Yes, it is generally safe to have an epidural to deliver your baby with fetal and neonatal alloimmune thrombocytopenia (FNAIT). The use of an epidural is commonly recommended during vaginal births, including those of FNAIT-affected babies, to manage your pain during labor; it poses no risk to your baby. It is also used in a cesarean delivery to eliminate pain during surgery.
How does an epidural work?
An epidural is an anesthetic administered during labor to provide pain relief from contractions during a vaginal delivery or the surgical intervention of a cesarean delivery.
A long, thin needle is inserted into your lower spine, between the vertebrae, into an area called the epidural space, so a catheter that delivers pain relief can be placed. The pain medication consists of a local anesthetic and an opioid, which block pain signals from traveling to the brain. The delivery of the drugs can be adjusted to reduce or increase the flow as necessary.
The use of an epidural in FNAIT
The birth of your baby following a FNAIT-affected pregnancy is not without the risk of complications. Due to a low platelet level, your baby’s blood doesn’t clot as it should, and even minor birth trauma can lead to uncontrollable bleeding. Your healthcare team may choose a cesarean as the safest option for you and your baby.
However, unless your baby has experienced FNAIT-related complications during pregnancy, such as an intracranial hemorrhage (ICH), you may choose to proceed with a vaginal birth. The choice of an epidural may contribute to a less stressful and potentially less traumatic delivery for your baby. You will also recover more quickly, allowing you to participate more actively in the postnatal care of your baby.
Why not to have an epidural during a FNAIT delivery
The vaginal delivery of your FNAIT-affected baby needs to avoid instruments that might cause skin abrasions or internal trauma. Assisted delivery with forceps or a vacuum-assisted delivery bring the risk of causing a life-threatening intracranial hemorrhage. As an epidural may reduce your urge to push, a vacuum-assisted delivery may become necessary.
Learn more about FNAIT causes and risk factors
Can an epidural cause side effects for you?
Minor side effects have been reported and include a drop in blood pressure, shivering, feeling itchy and localized pain at the injection site. Less commonly, the epidural can be less effective or only work on one side of the body.
Will the drugs of the epidural affect your baby?
A small amount of medication will enter your bloodstream and can potentially cross the placenta. This won’t harm your baby, but may cause temporary sleepiness just after delivery.
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