UW News

April 16, 1999

New “walking epidural” technique developed at UW Medical Center

Labor can be one of the most important and gratifying experiences in a woman’s life — as well as one of the most painful and uncontrollable. Thanks to new developments in anesthesiology, for many new mothers this is no longer the case. Recently, anesthesiologists at University of Washington Medical Center have refined the “walking epidural” technique by using meperidine (Demerol), thus minimizing uncomfortable side effects that can occur with commonly used pain control techniques.

Most walking epidural techniques use a combined spinal and epidural anesthetic, which involves puncturing the dura (the outermost membrane surrounding the spinal cord) with a thin needle and injecting medication into the spinal fluid. Sometimes spinal fluid can leak out and give women a headache, which can be fairly incapacitating, says Dr. Cliff Chadwick, associate professor of anesthesiology and director of obstetric anesthesia at UW Medical Center. “We do not puncture the dura but instead inject medication into the epidural space outside the dura,” he says.

Although the new technique might take five minutes longer to provide pain relief, there are very few side effects, such as the itching, nausea or vomiting that often occurs with other techniques, according to Chadwick.

The walking epidural was developed several years ago for women seeking a milder form of epidural pain control that would allow them to retain sensation in the legs and pelvic area, giving them the freedom to sit in a chair or walk to the bathroom.

Traditional epidurals generally use local anesthetics, but it has been found that epidural opioids (synthetic narcotics for pain control) work well for early labor. Therefore the walking epidural primarily uses opioids with little or no local anesthetic. “Spinal opioids are unique in that they interfere with pain sensation but not with normal motor and sensory function,” says Chadwick.

A walking epidural allows the pelvic muscles to function normally. In addition, some studies have suggested that walking may shorten labor. The only disadvantage of walking is that monitoring the baby is more inconvenient, unless a telemetry device is used, says Chadwick.

The first time a woman tries the walking epidural, she is supported by a nurse who has already assessed the patient?s blood pressure and strength to ensure she is not likely to fall. After that she can walk with a partner.

The walking epidural works best during the early stage of labor, when the cervix is dilated less than 5-6 cm. Typically a woman may choose to walk during the first few hours of active labor. At some point, most women will request additional pain relief and stronger medication will be required.

“The key is that women can decide how much anesthesia they want,” says Chadwick. “Experience has shown that in the later stages of labor, most women are no longer interested in walking.”

Expectant mothers interested in learning more about the walking epidural and other pain relief options may contact Sue Huth, perinatal education co-coordinator at UW Medical Center, at (206) 598-4003.