst," said the 24-year-old resident of Queens in New York City. "No one could forget that kind of pain."For years, pregnant women have had only two choices: endure the pain and fully experience the act of childbirth or get so drugged up that they don't even know when the baby has arrived.Now there is another option. Some have dubbed it the walking epidural, some, the epidural light. Whatever it's called, the new procedure allows women to feel their contractions without pain. And, at a select few hospitals, some women are actually walking around after receiving their epidurals."I think this is what a lot of women want," said Dr. Robert M. Weinberg, a professor at the Mount Sinai School of Medicine in Manhattan and director of obstetric anesthesiology at Elmhurst Hospital in Queens. "They still feel like an active participant in the labor, yet they're not in agony. It's a more natural feeling."In the traditional procedure, doctors pumped leg and abdomen- numbing anesthetics through a catheter into the epidural space -- the area of the back that lies between the vertebrae and the spinal cord.But studies have shown that women can get by with much smaller doses of anesthetic if it is mixed with a narcotic. Doctors generally don't like to give pregnant women a narcotic because it can be passed to the baby from the mother's bloodstream. But by injecting the narcotic directly into the spinal fluid, instead of the arm, doctors avoid the risk of having a drugged-up baby who has difficulty breathing after being born.The new procedure dulls the pain, but the mother-to-be still feels the pressure of her contractions, so she knows when to push. Many can move about more comfortably and even walk."This time it was completely painless," Olsen said. "I couldn't believe it. My stomach was numb, but I could feel my legs. I could turn over on my side by myself."While most physicians agree that the new technique makes for a more positive birthing experience, they differ when it comes to the question of whether a woman should be allowed to walk with a walking epidural.Some doctors believe that walking may speed the delivery. "When you look at the literature, some studies say it helps, some studies say it makes no difference, but no studies say it's bad," said Dr. Nancy Oriol, an assistant professor at the Harvard Medical School and director of obstetric anesthesia at the Beth Israel Hospital in Boston.In a study published in the journal, Anesthesiology, Oriol and her colleagues showed that 70 percent of women given the low-dose anesthesia were able to walk around on their own."There's a clear advantage from the patient's point of view," Oriol said. "Labor can last 12 hours. If you're stuck in bed all that time strapped down to a million things, it can be torture. Pregnant women often want to get up to use the bathroom, or they might just want to sit up in a rocking chair."But many doctors are more comfortable having their patients "strapped down to a million things."The crux of the matter for most obstetricians is fetal monitoring: should the mother and baby be hooked up and monitored continuously or is an exam once every 15 minutes -- the current recommendation of the American College of Obstetricians and Gynecologists -- enough to catch a fetus in trouble?About one in 1,000 to one in 2,000 fetuses develop serious problems during delivery, according to Dr. Stephen Myers, director of maternal-fetal medicine at the Mount Sinai Hospital in Chicago."You have to understand that we have to do lots of things to lots of patients who have no problems in order to prevent (problems with) that tiny percentage who will end up with something going wrong," Myers said.In Meyer's unit "there is a specific prohibition against walking," he said. "We don't have the nursing personnel to go chasing after patients every 30 minutes."Many doctors don't want their pregnant patients walking around because they fear lawsuits, said Dr. Steven Schwalbe, an obstetric anesthesiologist at the Albert Einstein School of Medicine.Time and time again, studies have shown that fetal monitoring is overused, according to Schwalbe. "But the reality is, that it's a pretty gutsy obstetrician who is willing to say, `OK, this patient doesn't need continuous monitoring. I'll disconnect her.'But to Myers, it's more important to monitor the baby than to give in to the latest trend. "This just sounds like a Yuppie thing to me," he said. "Fifteen years ago, they thought if you hung curtains and made the delivery room look like a living room, it make the labor better."I don't disagree that you want the labor and delivery to be the most positive experience possible, but I don't think there should be any unrealistic expectations, whether it's decor or a new medical technique."Most women don't want to walk anyway, said Dr. John F. Di Capua, director of the anesthesia pain service at the North Shore University Hospital in Manhasset, Long Island. "Many women, once they get that first ounce of relief, just want to rest," he added. "They just want to close the lights and relax."Olsen said she never felt like walking. "But having feeling helps," she said, her blues eyes lighting up as she smiled. "I felt my baby as she came out."

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