Spinal block - Pain medication, usually a narcotic, is injected directly into the spinal fluid. The procedure takes about five to 10 minutes to complete. Pain relief is immediate. A spinal anesthetic "blocks" sensation from the waist down. Unlike an epidural, the effects of a spinal block last only a few hours.
Combined spinal/epidural - This was the method of pain control used in the Northwestern University study. This one-two punch pain reliever is performed simultaneously. The spinal anesthetic is injected immediately. Once the effects of the spinal block begin to wear off, the epidural medication is then administered in dose increments.
The advantage of using both approaches is that patients can get immediate pain relief with the spinal block and still be able to walk around, since the medicine injected-narcotics-- do not cause muscle weakness. Once the epidural medication is delivered, leg muscles may be affected, depending on the epidural dose, and the patient may need assistance moving about.
The combination has been coined the "walking epidural," and has been popularized in the United Kingdom, explains anesthesiologist Jeffrey Katz of The University of Texas Medical School at Houston . It gained favor from the theory that walking sped along labor and delivery. "In surveys, the majority of American women have repeatedly rejected the idea of walking through their labors and studies have not consistently supported the notion that walking shortens the birth process," Katz says.
Systemic drugs - Pain medication, usually a narcotic like Demerol or a tranquilizer, is given to the patient intravenously. The medication affects the entire body, rather than just at the source. As a result, systemic drugs mostly relax the patient rather than completely block the pain of contractions. One disadvantage of systemic drugs is that they cross the placenta, and can affect the baby. The baby may be sleepier after delivery, which can interfere with initial attempts at breastfeeding.
UPDATED: 5-06-2005
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Dr. Larry Gilstrap is chairman of the Department of Obstetrics and Gynecology at the UT Medical School.
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Special Instructions for Children Being Vaccinated Against Flu for the First Time:
Children 6 months up to 9 years of age getting a flu vaccine for the first time will need two doses of vaccine the first year they are vaccinated. If possible, the first dose should be given in September or as soon as vaccine becomes available. The second dose should be given 28 or more days after the first dose. The first dose "primes" the immune system; the second dose provides immune protection. Children who only get one dose but who need two doses can have reduced or no protection from a single dose of flu vaccine. Two doses are necessary to protect these children. If your child needs two doses, begin the process early, so that children are protected before influenza starts circulating in your community. Be sure to follow up to get your child a second dose if they need one. It usually takes about two weeks after the second dose for protection to begin.
Because flu viruses change every year, the vaccine is updated annually. So even if you or your children got a flu vaccine last year, you both still need to get a flu vaccine this season to remain protected. If October and November slip by, and you haven’t gotten your children or yourself vaccinated, get vaccinated in December or later.
