Births from A to Z
Epidural anesthesia: making an informed choice
Many future mothers are afraid that medical interventions will be used in childbirth, including many fears related to epidural anesthesia. Is it really so dangerous for various complications for the woman and the baby?
Darya Volkova obstetrician-gynecologist, Moscow
Epidural anesthesia is a kind of anesthesia, when anesthetic is injected into the space under the hard shell of the spinal cord (into the epidural space). Epidural space separates the spinal cord and its membranes from the bone part of the spine. There is a blockage of pain impulses coming into the spinal cord, but the spinal cord is not affected.
Tribal pain refers to the most severe pain. Many women prepared for delivery manage to cope with it on their own. But, if the birth was very painful, anesthesia of labor is an aid - epidural anesthesia. In addition, there are medical indications when it is necessary to apply this kind of anesthesia.
When it is possible and when it is impossible to do epidural anesthesia?
In general, epidural anesthesia is carried out in the longest first period of labor, with increased pain from contractions. Usually it is done at the opening of the cervix at least 4 cm. If done earlier, violations of labor can develop, as it slows the opening of the cervix. And in the second stage of labor, in attempts, the effect of anesthesia should already be over. This is due to the fact that many muscles of the body are involved in the attempts: the diaphragm, the muscles of the abdomen and the thorax - and the woman must control this process herself. In addition, epidural anesthesia in childbirth lengthens the tedious period, so at the beginning of the anesthetist should stop the delivery of the drug.
If, for medical reasons, it is necessary to exclude an excruciating period (for example, there are changes on the fundus), anesthesia is performed during all deliveries.
After childbirth, if an episiotomy (cut of the perineum) was made, the anesthetic is resumed into the catheter and the perineum is anesthetized. During the suturing, the puerpera does not experience any sensations.
Indications for epidural anesthesia
Epidural anesthesia is a medical manipulation, after which complications are possible. Therefore, doctors try to do without it if possible. In our country, anesthesia is possible in childbirth at the request of a woman, but there are also clear medical indications for this manipulation:
Preterm pregnancy (for up to 37 weeks). At the same time, the muscles of the pelvic floor relax, the head of the premature baby experiences less overload and gently passes through the birth canal.
High blood pressure or gestosis (complication of pregnancy, characterized by increased pressure, swelling and the appearance of protein in the urine). Epidural anesthesia helps to reduce pressure.
Discordination of labor Is a complication of labor, in which different parts of the uterus contract with varying degrees of activity, that is, there is no coordination of contractions between them. It arises from the excessive contractile activity of the uterine musculature, and one of the reasons is the psychological strain of the woman. Epidural anesthesia during childbirth somewhat weakens the intensity of contractions, inhibits the action of oxytocin (a hormone that causes contraction of the muscles of the uterus), allows a woman to relax, due to what often occurs the restoration of labor.
Prolonged childbirth. The inability to fully relax for a long time leads to abnormalities of labor, therefore in the situation of prolonged delivery it is necessary to use anesthesia to give the woman a break and restore strength.
When epidural anesthesia can not be done?
Not all women in labor can use epidural anesthesia. As for any other medical manipulation, for her, too, there are a number of contraindications:
- Low blood pressure (less than 100 mm Hg).
- Deformations of the spine.
- Inflammation in the area of the alleged puncture.
- Violation of the blood coagulation system.
- An allergy in the past to anesthetics (even local ones).
- Neurological diseases of a woman.
Before making a choice in favor of epidural anesthesia, the specialist should talk with the mother and check all her tests.
Pros of epidural anesthesia
Anesthesia of childbirth, a decrease in the intensity of pain, the ability to relax and distract. During the rest, the woman breathes evenly, the blood supply of the placenta and the muscles of the uterus is restored, the concentration of oxygen in the blood of the mother and fetus increases.
The level of adrenaline, which increases muscle contraction and hyperventilation of the lungs (it violates uteroplacental blood flow) decreases. At the same time, there is no excessive load on the muscles of the uterus and the risk of development of discoordination of labor is reduced.
Erection of the cervix is easier - it opens smoothly, which makes it possible for the baby's head to gently move along the birth canal. The analgesic substance does not penetrate into the blood of the mother and baby, it spreads only through the subdural space of the woman's spinal cord. This kind of anesthesia only relieves the woman in childbirth from pain.
Epidural anesthesia during childbirth has long been used to help women in labor throughout the world. But, like any medical manipulation, she also has side effects. They happen rarely, but nevertheless the future mother should know about them.
The possibility of developing headaches and back pain. Such complications arise mainly when the catheter is misdiagnosed.
Epidural anesthesia lowers blood pressure, which can lead to oxygen starvation (hypoxia) of the placenta and fetus. In addition, because during epidural anesthesia a woman constantly lies (she does not feel the lower part of the body), large vessels are squeezed, which can also lead to hypoxia. In this case, blood pressure is monitored every half hour and adjusted if necessary by additional infusion of liquids. Usually puncture is performed under sterile conditions, but it is sometimes possible to get infection at the puncture site. In this case it is necessary to undergo a course of antibiotic therapy.
Hematoma (accumulation of blood) at the puncture site. This may be due to damage to blood vessels during puncture and clotting disorders. Over time, the hematoma dissolves.
Allergy to anesthetic. After the catheter is inserted, the anesthetist enters a trial dose of the drug to rule out an allergic reaction.
Thus, the maternity hospital staff should warn the woman about possible complications, and the mother in childbirth should evaluate all the pros and cons of this type of anesthesia.
Anesthesia in Caesarean section
To anesthetize the surgical intervention in labor, regional anesthesia (epidural, spinal) is currently used. Unlike general anesthesia, this kind of anesthesia allows a woman to remain conscious and in contact with doctors and her baby. In addition, there is no negative impact of narcotic analgesics on the body of mother and child (as with general anesthesia), which significantly reduces the process of rehabilitation after childbirth. The dose of the drug administered on the operating table is higher than during the natural delivery, so the woman can not move. Thus, she does not feel the moment of the cut at all. Sometimes, when the fetus is removed, the expectant mother feels sipping and raspiranie.
Cesarean section also uses spinal anesthesia. This manipulation is different in that the needle is injected deeper, piercing the hard shell of the spinal cord. Unlike epidural anesthesia, analgesia occurs almost immediately after the injection of an anesthetic. But the duration of anesthesia is not so great - about 30 minutes. But this time is enough for an operative intervention. This method is considered more dangerous, since there is a risk during the puncture to touch the spinal cord. Spinal anesthesia is used in the case of an emergency cesarean section, when there is no time to wait for the drug to act (for example, with acute fetal hypoxia).
Epidural anesthesia is a modern and safe method of anesthetizing labor. But sometimes it is accompanied by unpleasant side effects. Obstetricians-gynecologists advocate for the most natural birth and, if possible, recommend giving birth without medication, because only 15% of all women in labor really need anesthesia. But if you still need to resort to anesthesia, an experienced anesthesiologist will help to make the meeting with your baby as comfortable as possible.
Why is childbirth so painful?
Pain during labor. Contractions are contractions of the muscles of the uterus, leading to the opening of the cervix and the passage of the child through the birth canal. Painful sensations are caused by the pressure of the baby's head on the muscles of the perineum, on the muscles of the uterus. The uterine ligaments are tightened, the baby's head presses on the pain receptors.
Pain during attempts. There are active contractions of the uterine muscles, aimed at expelling the fetus from the uterus. This period is short, but due to the intensity of contractions, painful sensations become much stronger. But we must remember that only one-third of all sensations are due to physiological processes - muscle contractions, irritation of receptors, ligament tension. The remaining two-thirds are caused by the fear of a woman before giving birth.
Psychological stress. It is it that plays the leading role in obtaining pain. A woman is so afraid of pain that she becomes nervous, worried, unable to relax. This leads to an additional load on the muscles and increased pain.
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How is epidural anesthesia performed?
During the placement of the catheter, the woman lies or sits, bent over. The main thing at this moment is not to move, it is advisable not to breathe, so that the anesthesiologist can get to the right place and avoid complications. The lower back in the lower back is lubricated with a disinfectant solution to prevent infection. Then a needle is inserted into the target site and a very thin catheter is inserted through it and fixed to the skin. The whole process takes 5-10 minutes. If an additional dose of the drug is required, the anesthesiologist does this via an installed catheter. Anesthetic effect does not come immediately, but after 10-20 minutes. A woman can feel some numbness of the legs, tingling in the lower limbs, weakening of the fights. At the same time, she does not feel pain in the bouts, but she feels how the uterus strains during each contraction. If a woman is unaccustomed and difficult to get out of bed, she can just rest and even doze before the tight period. After the end of the drug all sensations are restored.