Tuesday, September 25, 2012

What Do You Mean? I can't have an epidural......

Well, I get a lot of questions about medical management of labor when I teach labor and delivery. Many of the most common questions concerns epidurals. No one wants pain. Everyone wants to be in control. No one wants it to affect the baby. Everyone makes a face when I teach that Foley catheters are used to drain the bladder when you have an epidural. Will an epidural stop labor? Everyone wants to know why they can't have a walking epidural. Can I push with an epidural or is it an instant ticket for vacuum extraction? You probably have your own questions. Scoliosis and epidurals? Harrington rods?

There is quite a bit of literature about the pros and cons of epidurals for pain management for many different situations; labor is one of them. There are even classes specifically designed to address epidurals. And you are more than welcome to make an appointment with the anesthesiology department where you are going to deliver to talk about your specific concerns, in advance.

My very commonly asked question these days is about epidurals and those gorgeous, sexy, colorful lower back tattoos.   An anesthesiologist won't go near a new tattoo where skin is still healing. The doctor would never touch a tattoo that looks red or swollen. If you have a well- healed tattoo, the doctor will most likely try to introduce the epidural catheter into an area that is "open". Where the tattoo design is interrupted and there is flesh that isn't exposed to the pigment used for the tattoo.  No one wants to be responsible for injecting those pigments into deeper tissue. And afterwards, there may be scarring near the placement site that might change the aesthetics of your tattoo.

There isn't a lot of research into this specific question. But as more and more young women decide to ornament themselves in this statement of self expression, I expect that the practice of placing epidural catheters will be controversial. This is a perfect example of a reason to perhaps delay tattooing your beautiful lower back. There are after all many other fetching body parts to decorate. If you have an existing tattoo, that is well healed, it's a good reason for that above mentioned consultation with the anesthesiology department where you plan to deliver to understand their protocols and procedures concerning epidurals and tattoos.

And, of course, there are other ways to manage discomfort in labor. Epidural isn't the only medical management available and there is a myriad of techniques that involve no medical management at all. Good time to learn about all your options for pain management and relief, before labor. Not when the doctor comes in to tell you that the department is averse to going through a tattoo to administer an epidural.