Probably, without exception, primiparous future mothers are afraid of the upcoming birth. A considerable share of horror stories that friends share and dazzle online forums make up stories about how painful labor and childbirth are painful.
Of course, the sensations that a woman experiences during labor can hardly be called pleasant, but they help to truly understand and realize the birth of a new life. However, today it is possible to bypass natural mechanisms and significantly simplify the life of a woman in labor, using epidural anesthesia during childbirth.
What is epidural anesthesia?
In the lumbar spine, in the epidural space (inside the spinal canal, between its outer wall and the solid membrane of the spinal cord), the spinal roots exit. It is on them that the transmission of nerve impulses from the pelvic organs occurs, including the uterus.
The injected painkillers block the transmission of pain impulses to the brain, thereby allowing the laboring woman not to feel the contractions. However, the dose is calculated so that the woman in labor did not feel anything below the belt, but could move independently. Epidural anesthesia during childbirth allows a woman to be fully conscious.
It is worth noting that the effect of epidural anesthesia, if there are no specific indications, applies only to contractions during the period of cervical dilatation. The period of attempts and the childbirth itself, the woman passes without anesthesia.
Epidural and spinal anesthesia: what is the difference?
Sometimes these two types of anesthesia are confused, which is not surprising, since they are very similar in appearance. The difference between spinal anesthesia is that more current needle is used, and the anesthetic is injected into the spinal fluid below the level of the spinal cord, therefore, the mechanism of drug action is somewhat different than with epidural anesthesia. In addition, the latter is considered safer for complications.
If the anesthesia is performed for medical reasons, it is done for free. In the case when a woman decides to give birth with epidural anesthesia, the price of this procedure will be about 3,000–5,000 rubles, depending on the hospital.
1. To make a puncture, a woman needs to sit down, bending her back, or lie on her side and curl up. In other words – to provide maximum access to the spine. And you need to really try not to move at all – to stand still in a position that the anesthesiologist can determine and be prepared for the fact that you will feel some short-term discomfort (at this moment it is important not to step back from the doctor). The more immobile you are, the less the risk of complications after epidural anesthesia.
2. The puncture area is thoroughly treated with an antiseptic solution.
3. An ordinary anesthetic injection is done in order to remove the sensitivity of the skin and subcutaneous fat in the place of the upcoming puncture.
4. The anesthesiologist punctures and inserts a needle into the epidural space of the spine until it reaches the dura mater.
If you feel that during the manipulation of the fight should begin – be sure to inform the anesthesiologist about it, he will stop. Remember: your main task is not to move!
Also tell your anesthetist if you feel any changes in your condition. These can be: numbness in the legs or tongue, dizziness, nausea and
5. A needle is used to hold a thin silicone tube – a catheter – through which painkillers enter the epidural space. The catheter remains in the back for as long as the analgesic effect is necessary. With him, a woman can move freely, but sudden movements should be avoided. During the birth itself, the catheter will also be in the back of the woman in labor.
While entering the catheter, you may feel a “backache” in the leg or back. This is normal – it means the tube touched the nerve root.
6. The needle is removed and the catheter tube is attached to the back with adhesive tape.
7. Trial delivery of a small amount of anesthesia is performed to check for inadequate body reactions.
8. After the delivery, the catheter removes the back of the happy mother, the puncture site is sealed with adhesive tape and recommends that the woman remain in a prone position for some time, this is necessary to minimize the risk of possible complications after epidural anesthesia.
Puncture and installation of the catheter take about 10 minutes. Act drugs usually begin within 20 minutes after administration. Many women are afraid of the possibility of spinal manipulation, as a rule, everyone wonders if epidural anesthesia hurts. We hurry to give you rest, rozhanitsa feel quite tolerable discomfort that will last only a few seconds. Subsequently, even when moving, the catheter is not felt.
The introduction of painkillers is possible in two modes:
- continuously, at short intervals – in small doses;
- once, with a repeat if necessary after 2 hours – while the drugs are in effect, the woman is recommended to lie down, as the vessels of the legs dilate, and the outflow of blood to them can lead to loss of consciousness if the woman gives birth.
What drugs are used for epidural anesthesia?
Commonly used drugs that are not able to penetrate the placenta: Lidocaine, Bupivacaine, Novocain.
Does epidural anesthesia affect the child’s health and labor?
At the moment, most experts believe that epidural anesthesia used during childbirth does not affect the child. The injected anesthetics do not penetrate the placenta and are not absorbed into the baby’s blood.
As for the generic activity, opinions diverge here. Some of the practicing anesthesiologists claim that anesthesia does not affect the course of labor, including the rate of disclosure, someone says that the speed of the first period of labor (cervical dilatation) increases, but the attempts become less pronounced. In any case, if anesthesia affects the labor, it is insignificant.
Indications for use
- Premature pregnancy. In this case, using the epidural anesthesia during childbirth, the pelvic muscles of the mother relax. This means that the child during the passage through the birth canal will be less resistance.
- Discordination of labor. This phenomenon occurs when there is contraction, but does not bring the desired effect: the muscles of the uterus contract incorrectly, not simultaneously, the disclosure of the cervix does not occur.
- Blood pressure is above normal. Anesthesia helps reduce and normalize pressure levels.
- The need for surgery (multiple pregnancy, too large child) or inability to perform general anesthesia.
- Long and painful childbirth.
In the western clinic, epidural anesthesia during childbirth is often performed without indications, simply so that the giving birth woman experiences as little discomfort as possible. However, expert opinions on this are diametrically opposed.
As with any medical intervention, epidural anesthesia during labor has a number of contraindications:
- pressure anomalies: low arterial or elevated cranial;
- spinal deformity and difficult access for insertion of the catheter;
- inflammation in the area of potential puncture;
- coagulation disorder, low platelet count or blood infection;
- the possibility of obstetric bleeding;
- intolerance to drugs;
- neuropsychiatric diseases or unconscious state of the woman in labor;
- certain diseases of the heart or blood vessels; in this case, the possibility of epidural anesthesia is considered individually;
- Refusal of the woman from anesthesia.
Consequences and complications after epidural anesthesia during childbirth
Anesthetic penetration into the venous bed. In the epidural space there are quite a lot of veins, which creates the threat of penetration of drugs into the bloodstream. If this happens, the woman will feel weakness, dizziness, nausea, an unusual aftertaste, numbness of the tongue. We wrote about this above and have already said that in the event of any deviations in well-being, it is urgent to inform the anesthesiologist about this.
Allergic reactions. If a woman has not experienced various anesthetics (painkillers) before giving birth, then during anesthesia it may turn out that she is prone to allergies to one or another drug, which in turn is fraught with the development of anaphylactic shock (disruption of vital systems and organs) . In order to eliminate a strong attack of allergy, a minimum proportion of anesthetics is first administered.
To quite rare, but having a place, complications after epidural anesthesia become difficulty breathing. Complication arises from the effects of anesthetics on the nerves leading to the intercostal muscles.
Headache and back pain. Sometimes women complain that they have a backache after epidural anesthesia. There is pain as a result of a puncture of the dura mater with a needle and the entry of a certain amount of cerebrospinal fluid into the epidural space. Back pain after anesthesia develops, usually within a day, but there are cases when it lasts for months, the same can be said for headaches. Usually, this complication is treated in a medical way or by repeating a puncture and introducing a small amount of a woman’s own blood into the “leak” place to seal the puncture.
Drop in blood pressure and, as a result, “flies” in the eyes, a sharp attack of nausea or vomiting. To prevent this consequence of the use of epidural anesthesia during childbirth, it is usually necessary to put a dropper and recommend lying for a while after the puncture and insertion of the catheter.
Muscle hypotonus bladder and difficulty urinating.
What else is dangerous epidural anesthesia? I would not want to scare future moms who are waiting for epidural anesthesia during childbirth, but still need to mention that very rarely such complications arise after anesthesia, as paralysis lower limbs.
Unsuccessful epidural anesthesia
According to statistics, in 5% of cases of epidural anesthesia during labor, anesthesia does not occur at all, and in 15% of cases it occurs partially.
Why it happens? First, it is not always possible to get into the epidural space. The reason for this may be the inexperience of the anesthesiologist (although usually young doctors carry out manipulations in the presence of more experienced colleagues), the excessive completeness of the woman or the anomalies of the spinal column.
Secondly, a woman may not feel pain on the right or left. The so-called mosaic anesthesia occurs if the connecting walls in the epidural space prevent the spread of anesthetics. In this case, it is necessary to inform the anesthesiologist, he will increase the concentration of drugs, advise to turn on the side where the anesthesia did not work or will make another puncture.
Epidural anesthesia: the pros and cons
So, if you do not have any indications or contraindications for epidural anesthesia during labor, and you are considering this option in order to make the appearance of the long-awaited baby more comfortable, carefully weigh all the positive and negative aspects.
It should be clarified that we do not consider the advantages and disadvantages of epidural anesthesia during labor before other types of anesthesia, but we will try to analyze it in relation to natural childbirth without medical intervention.
Advantages of epidural anesthesia
- the ability to anesthetize the labor activity, to make the birth process as comfortable as possible for the mother;
- the opportunity to “take a breather”, to rest or even sleep if the delivery lasts a very long time;
- relieving the risk of increased pressure in women suffering from hypertension.
Cons of epidural anesthesia
- risk of complications of varying severity
- a sharp drop in pressure in hypotonic women;
- loss of emotional contact with the child; This item causes a lot of controversy – often moms who have had a successful birth with epidural anesthesia, treat this statement with a good deal of cynicism, however let’s try to look at it from the side.
During childbirth, not only does the mother experience enormous stress, but at least she is in the usual conditions, but the baby has to master a completely new world. No wonder that passing a child through the birth canal is called “exile.” The kid is subjected to the strongest stress, preparing and leaving the safest place, plunging into a completely unfamiliar and in many ways hostile environment.
When both mother and baby are in pain, it binds and unites them. Probably, every mother, in which the child was ill, would gladly share his suffering, because for her it is unbearable to look from the side at the torment of her baby.
The same thing happens in childbirth, although we do not see the state in which the child is about to be born, this is no reason to leave him alone in such a difficult moment. It is better to prepare for childbirth, to study the techniques of proper breathing and relaxation, and try to help not only yourself but the child in a natural way.
In addition, it is known that pain provokes the release of endorphin – the hormone of happiness and pleasure. In newborns, the production of this hormone is not possible, so during birth they get it from the mother. And if the mother does not feel pain, then there is no need for the hormone — the woman’s body does not produce it either for herself or for the child who still needs it.
So, if epidural anesthesia is shown to a woman, then there is no point in talking about the expediency of its use. If a woman is literally “crazy” from unbearable pain (usually it happens if there are any obvious or implicit complications), then anesthesia is also a necessity.
However, if nothing prevents the normal course, the expectant mother should carefully weigh the pros and cons of using epidural anesthesia during childbirth.
Perhaps it is worth going through the process defined by nature to feel the present unity with the child, fully share the miracle of birth with it, and, ultimately, completely eliminate the risks associated with medical intervention in such a fine system as the spine.