Epidural anesthesia during childbirth: pros and cons, consequences, reviews

2024 Author: Priscilla Miln | [email protected]. Last modified: 2023-12-16 00:21

The birth itself for every woman is not as easy as it might seem. In addition to the fact that at this moment the load on the body falls to the maximum, 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. One of these is epidural anesthesia for childbirth (EA).

This technique has not yet been fully studied, and therefore here you can find both supporters and opponents. However, in order to make an important decision, it is necessary to find out what advantages and disadvantages such a procedure has. But an equally important point is what complications can be, both in relation to the mother and the child. Let's tryreveal all this and some more in the topic of this article.

General information

Pain during childbirth is experienced by almost every woman, and its intensity depends on several factors:

• The psychological state of the expectant mother.
• On how long contractions last and how intense they are.
• On how fast the cervix dilates.
• The age of the woman.

Severe pain provokes an appropriate reaction in all organs and systems, which adversely affects the condition of the woman herself and her child. Where do these feelings 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, let's introduce a little theoretical part. Depending on the location of the receptors that perceive the impact 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 straight to various parts of the main head organ. Due to this, part of the information is perceived by 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 muscular, cardiac, vascular, endocrine and other reactions.

The question may arise - what does epidural anesthesia have to do with childbirth and what is its essence? A little patience. The nerve pathways that conduct impulses during childbirth are presented as follows:

• One canal starts from the uterus and goes to the spinal cord in the area from the 10th thoracic to the first lumbar vertebrae.
• Another nerve canal falls on the area 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 irritation of the perineal tissues.

The main task facing anesthesia is to reduce the intensity of pain or interrupt impulses passing to the spinal cord and then to the brain. Thus, it is possible to reduce or completely eliminate the negative response of the female body and the fetus.

What is EA?

Under epidural anesthesia during childbirth, it is customary to understand regional anesthesia that blocks pain in a certain area. Its purpose is precisely analgesia, while anesthesia leads to a complete loss of sensation. In other words, EA produces a blockage of nerve impulses within the lower vertebrae of the spinal cord, due to which the intensity of sensations decreases.

To do this, special preparations of the group of local anesthetics are introduced into the epidural space using a catheter. Often thisBupivacaine or Ropivacaine. Moreover, they are administered in combination with opioid analgesics like Fentanyl or Sufentanil. This reduces the required dose of local anesthetic.

In order to prolong the action of the analgesic and stabilize blood pressure, drugs such as Epinephrine or Clonidine are used.

Benefits of the EA procedure

On the net you can find a wide variety of reviews about epidural anesthesia during childbirth, which can confirm the presence of certain advantages. The obvious pros are:

• Pain relief for childbirth. The intensity of pain is reduced, which allows the 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 level of oxygen in the plasma of the pregnant woman and the fetus.
• Adrenaline drops. Its high concentration leads to an increase in muscle contractions and hyperventilation of the lungs, due to which the uteroplacental blood flow is disturbed.
• The cervix dilates smoothly. In this case, the head of the child and he himself moves gently through the birth canal. Injected drugs do not penetrate into the woman's blood, therefore, do not reach the fetus. The substance is localized only in the subdural space of the spinal cord.

Epidural anesthesia for natural childbirth has been used for quite a long time and in many countries around the world. However, like any medicalprocedures, and this one has side effects. Although they are rare, the expectant mother simply must know about their existence.

There are also disadvantages

Now it's the turn to the minuses of EA, which are also present:

• Headaches may occur, but the root cause is often a misplaced catheter.
• With EA, blood pressure decreases, which can cause oxygen starvation (hypoxia) of the placenta and, as a result, the fetus. This can lead to squeezing of large vessels, since the woman is constantly in a supine position. Monitor pressure readings (every 30 minutes) and add fluid if necessary.
• The procedure is performed under sterile conditions, but despite this, there is a risk of infection at the puncture site. Then it threatens with various consequences of epidural anesthesia during childbirth. Therefore, sometimes it is necessary to undergo antibiotic treatment.
• Hematoma (accumulation of blood) may occur, which can usually be associated with damage to a vessel during a puncture. After a while, it dissolves.
• Possible allergy to anesthetic. After the anesthetist has placed the catheter, they will need to administer a trial dose of medication to check for an allergic reaction.

Therefore, every pregnant woman, in addition to the obvious pluses, needs to know about the minuses in order to make an informed decision.

Opinion of mothers

To understand how numerous women feel about EA, just visit any forum,dedicated to various pregnancy topics, including the possibility of anesthesia. Some note its positive effect due to its advantages, while others prefer natural childbirth. And, judging by some reviews, epidural anesthesia during childbirth scares them a little by carrying out the procedure itself, because the injection is made into the spine. As many mothers note, EA has long been a practice in the US countries, while in our country there is no significant progress in this area yet.

The rest are discussing the feasibility of such a procedure and comparing EA with other types of pain relief. Of course, many are concerned about the price of the issue.

Indications for the procedure

Because epidural anesthesia belongs to the category of medical procedures, after which complications can begin, doctors try to do without it. At least as far as possible. On the territory of 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:

• Premature pregnancy (about 37 weeks) - the woman's pelvic floor muscles are in a relaxed state, which allows the baby's head to pass freely through the birth canal, perceiving minimal overload.
• High blood pressure or preeclampsia - 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 reductionsections of the uterus of varying intensity, which is why there is no coordination of contractions between them. This usually leads to excessive contractile activity of the muscles of the uterus and the psychological stress of the woman. Due to EA, the intensity of contractions decreases, and the woman can relax.
• Long labor - it is impossible to maintain a relaxed state of the body for a long period of time, which is undesirable during childbirth. Therefore, if the process is expected to be lengthy, then epidural anesthesia during childbirth will be the best way for proper rest and recuperation.
• Caesarean section.

Thus, it is clear that this is not so much an indication for such anesthesia as a necessary measure depending on the situation.

When EA should not be done

We got acquainted with the testimony, but not every woman may be suitable for such a procedure, since there are some contraindications:

• Lower blood pressure - up to 100 mm Hg. st.
• Deformity or injury to the spine.
• Inflammatory process at the puncture site.
• Poor blood clotting.
• Reduced platelet count.
• Allergic reaction to anesthetic, including local.
• Diseases in a woman of a neurological nature.

As a result, the doctor needs to discuss all the nuances with the woman and get acquainted with her tests.

This will decide whether it is possible for the future mother to alleviate her condition duringchildbirth with EA or other options need to be explored. Otherwise, the consequences of epidural anesthesia during childbirth cannot be avoided, and the reviews confirm this, since, unfortunately, there were precedents.

Features of the EA procedure

Only anesthesiologists who have already passed the required level of training and have sufficient experience are en titled to conduct EA. The ward should contain everything necessary for constant monitoring of a woman and her child, general anesthesia. In addition, there should be an opportunity for intensive care and resuscitation.

Throughout the entire procedure, and then several days after its completion, the woman should be under the supervision of an obstetrician-gynecologist and an anesthesiologist. And if there are no contraindications and the woman agrees to such anesthesia, there are no reasons for refusal.

EA procedure

Before performing an EA procedure, the anesthesiologist must examine the woman and psychologically set her up. Familiarize yourself 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 insert a catheter, a woman can take a supine or sitting position. In the first case, the expectant mother should lie on her side and preferably the left one, her knees should be brought as close to her stomach as possible (as far as possible). In this position, the back arches, due to which the space between the vertebrae increases at the puncture site. In the second case, the woman bows her head to her knees andthe back is also arched.

To exclude pain from the injection, anesthesia of the skin and subcutaneous tissue is first done with "Lidocaine" or "Novocaine" using a thin needle. After that, 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 a needle is inserted and a thin catheter is inserted through it, which is fixed. Everything takes 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 the woman may feel the uterus tense with each contraction.

Consequences of epidural anesthesia after childbirth for mom

As with any medical intervention, epidural anesthesia can also be accompanied by various complications. Although they are rare and most of them are related to women's he alth problems.

A real case can be taken as an example. The woman had impaired blood clotting, which is a contraindication for the procedure. However, the doctor allowed her to be anesthetized, 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 possiblea complication is when cerebrospinal fluid leaks into the epidural space. In another way, it is called as 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 for several days or months. So think after that 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 spasms or even memory loss.

How can you understand the risk is always there and then as lucky. For this reason, only experienced professionals who know their business exactly are allowed to conduct EA.

Possible threat to baby

Epidural anesthesia can affect not only the woman herself, but also her child. Of course, it is good when childbirth proceeds in the absence of pain, but this particular procedure can have its negative impact:

• The number of heartbeats may decrease due to reduced blood supply through the uterus and placenta. In this case, an emergency caesarean section may be necessary.
• Babies born may have impaired breathing requiring mechanical ventilation, sometimes including intubation.

But these are not the only consequences of epidural anesthesia during childbirth for a child. In addition, there is a high risk of developing encephalopathy - 5 times higher than at birth in the absence of anesthesia. As a result, the child may be disoriented, his coordination is disturbed.movements, motor skills, sucking is difficult and a number of other undesirable consequences.

Besides, childbirth is a rather unpredictable process, where different things can happen, and medical intervention can almost always lead to some risk. Therefore, it is not worth doing such anesthesia just to get rid of pain, only if there are serious medical indications for this. In this case, it is already a necessity.

In addition, during childbirth, the psychological and emotional connection of the child with the mother is disrupted, which can have a bad effect on his perception: he may feel abandoned.

Epidural anesthesia for childbirth: pros and cons

Worth it or not to carry out this kind of anesthesia? It is impossible to answer this question unambiguously due to various circumstances. As noted above, in some situations such a procedure is simply indispensable. Therefore, the first thing a woman should do is think things over carefully, confidently weigh all the possible risks and listen to her inner voice. If there is any doubt, it is best to refuse.

However, in the presence of certain medical indications and in the case when a woman is unable 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 naturally. Moreover, this will strengthen the bond between mother and child.

There is no guarantee howPrecisely will pass childbirth after epidural anesthesia. Is it still possible to make your choice in favor of the natural process? After all, for all the time while 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.