A few days ago we informed you in detail about the main analgesic techniques (pharmacological or not) to better cope with the moment of delivery, and today we want to do the same with anesthesia.
There are many women who resort to the use of epidurals when giving birth , but are there other possible alternatives? What do they consist of and what implications do they have? Today we are talking about it, although we remind you of the importance of consulting all the doubts you have about it with your midwife or gynecologist.
What is anesthesia?
Anesthesia is the use of medications that are used to prevent the sensation of pain during a painful procedure or surgery . There are different types of anesthesia, but all are intended to block nerve impulses and, therefore, pain.
At the time of delivery there are different types of anesthesia, and each of them is indicated in a specific case or for a specific procedure. We will analyze them below:
Epidural anesthesia
It is the type of anesthesia best known and used by most pregnant women . Not in vain, and according to the data produced by the hospitals themselves, eight out of ten women resort to it at the time of delivery.
Epidural anesthesia consists of the reversible blockage of the nerve roots that cause pain. To do this, it is applied through an injection into the epidural space, leaving a thin tube called a “catheter” through which more anesthesia will be applied in a controlled way and without the need to puncture again.
When is it administered
It is the doctor or midwife who will indicate the most appropriate time to administer this anesthesia , since in case of a very advanced state of dilatation it may not be advisable to apply it, since it requires a time for it to take effect (between 15 and 20 minutes) , and in those cases the risks may outweigh the benefits.
It feels?
The normal thing is that after the application of anesthesia, the contractions feel more bearable, and the legs are left with a tingling sensation and somewhat heavy when moving. However, not all women react the same to an epidural: sometimes the legs are completely immobile, while in other cases it is not as effective as expected.
Side effects
A review of studies published in 2009 by Cochrane concluded that, although effective for pain relief during labor , epidurals also increase the risk of instrumental delivery (use of other drugs, forceps, vacuum cup, episiotomy, etc.), since on many occasions the woman loses the push reflex and needs help to get the baby out.
Among the main adverse effects caused by the use of epidurals, a drop in maternal blood pressure, headaches as a consequence of accidental puncture of the dura mater, and post-puncture low back pain have been observed. In addition, other adverse effects such as lengthening of the dilation phase, tremors, itching, or other more serious complications have also been associated.
Contraindications
As we can read in this information sheet prepared by the Hospital Universitario de Fuenlabrada (Madrid), epidural anesthesia is absolutely contraindicated in those patients who present infection at the puncture site, significant hypotension, intracranial hypertension, severe infrection syndrome, disorders of coagulation and anticoagulant treatments.
Spinal disorders and obesity are not contraindications, but they can make the technique difficult and even prevent it.
Its use is widespread in all hospitals, so consultation with the anesthetist in the last phase of pregnancy is usually highly recommended to clarify doubts and analyze the risks and benefits involved in the use of the epidural.
Walking epidural
As we have just seen, one of the main disadvantages of an epidural is that it tends to numb the legs, which is why most women must lie flat on the table and without the possibility of movement for the duration of their labor.
The walking epidural or ambulant epidural, is an anesthesia that manages to control the pains of contractions but without leaving the woman paralyzed from the waist down , which allows her to have freedom of movement, walk and thus help the labor to prosper .
It has been administered for a decade in some hospitals in our country, although it has been in recent years that it has begun to gain popularity.
It is applied the same as epidural anesthesia and the novelty is in its composition and in the combination of several drugs. This ensures that only the sensory fibers fall asleep, while those that control movement remain awake.
The walking epidural is contraindicated in the same cases as epidural anesthesia , and the main problems that may arise must also be taken into account, which are:
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It lasts a short time, so it only works in short deliveries.
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It is not indicated in advanced deliveries, since higher concentrations of drugs that can cause motor block are required.
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It is important to ensure that the mother can feel and move her legs correctly to avoid accidents and falls.
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It usually has side effects that are very similar to epidurals, although itching occurs more frequently with the use of this anesthesia.
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Not all hospitals offer it, since qualified personnel are required to care for pregnant women who receive it.
Spinal Anesthesia
It is a type of anesthesia similar to epidural but with immediate effect , of a determined duration (generally two hours) and indicated in short procedures, such as caesarean section.
Its administration is very similar to epidural anesthesia, except that it is done with a small gauge needle and the anesthetic is injected directly into the cerebrospinal fluid, without the need to use a catheter.
The adverse effects of spinal anesthesia as well as its contraindications are the same as in epidural anesthesia.
General anesthesia
General anesthesia in childbirth is only indicated in cases of emergency cesarean sections without a previous catheter, or in which there is no time to apply spinal anesthesia or is contraindicated.
General anesthesia leaves the patient unconscious, unable to move and is generally intubated and connected to an artificial respirator, and its use has significant complications for both the mother and the baby, hence it is indicated only in cases of extreme urgency.
Side effects
To the typical risks that the use of this type of anesthesia implies for the patient, the risk of neurological and / or respiratory depression in the newborn must also be added, as well as a delay in skin-to-skin contact between mother and baby.
Local anesthesia
Local anesthesia is injected into a specific area to provide pain relief during labor, when the patient does not have an epidural in place . It does not eliminate the pain of contractions, but it is effective in mitigating discomfort in the delivery phase.
When it’s used
It is used at the final moment of birth to relieve pain caused by stretching of the perineum, as well as numbing the area in case an episiotomy is needed or a tear occurs. It can also be applied immediately after birth, injected into the skin, muscle or cervix for quick and temporary relief of pain in the perineal area.
Risks of local anesthesia
As we can read on the website of the American Pregnancy Association, there are no significant risks when using local anesthesia , except for rare allergic reactions. However, some experts believe that local anesthesia could cause inflammation in the perineal tissue, thus increasing the chances of rupture or needing an episiotomy.
A few days ago we saw some measures that we can carry out during pregnancy to avoid, as far as possible, these types of associated risks.
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