Many women resort to the use of epidural anesthesia when giving birth . And although this anesthesia has undoubtedly been a before and after in the management of pain during childbirth, it is a personal decision that must be taken in a thoughtful way.
If you are pregnant and you are thinking of giving birth with epidural anesthesia, we will explain what it consists of, how it works during childbirth and what implications it has.
What is epidural anesthesia?
Anesthesia is the use of medications that are used to prevent pain during a painful procedure or surgery. There are different types of anesthesia, but all are intended to block nerve impulses and, therefore, pain .
During childbirth, the most frequently used anesthesia is epidural, which consists of reversible blockage of the nerve roots, avoiding pain in an entire region of the body.
When is it administered?
It will be the doctor or midwife who indicates the most appropriate time to administer epidural anesthesia according to your type of delivery. Generally, it is put on when the contractions are regular and intense (at least three contractions every ten minutes), three to four centimeters of dilation have been reached, and the cervix has been erased at least half.
In the case of a very advanced state of dilatation, it may not be advisable to put it in, as it requires a time for it to take effect (between 15 and 20 minutes), and in those cases the risks could outweigh the benefits.
How is it administered?
The anesthetist will tell you how to position yourself to administer the anesthesia . You should be sitting or lying on your side, and always with the curvature of the back outward. Before administering the epidural, the skin is disinfected and a local anesthetic is applied, to avoid pain when puncturing the lumbar area.
A needle is then inserted between the second and third vertebrae, or between the third and fourth. This needle penetrates the epidural space between the bony walls of the medullary canal and the sheath of the cord. A very thin and hollow tube called a “catheter” is inserted through it and is inserted after removing the needle. Y
Through the catheter, the necessary dose of anesthesia is applied by means of an automatic infusion pump. In this way, each time more anesthesia is needed, it will not be necessary to puncture again.
How does it feel after the administration of anesthesia?
The most common 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. During the delivery phase it is normal (and recommended) to notice the pressure exerted by the baby’s head; This will allow you to direct your pushing and help the baby to be born.
But, not all women react the same to an epidural . There are times when the legs are completely immobile, the contractions are not felt and there is no desire to push. While in other cases it is not as effective as expected.
Advantages of epidural anesthesia
Some pregnant women recognize that they are afraid of childbirth, especially because of the pain it may bring and the uncertainty of knowing if they will be able to cope. In these cases, epidural anesthesia can be a great help for the woman to face her delivery more calmly and confidently.
This would be one of the main advantages of epidural anesthesia, but there is more that we will detail:
-
Pain relief occurs without blocking any of the mother’s mental faculties, so that she can consciously experience the birth of her child .
-
Epidural anesthesia can be used throughout labor , and the intensity of the medication can be adjusted whenever the mother wants.
-
It avoids the need to apply another anesthetic in case the delivery is instrumental or an episiotomy is performed.
-
In the event that the delivery must finally end in a cesarean section, it is not necessary to apply any additional anesthesia so that the mother can be conscious at all times.
Risks of epidural anesthesia
But epidural anesthesia also carries a series of side effects and risks that the pregnant woman should be aware of, in order to make the decision with which she feels most comfortable at the time of delivery:
-
A review of studies published in 2009 by Cochrane concluded that the epidural increases the risk of instrumental delivery (use of other drugs, forceps, vacuum cup, episiotomy, etc.), since in many cases the woman loses the push reflex and needs help to let the baby come out .
-
Some women have a decrease in contractions, which lengthens the dilation phase and increases the chances of using oxytocin.
-
Fall in maternal blood pressure.
-
Severe headaches as a result of accidental puncture of the dura mater .
-
Post-puncture low back pain is one of the most frequent problems, affecting between 22% and 45% of patients
-
Uncontrollable tremors after childbirth.
-
Itches
-
Some women experience a fever after the administration of anesthesia, and without any infection causing it.
-
Urinary and / or fecal incontinence.
-
Postpartum nausea and vomiting.
-
Increases the risk of cesarean section when placed before minimal dilation recommendations.
-
It can affect the baby, lowering their heart rate during delivery and / or affecting their state of consciousness, which in turn would affect the early initiation of breastfeeding.
There are rarer cases in which the epidural can have serious or very serious effects , such as seizures, paralysis, meningitis from an infection at the puncture site, infection of the lung, or stroke.
Contraindications of epidural anesthesia
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.
A very personal decision
The first thing to keep in mind when deciding whether or not to resort to epidural anesthesia is that the experience can be very different from one woman to another, and even from one birth to another. Therefore, it is advisable not to get carried away by subjective opinions and in case of doubts always consult a professional .
And if you have made the decision not to resort to epidural anesthesia , we recommend putting it in writing in your birth plan, because although the use of this anesthesia is widespread and most women choose it, no hospital should give anything for done.
It is undoubtedly a totally personal decision that you must evaluate, and choose if you prefer to prioritize not feeling pain to the possible risks (which although they are minimal, there are), or on the contrary you prefer to look for other alternative methods to cope with the pains of Birth.
Photos | iStock
More information | Delivery is Ours
