Childbirth

What is an epidural

An epidural is an anesthesia that can be used during labor and delivery to eliminate pain. It is a free choice that provides for an anesthesiological visit to be done towards the end of the pregnancy.

As far as my experience is concerned, I have not been able to take advantage of this particular anesthesia: in the first birth because I had not had the anesthesiological visit towards the end of the pregnancy. In the second, I had “the papers in order” but the dilatation phase was so fast that there wasn’t even time to do it!

But let’s get into the details and try to explain some important things regarding specific epidural anesthesia for childbirth.

What is epidural anesthesia

It is an anesthesiological technique that allows to relieve pain during childbirth, that is, it allows to eliminate pain sensitivity while keeping the patient conscious. It is therefore not a general anesthesia that makes you lose consciousness.

As such, it can only be performed by an anesthesiologist after assessing the future mother’s health.

During pregnancy, those who want to use this technique must carry out an anesthesiological visit in which an informed consent is also delivered to be signed in case one chooses to use it.

In this consent, the patient is informed of any risks that may derive from it.

During labor, some blood tests are also done before the epidural is performed to check the feasibility of anesthesia. In fact, there are some pathologies that do not allow you to take advantage of this technique. Even taking some medicines does not allow you to resort to an epidural.

How is it done?

The spinal cord passes through a canal formed by the vertebrae and is surrounded by three protective membranes called the meninges.

The anesthetic is injected into the epidural space which is located between the dura mater (one of the three meninges that surround the spinal cord) and the vertebral column (usually at the level of the second and third or third and fourth lumbar vertebrae).

This injection is preceded by a local anesthesia so as not to feel pain. When the local anesthetic has worked, a special needle is inserted to the correct place, then a catheter (a thin plastic tube) is inserted through the needle. The needle is then removed and the catheter remains inserted so that the anesthetic can be injected.

The catheter is held in place with tape. The anesthetist uses this small tube to inject local anesthetic into the epidural space.

It is very important to remain still while the anesthetist is locating the site for the epidural injection and especially while the epidural needle is being inserted.

When the need for pain relief has passed (at the end of the delivery) the catheter is carefully withdrawn and the area covered with a plaster.

It takes about 30 minutes after the injection for the drug to take effect.

The pros and cons of the epidural

I think it is important that a woman can be informed and on the basis of this make her own decisions in an informed way.

There are different schools of thought but certainly the labor in epidural analgesia allows you to experience the birth of your child in a more serene way.

Epidural analgesia eliminates labor pain but allows ambulation and the patient remains active, cooperative with the midwives and can push.

It has some limitations. To be practiced in labor it must already be active, with valid contractions and a dilation of at least 2 centimeters but not more than 7 . It also anesthetizes the expulsive moment, the most emotionally intense one for a woman.

However, there are some side effects but with a very low incidence which are:

  • repeated administration of anesthetic can cause temporary weakness in the legs and increase the risk of using a vacuum cleaner to give birth
  • it could cause a drop in blood pressure, cause itching or fever during an epidural
  • the part of the body where you get an epidural can be very sensitive but only for a few days
  • back pain: the epidural relaxes the back muscles and because of this you can develop back pain after childbirth

Complications

With any procedure involving anesthesia there is a small risk of an unexpected reaction to the anesthetic. Complications specific to epidurals are rare but may include the following:

  • Heachache. The epidural can puncture the membrane lining the spinal cord and fluid can leak out. This puts pressure on surrounding nerves causing headaches. These can last up to a week or maybe more.
  • Bleeding. A blood vessel may be damaged .It could be.
  • The pushing phase may be prolonged or the parturient may not be able to push adequately and therefore it may be possible to use the suction cup to facilitate the birth of the child.
  • Infection. This is very rare because the skin is clean before the needle is inserted (sterile). If an infection develops, drainage of the infected area and antibiotics may be required.
  • Long-term numbness. It is possible to have after-effects of numbness for up to three months. Permanent damage , such as paralysis (total loss of feeling and movement) is extremely rare .

The risks are specific to each individual patient and differ for each woman depending on her condition.

It is always a good idea to ask your anesthesiologist for detailed information and how these risks apply to the individual.

There is no constraint in facing a birth in pain relief.

The woman must feel free to make her own choices. But knowing that in the ward where you will give birth (and here I strongly advise you to inform yourself first) there is a team of anesthesiologists who are experts in this technique, dedicated only to this type of intervention, active day and night, certainly gives greater psychological safety. And this regardless of whether or not you choose to use this service.

Dr Kathryn Barlow

Kathryn Barlow is an OB/GYN doctor, which is the medical specialty that deals with the care of women's reproductive health, including pregnancy and childbirth.

Obstetricians provide care to women during pregnancy, labor, and delivery, while gynecologists focus on the health of the female reproductive system, including the ovaries, uterus, vagina, and breasts. OB/GYN doctors are trained to provide medical and surgical care for a wide range of conditions related to women's reproductive health.

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