Almost all women who are about tosoon to become mothers, experience a certain fear and anxiety about the pain that almost inevitably accompanies the process of the birth of a baby. And, of course, all pregnant women without exception are concerned about the question of how to alleviate this condition and reduce the intensity of pain. Today, medicine offers a fairly large number of various methods of pain relief during childbirth. However, not all of them are equally good and popular - some doctors use more often, some - less often. And epidural anesthesia is increasingly used during childbirth. This is what will be discussed in today's article - after all, like any medical procedure, it has not only positive aspects, but also negative ones, side effects and contraindications. And therefore, its use is not appropriate in all cases.
Principle of operation of this method
So what is an epidural?Let's try to understand the mechanism by which epidural anesthesia works. The essence of this method of pain relief is the introduction of a strong painkiller into the epidural space. The epidural space is the gap that is located immediately under the dense membrane of the spinal cord lining the spinal canal from the inside. It is in this gap that a huge number of spinal nerves are located, which are responsible for delivering impulses from various internal organs to the central nervous system - to the brain and spinal cord. The same thing happens in the opposite direction - this allows for optimal coordination of the work of all organs and systems. The doctor punctures the membranes of the spinal cord and introduces a special painkiller. The puncture is made in the lower part of the spinal column, at the level of the lumbar region. It is in this area that the spinal cord itself ends, and only the spinal roots are located in the epidural space. It is these roots that transmit pain impulses to the central nervous system not only from the contracting uterus, but also from all organs located in the small pelvis. As mentioned above, epidural anesthesia in obstetrics has recently gained more and more ground due to its numerous advantages. For example:
- The woman is conscious all the time, is able to adequately respond to what is happening around her, and follow the recommendations of doctors and obstetricians.
- If necessary, the degree of intensity of anesthesia can be regulated, thereby ensuring a woman the opportunity to move fully.
- The medicine comes in very small doses,therefore it manages to destroy the liver almost in its entirety. And this means that the medicine does not have any negative impact on the child's body.
- Lack of an exit from anesthesia, which is quite a serious problem for many women.
Indications for epidural anesthesia
However, despite all the positive aspectsepidural anesthesia, it is not performed on all women without exception, because natural childbirth does not require active external intervention. Therefore, in order for epidural anesthesia to be used during childbirth, there must be strict contraindications. These include:
- Premature birth
In the event that a child is bornearlier than the due date, the doctor may decide on the need for epidural anesthesia. This is necessary to ensure that the pelvic floor muscles relax as much as possible. This will reduce to a possible minimum the resistance that the baby's head will encounter as it moves through the birth canal. This movement will be soft and gradual, which will significantly reduce the likelihood of the child receiving birth injuries.
- Surgery with surgery
Sometimes the birth process requires surgeryinterventions, for example, in breech presentation or multiple pregnancies. And in this case, of course, the best solution would be to use epidural anesthesia.
- Chronic Maternal Diseases
There are a number of chronic diseasesmothers, which reduce pain tolerance. In addition, they make it impossible to carry out other methods of anesthesia. For example, some diseases of the respiratory system exclude the possibility of inhalation anesthesia, and a tendency to allergic reactions - the use of drugs for intravenous anesthesia.
- Violation of labor
Sometimes it happens that a woman giving birthexperiences severe pain, and contractions are very unproductive - the cervix does not open. As a rule, this happens because the work of the uterine muscles is discoordinated - they contract unsynchronously, but out of sync. And epidural anesthesia in 98% of all cases very quickly brings this process back to normal, and allows the woman to rest a little from contractions that are extremely painful in such cases.
How is epidural anesthesia performed?
Despite the fact that almost all womenнаслышаны о преимуществах эпидуральной анестезии, многие из них патологически боятся самой процедуры. И чаще всего это происходит из-за банального отсутствия необходимой информации о том, как происходит эта процедура. В идеале перед ее проведением врач – анестезиолог должен подробно и на доступном языке объяснить рожающей женщине, что он намерен делать, и какого результата он планирует достигнуть. Кстати говоря, эпидуральная анестезия при родах может проводиться только с согласия самой рожающей женщины. Она должна подписать бумаги, в которых она выражает свое согласие на проведение этой процедуры обезболивания. После того, как все формальности будут улажены, врач приступит непосредственно к проведению эпидуральной анестезии. Для этого женщина должна либо сесть на стул, повернувшись лицом к спинке, либо лечь на бок, максимально близко подтянув ноги к животу. Таким образом, врач получит необходимый доступ к области, в которую и будет введен обезболивающий препарат. Место предполагаемого прокола тщательно обрабатывается антисептическим раствором, например, йодом или спиртом. После этого будет сделано местное обезболивание – анестетик введется под кожу, за счет чего нервные окончания кожи и подкожной клетчатки теряют свою чувствительность. И только после этого врач приступит к введению иглы в мозговые оболочки. Таким образом, женщина не испытает болевых ощущений – а ведь именно этого и боятся многие роженицы. После того, как игла войдет в мозговую оболочку, врач почувствует достаточно существенное сопротивление. Врач прекратит введение иглы и по ней, как по проводнику, введет катетер – мягкую силиконовую трубку, которая не повредит мозговые оболочки. По ней и будет подаваться обезболивающее лекарство, по мере его надобности. Анестезия начнет действовать достаточно быстро – примерно через 15 – 20 минут. Как правило, эпидуральную анестезию используют для того, чтобы обезболить именно самый продолжительный и самый болезненный период родов – первый, период раскрытия шейки матки. Как правило, проводить эпидуральную анестезию раньше, чем шейка матки откроется до четырех сантиметров, нецелесообразно. Однако в том случае, если идет речь и дискоординации родовой деятельности, врач может провести ее и раньше, чтобы нормализовать процесс и снизить страдания рожающей женщины. По мере того, как обезболивающий препарат начнет действовать на спинномозговые корешки, схватки становятся практически бесполезными. А, кроме того, практически во всех случаях врачи отмечают, что под воздействием эпидуральной анестезии шейка матки начинает открываться гораздо интенсивнее. А значит, первый период займет гораздо меньше времени. Но, тем не менее, практически всегда удлиняется второй период родов – потужной. Именно поэтому чаще всего примерно за полчаса перед предполагаемым началом потуг врачи – анестезиолог либо полностью прекратит введение обезболивающего препарата, либо же снижает его дозировку до предельного минимума. В том же случае, если во время родов у женщины образуются либо разрывы, либо разрезы промежности, после появления крохи на свет дозировка лекарственного препарата снова будет увеличена и врачи смогут безболезненно наложить на разрывы швы. Однако в некоторых случаях прекращение подачи лекарства не производится вообще – например, при проведении кесарева сечения, либо при необходимости полностью исключить потужной период – например, при пороках сердца у матери, близорукостью, применением акушерских щипцов.
Contraindications to the use of epidural anesthesia
No matter what positive properties it hasepidural anesthesia during childbirth, like any other medication, has a number of contraindications - factors in which this method of pain relief is unacceptable. Contraindications include:
- Loss of the woman in the womb of consciousness before the epidural anesthesia.
- Significantly low blood pressure - 100 mm Hg and below.
- Significant deformity of the spinal column.
- Problems from the circulatory system - a violation of blood clotting, extensive bleeding, infection of blood.
- Individual intolerance of the drug used to conduct epidural anesthesia.
- Exacerbation or severe course of neurological and mental illness.
- Refusal of the patient - it has already been mentioned above that this is an obligatory condition.
Epidural anesthesia during caesarean section
Not so long ago, if a childwas born by caesarean section, the mother could not see him in the first minutes of life, as she was under the influence of general anesthesia. In recent years, more and more operations are performed under epidural anesthesia. And this is a very good method of anesthesia, as the mother will be able to see her baby in the first seconds after birth, and she can also put him to the breast. Unfortunately, many women refuse a caesarean section with epidural anesthesia, as they are afraid that they will experience severe pain. However, this is not true at all - the concentration of the drug in this case will be much higher, and the pain relief will be 100%, the woman will not feel anything at all.
Side effects and complications of epidural anesthesia
In some cases, fortunately, it is enoughRarely, epidural anesthesia during childbirth can lead to certain side effects. One of the most common is a significant decrease in blood pressure. As a result of a strong decrease in pressure, the quality of blood flow in the placenta decreases, and, as a result, hypoxia. In order to avoid this, doctors intravenously infuse a saline solution. Another danger that can lie in wait for a woman is an allergic reaction to the drug used in epidural anesthesia. To avoid this adverse reaction, the anesthesiologist will administer a small amount of the drug before performing epidural anesthesia. After this, for a certain period of time, the doctor will closely monitor whether there are any undesirable negative consequences from the pregnant woman's body. In some cases, a certain number of complications are directly related to the complexity of the manipulation. If the inner leaflet of the hard shell was accidentally punctured, and as a result, the drug got into the spinal canal, the blood pressure may sharply and critically decrease, and the breathing process may become difficult. Very often, a woman who is about to have an epidural anesthesia is afraid that the doctor will injure the spinal cord with a needle. In fact, this is impossible, since it is located much higher than the puncture site. The only thing that can be touched with an epidural anesthesia is the nerve roots. If the catheter touches a nerve root, the woman will feel a sharp shooting pain in one of her legs. She should immediately tell her doctor about this, who will immediately change the position of the catheter. In very rare cases, it happens that pathogenic microflora penetrates into the place where the puncture was made. Sometimes this leads to the development of a local inflammatory process, and sometimes to meningitis, inflammation of the meninges. Fortunately, this happens rarely - and is successfully treated with medication. Discussing such a delicate issue as epidural anesthesia pros and cons, one cannot mention such a phenomenon as a headache. Indeed, many women really can start having a headache on the second or third day after childbirth. This occurs because the cerebrospinal fluid enters the epidural space. As a rule, the pain disappears on its own, without any external intervention, in about two to three weeks. In fact, all these side effects are extremely rare, so there is no need to worry about them. At the same time, the decision on the possibility and advisability of using epidural anesthesia in each specific case should be made only by a doctor - anesthesiologist. He will select the most optimal option for pain relief during labor, suitable for you. We recommend reading:
