The birth itself for each woman is not as easy as it might seem. In addition to the fact that at this moment the load on the body is at its maximum, so the mother herself experiences pain. And although this process is quite natural, almost every woman resorts to some means to facilitate the birth of a child. Epidural anesthesia during childbirth (EA) is one of these.
Such a technique has not yet been fully studied, and therefore both supporters and opponents can be found here. However, in order to make an important decision, it is necessary to find out what advantages and disadvantages such a procedure has. But no less important point is what complications can be, both in relation to the mother and the child. Let's try to reveal all this and some other in the subject of this article.
General information
Almost every woman experiences pain during childbirth, and its intensity depends on several factors:
- The psychological state of the expectant mother.
- From how long the contractions last and how intense they are.
- From how quickly the cervix opens.
- The age of the woman.
Severe pain provokes a corresponding reaction in all organs and systems, which adversely affects the condition of the woman herself and her child. Where do these sensations come from?
To understand whether epidural anesthesia has consequences during childbirth (for most mothers this is a very important and exciting question), as well as how it works, we introduce a little theoretical part. Depending on the location of receptors that perceive the effects of external stimuli, there are several types of sensitivity:
- Exteroceptive (pain, temperature and tactile). Information comes from the receptors of the skin and mucous membranes.
- Proprioceptive. These are receptors for joints, tendons, muscles, etc.
- Interoceptive. Here we are talking about internal organs, including blood vessels.
Most of the impulses through all channels enter the spinal cord, after which it is sent directly to various parts of the main brain organ. Due to this, part of the information is perceived by the consciousness, after which the body's response to a particular stimulus is formed at a conscious or reflex level. This manifests itself in the form of muscle, cardiac, vascular, endocrine and other reactions.
The question may arise - and where does epidural anesthesia during childbirth and what is its essence? A little patience. The nerve pathways that conduct impulses during childbirth are presented as follows:
- One channel starts from the uterus and goes to the spinal cord in the region from 10 thoracic to the first lumbar vertebrae.
- Another nerve channel is located in the region from the fifth lumbar to the first sacral vertebra. In this case, irritation of the pelvic organs occurs.
- The area from the second to the fourth sacral vertebra is responsible for the perineal tissue irritation.
The main task facing anesthesia is to reduce the intensity of pain or to interrupt the impulses passing to the spinal cord, and then the brain. Thus, it is possible to reduce or completely eliminate the negative response of the female body and fetus.
What is EA?
Epidural anesthesia during childbirth is understood to mean regional anesthesia, which blocks pain in a certain area. Its goal is precisely analgesia, while anesthesia leads to a complete loss of sensation. In other words, EA blocks nerve impulses within the lower vertebrae of the spinal cord, due to which the intensity of sensations decreases.
For this, special preparations of a group of local anesthetics are introduced into the epidural space using a catheter. This is often Bupivacaine or Ropivacaine. Moreover, they are administered in combination with opioid analgesics like Fentanyl or Sufentanil. This allows you to reduce the required dose of local anesthetic.
In order to prolong the effect of the analgesic and stabilize blood pressure, such drugs as Epinephrine or Clonidine are used.
EA Benefits
In the network you can find a wide variety of reviews about epidural anesthesia during childbirth, which can confirm the fact of the presence of certain advantages. The obvious pluses are:
- Anesthesia for childbirth. The intensity of pain decreases, which allows a woman to relax a bit and distract herself. And the importance of rest is simply invaluable - in this case, the mother breathes evenly, measuredly, the blood supply to muscle tissues and the placenta improves, which leads to an increase in the oxygen level in the plasma of the pregnant woman and the fetus.
- Adrenaline goes down. Its high concentration leads to an increase in muscle contractions and hyperventilation of the lungs, which is why uterine-placental blood flow is impaired.
- The cervix opens smoothly. In this case, the head of the child and he himself moves gently along the birth canal. The injected drugs do not penetrate the blood of a woman, therefore, do not reach the fetus. The substance is localized only in the subdural space of the spinal cord.
Epidural anesthesia in natural childbirth has been used for quite some time and in many countries of the world. Nevertheless, as with any medical procedure, this one has side effects. Although they are rare, but the expectant mother is simply obliged to know about their existence.
There are also disadvantages
Now the turn has come to the cons of EA, which are also present:
- Headaches can occur, but often their main reason lies in the incorrect placement of the catheter.
- With EA, blood pressure decreases, due to which oxygen starvation (hypoxia) of the placenta and, as a consequence, of the fetus can occur. Compression of large vessels can lead to this, since the woman is constantly in a supine position. It is necessary to monitor pressure readings (every 30 minutes) and, if necessary, infuse fluid.
- The procedure is carried out under sterile conditions, but, despite this, there is a risk of infection at the puncture site. Then it threatens with different consequences of epidural anesthesia during childbirth. Therefore, sometimes you have to undergo antibiotic treatment.
- A hematoma (accumulation of blood) may occur, which can usually be associated with damage to a vessel during a puncture. After some time, it resolves.
- Possible allergy to anesthetic. After the anesthetist has installed the catheter, he needs to administer a test dose of the drug to detect an allergic reaction.
Therefore, in addition to the obvious pluses, every pregnant woman needs to know about the minuses in order to make an informed decision.
Mother's opinion
To understand how many women relate to EA, it’s enough to visit any forum devoted to various topics of pregnancy, including the possibility of anesthesia. Some note its positive effect due to pluses, while others prefer natural childbirth. And, judging by some reviews, epidural anesthesia during childbirth scares them a little by the procedure itself, because an injection is made into the spine. As many mothers note, EA has already become a practice in the USA, while in our country there is no significant progress in this area.
The rest are discussing the feasibility of such a procedure and compare EA with other types of pain relief. Of course, many are concerned about the price of the issue.
Indications for the procedure
Since epidural anesthesia belongs to the category of medical procedures, after which complications can begin, doctors try to do without it. At least as much as possible. In our country, a woman decides whether or not to do this kind of anesthesia. At the same time, there are clearly regulated indications for epidural anesthesia during childbirth:
- Preterm pregnancy (about 37 weeks) - the pelvic floor muscles of a woman are in a relaxed state, which allows the baby's head to freely pass through the birth canal, perceiving minimal overload.
- High blood pressure or gestosis - in this case, such anesthesia is appropriate due to the fact that it reduces it.
- Discoordination of labor - this complication of pregnancy is characterized by a reduction in the sections of the uterus of varying intensity, which is why coordination of contractions between them is absent. This usually leads to excessive contractile activity of the muscles of the uterus and psychological stress of a woman. Due to EA, the intensity of contractions decreases, and the woman can relax.
- Long delivery - it is impossible for a long period of time to maintain a relaxed state of the body, which is undesirable during childbirth. Therefore, if the process is expected to last a long time, then epidural anesthesia during childbirth will be the best means for proper rest and recovery of strength.
- Cesarean section.
Thus, it can be seen that this is not such an indication for such anesthesia as a necessary measure, depending on the situation.
In which cases you can not do EA
We familiarized ourselves with the testimony, but not every woman can approach this procedure, since there are some contraindications:
- Low blood pressure - up to 100 mm RT. Art.
- Deformation or damage to the spine.
- The inflammatory process at the puncture site.
- Poor blood coagulation.
- Decreased platelet count.
- Allergic reaction to anesthetic, including local.
- Diseases in a woman of a neurological nature.
As a result of this, the doctor needs to discuss all the nuances with the woman and familiarize herself with her analyzes.
This will make it possible to decide whether the future mother can alleviate her condition during childbirth with the help of EA or whether other options should be sought. Otherwise, the consequences of epidural anesthesia during childbirth cannot be avoided, and reviews confirm this, because, unfortunately, there were precedents.
Features of the EA procedure
Anesthetists who have already passed the required level of training and have sufficient experience are entitled to conduct EA. In the ward there should be everything necessary for continuous monitoring of a woman and her child, general anesthesia. In addition, there should be an opportunity for intensive care and resuscitation.
Throughout the procedure, and then a few days after its completion, a woman should be monitored by an obstetrician-gynecologist and anesthetist. And if there are no contraindications and the woman agrees to such anesthesia, there are no reasons for refusal.
EA procedure
Before performing the EA procedure, the anesthetist must examine the woman and psychologically adjust her. To familiarize with all the pros and cons, find out the feasibility of anesthesia, and also obtain the consent of the mother herself. This will avoid the serious consequences of epidural anesthesia after childbirth.
To place a catheter, a woman can take a lying or sitting position. In the first case, the expectant mother should lie on her side and preferably the left, her knees should be brought as close to her stomach as possible (as much as possible). In this position, the back bends, due to which the space between the vertebrae increases at the puncture site. In the second case, the woman bends her head to her knees and her back is also arched.
To exclude pain from an injection, anesthesia of the skin and subcutaneous tissue with Lidocaine or Novocaine is made with a thin needle. After this, a catheter is inserted, the main thing is not to move or even breathe, so that the process goes without complications.
But before inserting the needle, the puncture site is treated with a disinfectant solution to prevent infection. Then the needle is inserted and through it a thin catheter, which is fixed. Everything takes from 5 to 10 minutes.
The analgesic effect occurs 10-20 minutes after the administration of the drug, while the woman may feel numbness and tingling in the lower extremities, and the contractions are weakened. There is no pain itself, but a woman can feel the uterus tensing with every contraction.
The consequences of epidural anesthesia after childbirth for mom
As with any medical intervention, epidural anesthesia can also be accompanied by various kinds of complications. Although they are rare and most of them are associated with problems in terms of women's health.
An example is the real case. The woman had blood clotting, which is a contraindication for the procedure. Nevertheless, the doctor admitted her to anesthesia, but as a result an epidural hematoma developed. Fortunately, there was no surgical intervention, and the hematoma resolved itself, but it took a month.
Another possible complication is when cerebrospinal fluid flows into the epidural space. In another way, it is called a puncture of the meninges, which is caused by the carelessness of doctors. As a result of such an oversight, a woman begins to worry about headaches, and they can last several days or months. So, then think about whether to do epidural anesthesia during childbirth or not?
In addition, the doctor may lead the wrong dosage of the drug in a big way. This can cause cramping or even memory loss.
As you can understand the risk is always there and how lucky. For this reason, only experienced professionals who know their job exactly are allowed to conduct EA.
Possible threat to the child
Epidural anesthesia can affect not only the woman herself, but also her baby. Of course, it is good when childbirth occurs in the absence of pain, but specifically this procedure can have its negative effect:
- The number of heart contractions may decrease due to a decrease in blood supply through the uterus and placenta. In this case, emergency caesarean section may be necessary.
- In children born, breathing may be impaired, requiring mechanical ventilation, sometimes including intubation.
But these are not the only consequences of epidural anesthesia during childbirth for the baby. In addition, there is a high risk of developing encephalopathy - 5 times higher than at birth in the absence of anesthesia. As a result of this, the child may be disoriented, his coordination of movements, motility is impaired, sucking and a number of other undesirable consequences are difficult.
In addition, childbirth is a rather unpredictable process where different things can happen, and medication intervention can almost always lead to some kind of risk. Therefore, it is not worthwhile to conduct such anesthesia just to get rid of the pain, only if there are serious medical indications for it. In this case, this is already a necessity.
In addition, during childbirth, the psychological and emotional connection of the child with the mother is disrupted, which can adversely affect his perception: he may feel abandoned.
Epidural anesthesia during childbirth: pros and cons
Is it worth it or not to carry out this kind of anesthesia? It is impossible to unequivocally answer this question due to various circumstances. As noted above, in some situations, such a procedure is simply indispensable. Therefore, the first thing a woman should think carefully is to weigh all possible risks with confidence and listen to her inner voice. If there is any doubt, it is better to refuse.
However, in the presence of certain medical indications and in the case when a woman is not able to endure pain, the answer suggests itself. But if a woman has no contraindications to such a procedure, and she herself feels confident in her abilities, childbirth can take place in a natural way. Moreover, this will strengthen the bond between mother and child.
There is no guarantee how the delivery will take place after epidural anesthesia. Perhaps, nevertheless, make your choice in favor of the natural process? Indeed, for all the time that the mother was carrying a baby in herself, his appearance will be the most joyful and long-awaited gift of fate and a reward for a difficult test at the same time.