Why is an epidural called an epidural?

[sivman17]

We dissected the spine today. The epidural space is outside the dura mater. When a woman gets an epidural injection, they inject through the dura mater and arachnoid mater into the subarachnoid space where the CSF is. Why, then, do they call it an epidural injection, and not an endodural? Seems like that would make more sense to me.

I even asked my TA and she said she had always wondered that too but she did not know the correct reason.

Any thoughts?

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[hoqhuuep]

They inject the anesthetic into the epidural space.

 

[WellWornLad]

They inject the anesthetic into the epidural space.

Yes, they definitely don't go through the dura for an epidural.

 

[sivman17]

Yes, they definitely don't go through the dura for an epidural.

i looked it up.. apparently spinal anesthesia is when they inject a local anesthetic into the CSF, not an epidural.

question solved.

 

[weightyheart]

In any case, it would not be called an endodural. It may be called a subdural, which is unlikely, or a subarachnoid.

Why, then, do they call it an epidural injection, and not an endodural? Seems like that would make more sense to me.

 

[Narcotized]

When a woman gets an epidural injection, they inject through the dura mater and arachnoid mater into the subarachnoid space where the CSF is. Why, then, do they call it an epidural injection, and not an endodural?

Actually, the correct terminology for an epidual injection into the subarachnoid space is known as a "fuq-up".

 

[pgg]

Actually, the correct terminology for an epidual injection into the subarachnoid space is known as a "fuq-up".

It's also referred to as an "imminently impending intubation" ... or a triple-I for short.

 

[Jeff05]

epidural means exactly that epi- (on top of) the -dura (dura mater). this is a space OUTSIDE of the thecal sac (contains the CSF and the spinal cord).

if the needle is advanced and pierces the dura the injection is known as a spinal.

 

[greatnt249]

When a woman gets an epidural injection, they inject through the dura mater and arachnoid mater into the subarachnoid space where the CSF is.

If they're doing what you describe, then they're doing it wrong. An epidural involves puncturing through the skin, through the supraspinous ligament, through the interspinous ligament, and then through the ligamentum flavum, but not through the dura mater (thus involving the epidural space), and then injecting the anesthetic.

 

[Bertelman]

They inject the anesthetic into the epidural space.

It's rather fun, actually.

You should be more amazed that a 9 lb. bowling ball squeezes out of a pelvis and vagina.

 

[fakin' the funk]

that a 9 lb. bowling ball squeezes out of a pelvis and vagina.

Speaking of avoiding trauma to the wifey's holy bits, what's the chances of a purely elective section on a healthy mom?

 

[Bertelman]

Speaking of avoiding trauma to the wifey's holy bits, what's the chances of a purely elective section on a healthy mom?

You'll need to find the right OB. Without getting too personal though, I'm not sure what you are looking to avoid. That passage is designed to accommodate the baby. If you start out with a C/S, you've sort of chosen the path for all future deliveries.

 

[periopdoc]

Speaking of avoiding trauma to the wifey's holy bits, what's the chances of a purely elective section on a healthy mom?

Totally possible with the right OB. Some OB's are militantly against elective primary c-sections, some are ardent supporters of the safety of this procedure. Do your research so you aren't dissuaded from your choice by one or the other. Just keep in mind that the statistics on fetal/ maternal c-section outcomes are skewed by the simple fact that most primary c-sections are done after a failed trial of labor when you would expect worse outcomes. Also, the individuals that are militantly against c-sections, epidurals, hospital births etc tend to shout the loudest on the internet and in print. Look for data on truly elective primary c-sections and realize that, in some countries, elective primary c-sections are widely available and preferred by moms and docs.

Try this thread for a start. By the second page, the thread gets hijacked into a discussion of c-section data.

That passage is designed to accommodate the baby. If you start out with a C/S, you've sort of chosen the path for all future deliveries.

If the vagina and pelvis were designed to accommodate a baby, then it was by a pretty bad engineer who didn't include much tolerance in the design. There is a fair amount of trauma to the pelvic musculature during delivery of a baby. Most women and men can feel a definite difference in sexual sensations following recovery from a vaginal delivery. There is a wide spectrum of response to the more relaxed sensation ranging from improved sexual enjoyment to an new inability to orgasm from vaginal intercourse. To some degree, the latter can be resolved by rigorous PC exercise or surgical repair, but some couples have to learn new ways of achieving orgasm.

While having a one c-section does not obligate you to c-sections for all of your future deliveries (hello VBAC), it would be highly unusual for a woman to choose a primary elective c-section and then decide that with a subsequent pregnancy she wants to try vaginal birth.

- pod

 

[Bertelman]

If the vagina and pelvis were designed to accommodate a baby, then it was by a pretty bad engineer who didn't include much tolerance in the design. There is a fair amount of trauma to the pelvic musculature during delivery of a baby. Most women and men can feel a definite difference in sexual sensations following recovery from a vaginal delivery. There is a wide spectrum of response to the more relaxed sensation ranging from improved sexual enjoyment to an new inability to orgasm from vaginal intercourse. To some degree, the latter can be resolved by rigorous PC exercise or surgical repair, but some couples have to learn new ways of achieving orgasm.

While having a one c-section does not obligate you to c-sections for all of your future deliveries (hello VBAC), it would be highly unusual for a woman to choose a primary elective c-section and then decide that with a subsequent pregnancy she wants to try vaginal birth.

- pod

Fair enough. I was speaking from my experience, which is to say I have noticed no difference in postpartum activities, by either party. I know any topic regarding childbirth will be an emotional flashpoint, and this is no different. I just personally can't see why one would want to schedule a C/S just to avoid the possibility of a change in future sexual performance. I'll tell you what changes future sexual performance- HAVING KIDS! No matter how they come out, your sex life will be different.

I understand VBACs are possible, but they bring with them their own increased risk of complications.

As for the engineering behind the female pelvis, I would say it is pretty remarkable in its ability to achieve multiple goals. It's primary purpose is not to deliver progeny. But for a secondary function, I think it does its job.

 

[Jeff05]

the number 1 function of the female pelvis IS TO give birth. the point of life is to survive through reproduction. the fittest pass on their genes to future generations.

the "design" is good enough when it comes to populations. sure 1 in 100 used to die, but that's a 99% success rate. not bad.


http://en.wikipedia.org/wiki/Maternal_death
The death rate for women giving birth plummeted in the 20th century.
The historical level of maternal deaths is probably around 1 in 100 births.[11] Mortality rates reached horrible proportions in maternity institutions in the 1800s, sometimes climbing to 40 percent of birthgiving women. At the beginning of the 1900s, maternal death rates were around 1 in 100 for live births. The number today in the United States is 11 in 100,000, a decline by two orders of magnitude.[9]

 

[periopdoc]

sure 1 in 100 used to die, but that's a 99% success rate. not bad.

Please do not ever anesthetize me. [/jk]

- pod

 

[periopdoc]

I'll tell you what changes future sexual performance- HAVING KIDS! No matter how they come out, your sex life will be different.

I just personally can't see why one would want to schedule a C/S just to avoid the possibility of a change in future sexual performance.

There are multiple reasons why women want elective primary c-sections and sexual functioning fears are only one of them. Most commonly, a woman wants to have a defined date of delivery. It enables her to schedule support to be there when she needs it. Sometimes it is for fears of urinary and fecal incontinence. Some women do not want to go through the pain of labor and feel that the pain of c-section is preferable and more controllable. Some have pregnancies with higher risk of failed trial of labor and elect to go straight to c-section.

I think that women need to make educated and informed choices with their physicians as to the mode of delivery and pain control that they want. Unfortunately, there is so much pressure from natural childbirth advocates telling women that they are somehow "less of a woman" if they need an epidural or c-section that it can be hard to have a frank discussion about what the individual woman wants and what her fears are. Women are made to feel guilty, ignorant, and selfish for caving in and obtaining adequate pain control (epidural) or "failing" to deliver vaginally.

- pod

 

[Bertelman]

the number 1 function of the female pelvis IS TO give birth. the point of life is to survive through reproduction. the fittest pass on their genes to future generations.

Let me rephrase- I was referring to the bony pelvis. I understand the pelvic organs are there only to deliver babies.

 

[Bertelman]

There are multiple reasons why women want elective primary c-sections and sexual functioning fears are only one of them.

Absolutely true, that just seemed to be where funk was coming from on this.

 

[USAnesthesiaDoc]

There are multiple reasons why women want elective primary c-sections and sexual functioning fears are only one of them. Most commonly, a woman wants to have a defined date of delivery. It enables her to schedule support to be there when she needs it. Sometimes it is for fears of urinary and fecal incontinence. Some women do not want to go through the pain of labor and feel that the pain of c-section is preferable and more controllable. Some have pregnancies with higher risk of failed trial of labor and elect to go straight to c-section.

I think that women need to make educated and informed choices with their physicians as to the mode of delivery and pain control that they want. Unfortunately, there is so much pressure from natural childbirth advocates telling women that they are somehow "less of a woman" if they need an epidural or c-section that it can be hard to have a frank discussion about what the individual woman wants and what her fears are. Women are made to feel guilty, ignorant, and selfish for caving in and obtaining adequate pain control (epidural) or "failing" to deliver vaginally.

- pod

They essentially want to avoid a cloaca...