Virtually all women who are in thesoon become mothers, experience a certain fear and anxiety before the pain that almost inevitably accompanies the process of the appearance of crumbs. And, of course, all pregnant women without exception worry about the question of how to ease this condition and reduce the intensity of pain. To date, medicine offers a fairly large number of the most diverse methods of anesthetizing labor. However, not all of them are equally good and popular - something doctors use more often, something - less often. And more often epidural anesthesia is used during childbirth. It is about her that will be discussed in today's article - indeed, like any medical procedure, it has not only positive aspects, but also negative, side effects and contraindications. So, its use is not always appropriate in all cases.
Principle of operation of this method
So what is epidural anesthesia? Let's try to understand the mechanism by which epidural anesthesia operates. The essence of this method of anesthesia lies in the introduction into the epidural space of a potent analgesic drug. Epidural space is the interval that is immediately under the dense shell of the spinal cord lining the vertebral canal from the inside. It is in this gap that there is a huge number of spinal cord nerves that are responsible for the delivery of 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 the optimal coordination of the work of all organs and systems. The doctor makes a puncture of the spinal cord and introduces a special anesthetic drug. The puncture is made in the lower part of the spine, at the level of the lumbar region. It is in this area that the spinal cord itself ends, and in the epidural space there are only spinal cord nerves. It is these roots that transmit to the central nervous system painful impulses not only from the contracting uterus, but also from all organs located in the small pelvis. As mentioned above, in recent years, epidural anesthesia in obstetrics has become more and more firmly established, due to its numerous advantages. For example:
- The woman is always conscious, able to respond adequately to what is happening around, to follow the recommendations of 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 by all women without exception, because naturally occurring births do not require active intervention from the outside. Therefore, in order to apply epidural anesthesia during childbirth, there must be strict contraindications. These include:
- Premature birth
In the event that a child is bornbefore the due date, the doctor can decide on the need for epidural anesthesia. This is necessary in order to relax the muscles of the pelvic floor as much as possible. This will reduce to a possible minimum the resistance, which in the process of moving through the birth canal will meet the head of the crumbs. This progress will be mild and gradual, due to which the likelihood of a child getting birth trauma will decrease several times.
- Surgery with surgery
Sometimes the generic process requires an operationalinterventions, for example, with breech presentation of the fetus, or with multiple pregnancies. And in this case, of course, the best way is to use epidural anesthesia.
- Chronic Maternal Diseases
There are a number of chronic diseasesmothers who reduce the tolerability of pain. In addition, because of them, it becomes impossible to conduct other methods of anesthesia. For example, some diseases of the respiratory system exclude the possibility of inhalation anesthesia, and the tendency to allergic reactions is the use of drugs for intravenous anesthesia.
- Violation of labor
Sometimes it happens that a woman giving birthfeels the strongest pain sensations, and fights are very unproductive - the cervix of the uterus does not open. As a rule, this is due to the fact that the work of the uterine muscles is discordant - they are not contracted synchronously, but in disagreement. And conducting epidural anesthesia in 98% of all cases very quickly leads this process back to normal, and allows a woman to rest a little from extremely painful in such cases of fights.
How is epidural anesthesia performed?
Despite the fact that almost all womenhave heard about the benefits of epidural anesthesia, many of them are pathologically afraid of the procedure itself. And most often this is due to the banal lack of necessary information about how this procedure is going on. Ideally, before it is carried out, the anesthesiologist should explain in detail and in an accessible language to the woman giving birth, what he intends to do, and what result he plans to achieve. Incidentally, epidural anesthesia during childbirth can only be carried out with the consent of the woman giving birth. She must sign the papers in which she agrees to carry out this procedure of anesthesia. After all the formalities are settled, the doctor will proceed directly to conducting epidural anesthesia. To do this, a woman must either sit on a chair, turning her face to the back, or lying on her side, pulling her legs as tight as possible to her belly. Thus, the doctor will receive the necessary access to the area in which the anesthetic drug will be administered. The site of the proposed puncture is carefully treated with an antiseptic solution, for example, iodine or alcohol. After this, local anesthesia will be done - the anesthetic will be injected under the skin, due to which the nerve endings of the skin and subcutaneous tissue lose their sensitivity. And only after that the doctor will start to introduce the needle into the meninges. Thus, a woman will not experience pain - and that's what many mothers are afraid of. After the needle enters the brain, the doctor will feel quite substantial resistance. The doctor will stop injecting the needle and along it, as a guide, he will insert a catheter - a soft silicone tube that does not damage the meninges. It will be given an anesthetic medicine, as it is needed. Anesthesia will begin to act fairly quickly - in about 15 to 20 minutes. Typically, epidural anesthesia is used to animate the very longest and most painful period of labor - the first, the period of opening the cervix. As a rule, epidural anesthesia is performed earlier than the cervix will open up to four centimeters, it is inadvisable. However, if there is a speech and discoordination of labor, the doctor can conduct it earlier, in order to normalize the process and reduce the suffering of a woman giving birth. As the anesthetic drug begins to act on the spinal roots, the contractions become practically useless. And, in addition, in almost all cases, doctors note that under the influence of epidural anesthesia, the cervix begins to open much more intensively. So, the first period will take much less time. But, nevertheless, the second period of labor is almost always extended - an exaggerated one. That is why, most often about half an hour before the alleged start, attempts by anesthesiologist either completely stop the injection of an anesthetic drug, or reduce its dosage to the minimum. In the same case, if during the birth the woman develops either ruptures or perineal incisions, after the appearance of the crumb on the light, the dosage of the medicine will again be increased and the doctors will be able to painlessly apply seams to the tears. However, in some cases, the cessation of the medication is not done at all - for example, when conducting cesarean section, or if necessary, completely eliminate the excruciating period - for example, in heart defects in the mother, nearsightedness, the use of obstetric forceps.
Contraindications to the use of epidural anesthesia
Whatever positive properties did not haveepidural anesthesia during childbirth, it, like any other medication, has a number of contraindications - factors in which this method of anesthesia is unacceptable. Contraindications include:
- Loss of the woman in the womb of consciousness before the epidural anesthesia.
- Significantly lowered arterial pressure - 100 mm Hg. Art. 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 the childwas born by caesarean section, my mother could not see him in the first minutes of life, as she is under the influence of general anesthesia. In recent years, more and more operations are performed under epidural anesthesia. And this is a very good way of anesthesia, since my mother will be able to see her baby in the first few seconds after delivery, and can also apply to the breast. Unfortunately, many women refuse cesarean section with epidural anesthesia, because they fear that they will experience strong pain. However, this is not so - the concentration of the drug in this case will be much higher, and anesthesia will be absolute, the woman will not feel anything.
Side effects and complications of epidural anesthesia
In some cases, fortunately, it is rare enough,epidural anesthesia during childbirth can lead to certain side effects. One of the most common ones is a significant decrease in blood pressure. As a result of a strong decrease in blood pressure, the quality of blood flow in the placenta decreases, and as a result, hypoxia. In order to avoid this, physicians inject intravenously saline. Another danger that can lie in wait for a woman is an allergic reaction to a medication used in epidural anesthesia. In order to avoid this undesirable reaction, the anesthesiologist will administer a small amount of medication before conducting epidural anesthesia. After that, for a certain time, the doctor will closely monitor if the unwanted negative consequences from the part of the body of the pregnant woman follow. In some cases, a number of complications are directly related to the complexity of manipulation. In the event that the inner sheet of the hard shell was accidentally punctured, and as a result, the medicine got into the spinal canal, the level of arterial pressure can sharply and critically decrease, the breathing process becomes more difficult. Very often a woman who is in need of epidural anesthesia fears that the doctor injures the spinal cord with a needle. In fact, this can not be done, since it is much higher than the puncture site. The only thing that can be caught with epidural anesthesia is the nerve roots. In the event that the catheter touches the nerve root, the woman will feel a sharp shooting pain in one of the legs. She should immediately tell your doctor about it, which will immediately change the position of the catheter. In very rare cases it happens that the pathogenic microflora penetrates into the place where the puncture was performed. Sometimes this leads to the development of a local inflammatory process, and sometimes - to meningitis, inflammation of the meninges. Fortunately, this happens rarely - and successfully lends itself to medical treatment. Discussing such a delicate issue as epidural anesthesia for and against, one can not mention a phenomenon such as a headache. Indeed, many women are really on the second - third day after childbirth can begin to hurt your head. This is due to the fact that the cerebrospinal fluid enters the epidural space. As a rule, the pain disappears on its own, without any interference from outside, in about two to three weeks. In fact, all these side effects are extremely rare, so they should not be feared. And at the same time, the decision on the possibility and appropriateness of using epidural anesthesia in each case should only be taken by an anesthesiologist. He will choose the most optimal variant of anesthesia in childbirth, suitable for you. We advise you to read: