Epidural anesthesia: making an informed choice. Epidural anesthesia consequences for the child

Fear of the unknown is always present. This is one of the reasons why women agree to use medications to eliminate or reduce labor pain. Epidural anesthesia is considered the safest medical method to cope with this task. Regional administration of drugs into the space near the spine allows the woman to remain conscious and not feel contractions. But is it painful to have epidural anesthesia during childbirth, what is the manipulation and what are its consequences - these are the doubts that are present in the head of every pregnant woman.

The fear that epidural anesthesia is painful is associated with the idea of piercing with an impressive needle and inserting a catheter directly into the back, into the spine. But most mothers who have undergone the procedure compare the sensation to a “mosquito bite.” There are two explanations for this.

Firstly. Before the procedure, local anesthesia is performed. An anesthetic is injected under the skin, which disables the area for further actions. Secondly. The procedure is usually resorted to at a time when contractions have already begun, the cervix has dilated by 4-6 cm. That is, the woman has had time to feel the beauty uterine contractions, but in comparison with them, injecting epidural anesthesia does not hurt.

To avoid a decrease in blood pressure, women in labor are given about a liter of saline intravenously using a dropper. Then the back area is wiped with an antiseptic, usually a special iodine solution. Touching the skin with cold liquid is unpleasant. Then they give an injection of local anesthetic and begin the main procedure.

Is it painful to have an epidural? Usually not. Unpleasant - yes. A woman should not feel pain. But it all depends on the individual sensitivity threshold. Real discomfort arises due to the fault of an inexperienced doctor, depending on how successfully the administration itself took place, without errors.

The second most important reason why epidural anesthesia can be painful is misbehavior women or medical staff. The needle and catheter are inserted between contractions, when the woman in labor is able to bend while sitting or curl up while lying on her side. It is difficult to remain in this position and not twitch.

Execution conditions

The decision to use painkillers when a child is born can be made in advance and stipulated in the contract. The method is used without prior approval, either in fact or at the request of the woman.

According to indications during childbirth, an epidural should be placed in the following cases:

emergency caesarean section;
maternal health status – hypertension or retinal detachment;
ineffective, exhausting contractions that do not lead to dilatation of the cervix.

During surgery, the woman is given high dose anesthetic, for the so-called complete blockade. The catheter is disconnected only after the operation and suturing are completed.

At natural childbirth most often used is the so-called partial or almost complete blockade when a woman feels the body, lower limbs. There are two options: the anesthetic will be supplied through the catheter throughout the contractions and until the end of labor or before the start of pushing, the administration of the painkiller will stop.

Do you use an epidural for pushing? Usually, in case of high blood pressure or vision problems, in order to avoid complications, medications are continued until the end of childbirth. But most often, doctors prefer that the effect of anesthesia weakens by the time the fetus is expelled.

Mothers who received an epidural while pushing note that they did not feel pain during this period of labor. But there is a catch in the situation. You have to push at the doctor’s command, without physiological urges. Not all women cope with this correctly and therefore the risk of complications is high.

Unproductive, but regular contractions, in which there is no opening, are described by women as especially painful. An anesthetic injected into the epidural area not only relieves pain, but also relaxes the cervix, thereby reducing contractions. Then, after the epidural, pushing begins and the baby is born. The catheter remains in the back in order to resume the supply of the drug when suturing the ruptures.

Advantages and disadvantages

Officially, epidural anesthesia is an effective and gentle method for severe pain during childbirth. Complications after the procedure are rare; according to statistics, they occur no more than 1 time in 80,000 cases. Among them: complete or partial absence result, hematoma formation, allergic reactions to the injected drug, paralysis and others.

Back pain or headaches that occur after a woman decides to give birth with epidural anesthesia are associated with accidental puncture of the dura mater and subsequent leakage of cerebrospinal fluid. In fact, postpartum complaints depend entirely on the experience of the doctor.

One of the most dangerous aspects of such anesthesia is that a woman, without feeling anything, may miss an unexpected deterioration during childbirth. Doctors constantly monitor the child’s health during labor: they record the fetal heartbeat and measure the mother’s blood pressure.

With an epidural, giving birth is not painful, while maintaining clarity of consciousness. Even if the effect of the drugs on pushing is absent, the woman has the opportunity to rest during contractions and gain strength. The advantage of the procedure over others using medicinal methods pain relief is the lack of penetration of active substances into the bloodstream of the mother and child.

Is it painful to give birth with an epidural? If we mean pushing, the process of expelling the fetus itself, then everything depends on whether the supply of medications through the catheter continues. If we are talking only about contractions, then in the overwhelming majority, women do not experience pain, even with partial, incomplete blockade of nerve endings.

What to choose

The natural birth of a child requires the absence of any medical intervention, including the use of pain relief. But the fear of a painful birth without an epidural is the reason why women plan a caesarean section without an indication.

According to a Cochrane review, this type of anesthesia can relieve pain more effectively than any other method available today. According to statistics, those who gave birth with an epidural remember childbirth not as a test, but as a normal medical procedure.

Is it better to give birth on your own or with an epidural? There is no clear answer. Before making a decision, you should weigh all the pros and cons, indications and contraindications, and assess the risk undesirable consequences. You can use anesthesia at almost any stage of labor, but before pushing.

If you decide to have epidural anesthesia, it is better to first select a clinic and a doctor with sufficient experience and a good reputation. Explore modern technology, types of drugs used and their effectiveness. For each case of childbirth, an individual pain relief regimen with complete or partial loss of sensitivity is possible.

The choice is also complicated by the ambiguous position of gynecologists on pain relief methods. Some obstetricians routinely use epidural anesthesia, while others advise not to rush into using medications. It is impossible to predict whether the chosen drug will work or not.

A woman must decide for herself whether to have an epidural. It is important to be confident in your choice. Doubts often cause unnecessary anxiety and subsequently lead to difficulties in childbirth.

Every day in medical clinics held a large number of operations. Surgery is impossible without appropriate anesthesia, that is, anesthesia is required, otherwise it will be simply unbearable to endure such pain. There are many types of anesthesia. In this article we will look at what epidural anesthesia is, in what cases it can be used, and whether there are any contraindications.

What is epidural anesthesia

This type of pain relief is one of the regional epidural methods - it is the introduction of medications directly into the epidural space of the spinal column through a catheter. During such anesthesia, the following results can be achieved:

Loss of pain sensitivity.
General sensitivity decreases or almost disappears.
Muscle relaxation.

The mechanism of action of epidural anesthesia is due to the fact that the medicine penetrates through the dural couplings, as a result of which the passage of nerve impulses is blocked.

How epidural anesthesia works

In humans spinal column and the nerve endings in the neck are in the dura mater. The epidural region is located around the membrane and runs along the spine. Nerves in the direction of the neck, arms and shoulders cross it, their inflammation leads to pain in the epidural area.

Medicine injected into this area causes loss of sensation and dullness of pain. The transmission of nerve impulses is blocked, which gives this effect.

When is epidural anesthesia used?

Considering that this type of anesthesia is used during surgery in various areas body, we can say that the risk of use may be greater or lesser. For example, epidural anesthesia of the chest, groin area, legs and abdomen is less risky than analgesia in the neck and arms. The use of such anesthesia for the head is impossible, because the innervation of this part of the body is carried out using the cranial system.

Epidural anesthesia is most often used:

As a local anesthetic if not intended surgical intervention, for example, during labor.
As an addition to general anesthesia, then it is possible to reduce the amount of opioids used.
Epidural anesthesia is often used for caesarean section.
IN postoperative period to relieve pain.
For the treatment of back pain. In this case, injections are introduced into the epidural area. steroid drugs and analgesics.

The doctor decides which anesthesia to give preference to, general anesthesia or epidural, in each specific case.

Methods of epidural anesthesia

Every year more and more appear in the arsenal of doctors the latest tools for this type of anesthesia. When doctors are faced with a choice: general or epidural anesthesia, then, if possible, choose the latter. A large selection of medications for its implementation allows you to choose the most suitable option for each patient.

In addition to a variety of drugs for anesthesia, there are also various ways such anesthesia:

Continuous. In this case, the anesthetic is continuously injected into the spinal space. In this way, you can achieve pain relief for the entire period of the operation, and less medication will be required.
Periodic administration. The supply of the drug is ensured only when there is an urgent need for it.
Pain relief at the request of the patient. When using this method, the patient has a button under his hands. If there is a need for pain relief, then when you press it, a part is supplied to the epidural area medicine.

Doctors have drugs that perfectly stop pain syndrome, but retain mobility and consciousness remains clear.

In what cases is epidural anesthesia indicated?

Most surgeons consider this method of anesthesia the most suitable during leg operations. It allows not only to relieve pain and relax the muscles as much as possible, but also to reduce blood loss.

Indications for the use of epidural anesthesia may vary, for example:

This method is absolutely safe for the kidneys and prostate gland.
Used for organs abdominal cavity and small pelvis.
Widely used during surgery on the stomach and intestines.
Can be used for heart defects and diabetes.

But this does not mean that epidural anesthesia is always used for such pathologies. Everything is decided in each case individually.

Contraindications for use

Epidural anesthesia has the following contraindications: categorical and relative. The first category includes:

Relative contraindications are much broader and include:

Excess weight.
Poor body condition.
Chronic diseases of the spinal column.
Childhood.
Diseases of a neurological nature.
Severe hypotension and many others.

The quality of epidural anesthesia will depend not only on the existing pathology and health status of the patient, but also on the drug that is supposed to be used.

Epidural anesthesia for caesarean section

When all indications for carrying out caesarean section, then an epidural is often used instead. This method is selected in advance, as it requires some preparation.

The drug is administered to a specific place at the lumbar level, where the nerve endings exit from spinal cord. The drug is administered through a special catheter tube; medication can be added at any time during the operation.

As a result of such anesthesia, consciousness remains clear, and sensitivity below the belt disappears. The woman can see and hear doctors, but does not feel pain.

When choosing between epidural or general anesthesia for caesarean section, it is worth considering the indications and contraindications for anesthesia.

Indications for such anesthesia

Most often, epidural anesthesia is used:

If labor activity began ahead of time, for example, at 36-37 weeks. This anesthesia relaxes the pelvic muscles, and the baby’s head does not experience as much stress as it moves through the birth canal.
Severe hypertension.
When various departments the uterus contracts with varying intensity. Epidural anesthesia reduces the intensity of the contraction.
During prolonged labor, when for a long time there is no complete relaxation. This can lead to birth abnormalities, so epidural anesthesia is used to help the woman gain strength.

Contraindications

In addition to the indications, in the case of cesarean section there are also contraindications for such anesthesia, these include:

Availability inflammatory process at the puncture site.
Infectious diseases.
Allergic reaction to drugs.
If there is a scar on the uterus.
If the child is located transversely or takes an oblique position.
Narrow pelvis of a woman in labor.
Large baby weight.
If the woman herself does not want this type of anesthesia, then doctors cannot use it against her will.

Before using epidural anesthesia, the consequences, disadvantages and advantages must be considered.

Benefits of epidural anesthesia for caesarean section

The advantages of this type of pain relief include:

The woman remains conscious throughout the operation; there is no risk of intubation or aspiration.
No upper irritation respiratory tract, as with general anesthesia, which is especially preferable for patients with asthma.
The cardiovascular system works stably, since the drug acts gradually.
The relative ability to perform movements is preserved.
With this anesthesia, you can increase the time of pain relief, since the anesthetic is injected through the catheter at any time.
After surgery, opioid medications may be given to relieve pain.

In addition to the advantages, it is necessary to note the disadvantages of such anesthesia.

Disadvantages of epidural anesthesia

Any method of surgical intervention, as well as anesthesia, has its drawbacks. The disadvantages of epidural pain relief include:

An anesthesiologist made a mistake when administering the drug when the medicine gets inside the vessel. This may lead to seizures, sharp decline blood pressure.
There is a danger of subarachnoid injection, as a result of which a total spinal block develops.
To perform such anesthesia, you must have good skills, since this anesthesia is the most difficult.
The drug begins to act only after 15-20 minutes, so surgery cannot begin immediately.
There is a risk of inadequate pain relief when the nerve endings are not completely blocked, and discomfort remains during the operation.
It is necessary to carefully select drugs for such anesthesia during cesarean section, as some can cross the placenta and cause breathing problems and heart rate fetus
After surgery, you may feel back pain, headache.

To do right choice If you are going to have an epidural or general anesthesia, you need to weigh the pros and cons. Take into account existing contraindications and choose the most suitable type of anesthesia.

Complications of epidural anesthesia

Epidural anesthesia rarely causes complications, although such cases do occur.

Most often noted:

In 1 out of 20 patients, the drug does not fully act, and the nerve endings are not completely blocked, which means that pain relief will be ineffective.
In the presence of coagulopathy, there is a risk of hematoma formation.
Accidental injury during puncture may result in leakage of cerebrospinal fluid into the epidural area. This can lead to headaches after surgery.
A large dose of pain medication may be toxic, resulting in an ineffective blockade.
Can be side effects from the use of specific pain medications.

From all of the above, we can conclude that epidurals have serious health consequences in very rare cases.

Epidural anesthesia in “mammy” circles is usually called an epidural. The phenomenon, although new, is very popular and, judging by the reviews, “saving.” Those who gave birth with an epidural are completely delighted, those who did not give birth at all and are afraid of childbirth like fire - also for her, those who gave birth successfully without pain and anesthesia - as usual: neither for nor against. However, every woman still needs to know what it is, with what and how it is eaten.

Epidural anesthesia is performed only before the start of pushing, during the period of painful contractions, because its main purpose is to block pain, while the woman feels the contractions and, most importantly, remains conscious.

The puncture (injection) site is the epidural space of the spine (where the spinal cord ends). Using a needle, a catheter is attached to the back, through which as many injections are administered as is safe and necessary for the “suffering” woman in labor. The local anesthetic blocks the nerve impulses that transmit pain signals to the brain. And after 20 minutes you will not feel any pain, and sometimes even the entire lower part of your body.

Epidural is a necessity...

Definitely, the woman in labor herself makes the decision whether to inject or not to inject the “magic” injection. Usually, a woman decides what to do long before giving birth. After all, strict medical indications There is no requirement for epidural anesthesia. It is usually used only for severe pain during vaginal delivery. It can also be used instead general anesthesia during caesarean section. It is considered better if the operation will take place with the mother fully conscious, naturally without pain. Epidurals are also used for postpartum procedures.

In addition to the fact that this anesthesia alleviates “contraction” pain, it also shortens the period of cervical dilatation and has absolutely no effect on the newborn, because the drug enters the child’s blood in very small doses.

Most often, an epidural is offered for severe gestosis, fetoplacental insufficiency, arterial hypertension, diseases respiratory system, severe heart defects and other conditions.

...or a whim?

Many women, without even feeling the pain of labor, deliberately plan to anesthetize the process of contractions. It’s easy to say that this is a woman’s whim, but doctors assure that if a woman is catastrophically afraid of childbirth, then even small painful sensations can cause stress not only for her, but also for the unborn baby. And the stressful course of childbirth cannot bring anything good. This is why obstetricians and gynecologists do not dissuade “fearful” mothers from getting an epidural.

Women who gave birth using epidural anesthesia are absolutely no different from those who gave birth, as they say, in a “natural” way. They felt contractions, and the fact that the pain was minimal was only a plus, because all that remained from the birth process were positive emotions. Psychologists say that after an “epidural birth,” women more easily agree to have another birth.

Epidural anesthesia during childbirth: contraindications

However, not every woman can take advantage of such a seductive pain-relieving method. Epidural anesthesia has multiple contraindications, which must be taken into account during childbirth, otherwise there is a high risk of getting reverse effect: instead of relief, cause complications.

Contraindications to epidural anesthesia are:

birth bleeding;
problems with blood clotting;
low platelet count in the blood;
uncorrected hypovolemia (decreased circulating blood volume);
defeat skin at the injection site;
tattooing at the puncture site;
tumors or infections at the site of the intended injection;
increased intracranial pressure;
arrhythmia;
epilepsy;
allergy to the injected anesthetic;
increased body temperature;
organic diseases of the central nervous system ( multiple sclerosis, muscle atrophy);
heart defects;
cardiovascular collapse;
traumatic shock;
posthemorrhagic collapse;
intestinal obstruction;
spinal cord diseases;
diseases and disorders of the spine, etc.

Regarding the latter: epidural anesthesia is contraindicated for scoliosis, lordosis high degree, tuberculous spondylitis, some spinal injuries or operations in this area, with displacement and prolapse of intervertebral discs in the area of the proposed puncture. But the curvature of the spine absolute contraindication does not require epidural anesthesia, although it may cause some difficulties.

In addition, 12 hours before the epidural, you should not inject Clexane.

It should be understood that contraindications to epidural anesthesia can be absolute (that is, excluding its use in any case) and relative (which come into effect only in specific cases), which a qualified specialist must know about. Eg, relative contraindications to an epidural are obesity, reduced age, and young age of the woman in labor.

Consequences of epidural anesthesia during childbirth

And now about all the pros and cons in brief. The most important thing in a successful epidural is an experienced anesthesiologist. All sorts of consequences, both pleasant and not so pleasant, depend on it.

Also important point is the use of high-quality tools and especially drugs. Most often, domestic medicine offers the familiar Lidocaine, the effect of which is very short, and its safety is poor (they say that this drug can inhibit labor). Only Bupivacaine and Ropivacaine provide a truly good and safe effect, and we have a hard time with them.

It is impossible not to mention the obvious disadvantages of epidural anesthesia. The most important disadvantage and common complication is headache, which can last for a very long time after childbirth (sometimes up to 3 months!).

Also, as a result of the anesthesia, blood pressure may decrease, back pain may occur, and, rarely, allergic reactions to the injected drug may occur. And the ability to move after such an injection is sharply reduced, the feet and legs often swell.

You may be more intimidated by others dangerous consequences Epidurals. They even talk about meningitis and paralysis of the mother in labor, and fetal asphyxia is also attributed here. But if you believe everything they say, you won’t want to live like that at all. What is the most important thing in childbirth? Right! Positive attitude! Therefore, dear bellies, don’t worry about anything. I’m sure you’re strong and you definitely won’t need an epidural!

Especially for- Tanya Kivezhdiy

From Guest

I gave birth to my first with an epidural, my arms went numb instead of my legs... I wanted to kill the anesthesiologist, who opened his eyes from shock and threw up his hands saying “in history this is possible, but in practice I have not seen this.” Thank God everything went away by the end of labor... but I didn’t feel any relief from the pain of labor!!! Now I’m going to give birth to my second and will refuse this procedure!! But everyone has their own head, which must make a decision independently. I just want to warn you that sometimes things may not go according to plan(((

From Guest

I gave birth for the second time with an epidural, the contractions passed with minimal pain, when I went to give birth I didn’t feel anything at all, just a feeling of expansion, and I gave birth to another plus in just an hour. It's quick and almost painless. Only a good memory compared to that first time without an injection, I don’t wish anyone to endure all this pain. So, expectant mothers, don’t be afraid of the injection; it’s not noticeable at all and give birth with it!

From Guest

We had a cesarean with an epidural, but I didn’t feel anything painful, but after 6 months had passed, I had pain in my spine, I couldn’t stand bent over, and I couldn’t walk with a child in my arms for a long time, my spine started to ache, just like if any a draft down the back. And everyone I know has the same problems. So, God willing, the birth will happen somehow without her.

Childbirth is a painful process, so many women, especially first-time mothers, seriously think about the possibility of giving birth under anesthesia. Epidural anesthesia is very popular among all methods of drug pain relief for childbirth. Experts say that this is the most gentle and safe anesthesia for both the mother and the child. However, despite the numerous advantages of epidural anesthesia, not every expectant mother medical indicators it may be offered.

Epidural anesthesia is a method of local anesthesia in which an anesthetic is injected using a special catheter into the epidural (epidural) space between the 3rd and 4th vertebrae lumbar region the spine, where the spinal nerves pass, responsible for transmitting pain impulses to the brain. The injected medications block these impulses, so that the woman does not experience any pain during contractions, and is at the same time conscious. It is important here not to confuse concepts such as epidural anesthesia and spinal anesthesia. In the first case, in addition to anesthesia, the lower part of the woman’s body is completely immobilized, and in the second, the ability to move is preserved, the woman in labor feels contractions of the uterus, but they pass painlessly for her.

Mechanism of epidural pain relief

Epidural and spinal anesthesia are performed using the same technique, only for spinal anesthesia a thinner needle is used, and the anesthetic itself is injected directly into the cerebrospinal fluid.

The algorithm of actions of the doctor and the pregnant woman will be as follows:

The woman in labor must take one of the necessary positions that will provide the doctor with maximum access to the spine: either sit down with her back bent, or lie on her side, curled up.
A woman needs to strictly follow the doctor's instructions. The main thing is not to move for the period of time that he names. Any unnecessary body movement can lead to unpleasant consequences and complications during childbirth.
Before the doctor gives the injection, he will treat the puncture area with a special antiseptic. The woman will be warned that during the injection she may feel unpleasant pain, because the needle included in the epidural anesthesia kit differs in thickness from a regular needle. In some cases, but extremely rarely, the anesthesiologist may suggest that the woman in labor be given an anesthetic injection to relieve sensitivity of the skin in the place where the puncture will be made to administer anesthesia.
The needle will be inserted into the epidural space of the spine until it touches the meninges. Then a catheter will be passed through the needle, through which painkillers will be administered: lidocaine, bupivacaine or novocaine are drugs that cannot penetrate the placenta and, accordingly, will not harm the fetus. At the time of the puncture, the woman in labor may feel a shooting sensation in her leg or back, which is normal and an indication that the catheter tube has reached the nerve root.
The needle is removed and the catheter tube is secured to the woman's back using an adhesive tape; it will remain there as long as the effect lasts. medications, perhaps until the end of childbirth.
First, the anesthesiologist will administer a test dose of the drug. If 20 minutes after this the woman no longer feels pain, and there is no numbness of the tongue, dizziness or nausea, it means that the body adequately perceives anesthesia. Normally, the entire process - puncture and installation of the catheter - takes no more than 10-15 minutes.
The doctor will then administer a pain reliever in one of the following directions: possible modes: either every 20 minutes in small doses, or every two hours. All this time, the woman in labor should lie quietly, because epidural anesthesia dilates the blood vessels in the legs, and if the woman stands up or makes another sudden movement, she may lose consciousness.

Medical indications for epidural anesthesia

IN perinatal centers In developed Western countries, epidural anesthesia is prescribed to absolutely all women in labor who have no obvious contraindications to it in order to facilitate the birth process. And almost all women agree to this in order to avoid excruciating pain during labor. That is, while still pregnant, women plan with their attending physicians the method of delivery. Is epidural anesthesia performed in our country? Yes, but most doctors are still more inclined to think that childbirth is absolutely normal physiological process, which, if it proceeds without complications, can pass without such medical intervention as pain relief. And epidural anesthesia is offered only to those women in labor who have certain medical conditions.

These include:

Premature birth. This type of anesthesia encourages the woman's pelvic floor muscles to relax so that the baby can pass through the birth canal with less resistance.

Weak or irregular contractions that cause a woman very severe pain, but do not give the desired effect - the cervix does not open.

High blood pressure - an “epidural,” as pregnant women say, can normalize blood pressure.

Heart failure, birth defects blood vessels, somatic diseases, such as diabetes or bronchial asthma.

Multiple pregnancy or one large fetus.

A pregnant woman has some kind of pathology - malpresentation of the fetus, strong entanglement. In this case, the woman is given an epidural anesthesia for a caesarean section.

Panic fear of childbirth, psychological unpreparedness of a woman.

As a rule, the introduction of epidural anesthesia is carried out either immediately - on initial stage contractions, or already in the process, when the doctor is finally convinced that the contractions are not false, and the woman is in labor.

For which women in labor is epidural anesthesia contraindicated?

Even when a woman requires a spinal or epidural anesthesia during childbirth, the doctor has the right to refuse this if he has the right to do so. the following medical reasons:

A woman in labor has unstable blood pressure - it rises and then drops sharply.
There are any deformities in the spine.
There is an inflammatory process in the area where the puncture is to occur.
Poor blood clotting.
Heat.
Obstetric hemorrhage began.
There is an intolerance to certain drugs included in epidural anesthesia.
The woman in labor has psychoneurological diseases, or she was admitted to the maternity hospital unconscious.

Complications and consequences of epidural anesthesia during childbirth

If the technique of performing epidural anesthesia is done professionally, then, as a rule, no complications can arise. However, it is wrong to completely exclude them. A woman who decides to resort to this type of pain relief during childbirth must be aware and clearly understand what the consequences of epidural anesthesia may be for her and her child.

What problems might a woman have?

It is absolutely normal if a woman in labor after epidural anesthesia has painful sensations in the lower part of the spine, in the place where the anesthesia was administered. Only in the case when a woman’s back bothers her for more than three days after epidural anesthesia, it is necessary to inform the doctor about this in order to avoid sad consequences. What other complaints, besides back pain after epidural anesthesia, may arise:

Some women in labor experience headaches after an epidural. They usually last for three weeks after birth. This can happen if the puncture results in damage to a hard meninges, and cerebrospinal fluid leaked into the epidural space.
In the place where the puncture was made, inflammation began or a hematoma formed. This problem can only arise if the anesthesiologist violated the rules of sterility during the procedure.
After epidural anesthesia, an allergy appeared in the form of a rash or swelling, because a woman in labor may not be aware of her susceptibility to some components of anesthesia.
It became difficult to breathe due to the fact that the anesthetic affected the nerves going to the intercostal muscles.
There were problems with urination due to hypotonicity of the bladder muscles.
Muscle tremors appeared.
There was no pain relief. According to statistics, this happens in 5% of cases.
The most severe complication epidural anesthesia is paralysis, but, fortunately, such cases are extremely rare and occur either due to the inexperience of the anesthesiologist, the excessive obesity of the woman in labor, or the presence of some anomalies of the spinal column.

What problems might a child have?

Doctors do not undertake to completely rule out the possibility of anesthetics affecting the fetus, because after all, before it is separated from the mother, the child is influenced by what happens to her body. If epidural anesthesia drugs penetrate the placental barrier with the mother’s blood flow into the baby’s blood, then the following complications may occur:

The pulse rate will decrease and the heart rhythm will worsen.
Breathing problems will occur, which may become chronic.
The child is diagnosed with encephalopathy.
The baby will be prescribed a course of antibiotics from the first days of life due to a very high temperature.

Advantages and disadvantages of epidural anesthesia during childbirth

As often happens in such cases, these contradictions are associated with a lack of knowledge about the “epidural” and are based mainly on misconceptions and speculation. We will look at the most common myths about this method of labor pain relief to help expectant parents understand what is true and what is just fiction.

Myth No. 1. Childbirth is a natural process and there is no need for pain relief.

There are various individual characteristics state of health of the woman in labor or the course of labor, aggravating pain expectant mother during contractions. Sometimes doctors have to deal with the so-called pathologically low threshold of pain sensitivity of a woman in labor. This term refers to the high reactivity of the central nervous system in response to minimal painful stimuli. Owners of low pain threshold They begin to experience pain during childbirth much earlier, and the degree of discomfort is much more intense than in women with normal pain sensitivity. Moreover, the intensity of pain during contractions is so significant that the woman in labor cannot tolerate it. In such cases, psychological preparation for childbirth and self-anesthesia skills may not be enough. In situations where the use of physiological measures of pain relief during childbirth (massage, breathing techniques, aquatherapy, active behavior during childbirth) turns out to be ineffective, modern medicine offers medical pain relief for childbirth using epidural anesthesia.

Myth No. 2. Anesthesia during childbirth is only needed for pain relief.

Epidural anesthesia during childbirth is used not only to relieve pain from contractions, but can also be used to correct various pathologies development of labor activity. There are a number of complications of childbirth, for which epidural anesthesia is the only effective treatment method that allows you to normalize the birth process, avoid the need for surgery and maintain the health of the mother and fetus. Thus, this type of anesthesia is used to treat incoordination of labor - a pathology in which the uterus contracts painfully and unsystematically, and the dynamics of labor - dilatation of the cervix - is absent. This complication is most often associated with increased psycho-emotional excitability of the woman in labor against the background of fear of childbirth. Due to pathological emotional arousal, the activity of the cerebral cortex increases, and signals coordinating labor activity arrive to the uterus randomly and unevenly. As a result, instead of a targeted contraction of the myometrium (the muscular wall of the uterus), which should ensure the opening of the cervix and the advancement of the fetus, many ineffective focal contractions occur simultaneously in the uterine wall.

In addition to the fact that such muscle activity is unproductive, that is, it does not cause dilatation, it poses a danger to the health of the woman in labor and the fetus. As a result of constant focal contractions of the myometrium, blood flow in the uterine and placental vessels that carry oxygen to the fetus is disrupted. If labor does not normalize within a few hours, such contractions can lead to acute intrauterine hypoxia ( oxygen starvation) fruit. For the mother, incoordination is dangerous due to placental abruption and even uterine rupture. Epidural anesthesia helps to quickly normalize the nervous regulation of myometrial contractions due to a pronounced analgesic effect. As soon as the anesthetic begins to act, the woman in labor loses pain sensitivity. Having ceased to feel contractions, the woman no longer experiences fear and calms down, which, in turn, means a decrease in the pathological activity of the cerebral cortex. Subsequently, nerve impulses arrive evenly to the uterus, it begins to contract productively, and childbirth continues naturally.

Another pathology of labor in which an epidural is used is associated with cervical dystocia. This complication is characterized by the absence of dilation of the cervix against the background of intense growing contractions due to biological immaturity birth canal. This term refers to the discrepancy between the condition of the cervix and vaginal walls and the duration of pregnancy. Normally, before childbirth, the cervix gradually shortens and begins to open slightly, the tissues of the vagina and cervix become soft and elastic. If, at the time of the onset of regular labor, the cervix remains firm and long, as in mid-pregnancy, and cervical canal– closed, dilatation does not occur, despite the active contractile activity of the uterus. This type of labor development is certainly a pathology and dangerous for the health of the mother and fetus: against the background of intensifying contractions, cervical ruptures, separation of the cervix from the body of the uterus, and ruptures of the side walls of the uterus can occur. These complications are extremely dangerous, they are accompanied by massive bleeding, require emergency surgical intervention and can lead to the death of the woman in labor (from blood loss) and the fetus (from blood loss). acute hypoxia). The most effective method The only way to correct such an unsuccessful birth scenario is epidural anesthesia. In the presence of strong contractions, the “epidural” works as a powerful antispasmodic, promoting rapid softening of the cervix and its non-traumatic opening.

Epidural anesthesia is also used for artificial maintenance normal level blood pressure during labor in women suffering from various forms arterial hypertension. In addition, an epidural is absolutely indispensable in cases where it is necessary to minimize or even completely eliminate the period of pushing without resorting to surgical delivery. We are talking about diseases in which the expectant mother can give birth herself, but full participation in the pushing process can harm her health. An example of such a situation is heart defects or heart rhythm disturbances of the mother in labor, problems with the retina of the eye, high blood pressure fundus, varicose veins, thrombophlebitis (inflammation vascular wall with the formation of blood clots, the same arterial hypertension(high blood pressure). In these cases, to facilitate the period of pushing, the effect of epidural anesthesia is extended almost until the stage of cutting in the head (the appearance of the head in the lumen of the perineum during a contraction). Then an incision is made in the perineum, and the baby is born with minimal physical effort on the part of the mother, while maintaining her health and without exposing her to the risks associated with the need for surgical intervention.

Myth No. 3. For epidural anesthesia, narcotic substances are used that are dangerous for the expectant mother and baby.

This opinion is absolute speculation: neither drugs nor other potent drugs are used in this version of pain relief. This is the main advantage of epidural anesthesia and makes it the most preferred option for labor pain relief. The drugs used for epidurals are familiar to most expectant parents... after visiting dental office: These are the drugs used for “freezing” in dental treatment. These are drugs of the novocaine series: lidocaine and its more modern derivatives, for example, sovcocaine and mercocaine. These medications do not cross the placental barrier and thus do not directly affect the fetus. In addition, during epidural anesthesia, these drugs, in principle, do not have time to enter the general bloodstream: the drugs are injected into the spinal canal and dissolved in cerebrospinal fluid. However, this does not mean that anesthetics are completely safe: individual intolerance to drugs in this group often occurs, so before administering anesthesia, the doctor always carefully asks the expectant mother about allergic reactions on medications and first administers a test dose of the medicine, carefully observing her well-being.

Myth No. 4. During epidural anesthesia, there is a needle constantly in the back, which can damage the spinal cord.

This is the most common fear associated with the use of an epidural among expectant parents. In fact, it is completely groundless: the medicine is injected not into the spinal cord, but into the spinal canal, which contains cerebrospinal fluid, the liquid that washes the spinal cord, and it does not enter through a “needle in the back,” but through a special catheter, which the anesthesiologist installs when performing pain relief manipulations during childbirth. To understand everything, we will tell you in more detail about the technique of epidural anesthesia. The expectant mother is asked to take the starting position, which makes it easier for the doctor to carry out the manipulation. There are two options for the patient’s initial position, depending on her state of health, the stage of labor and anatomical features structure of the spine. In the first case, the woman in labor is seated with her back to the doctor and asked to tilt her head to her knees. In the second option, the expectant mother takes the same “fetal position” while lying on her side with her back to the doctor. After superficial anesthesia of the skin in the intervention area, the doctor makes a puncture between the vertebrae using a special needle, which does not remain in the patient’s back, but only serves as a guide. Then, through this needle, a soft flexible tube is inserted into the puncture site - a thin catheter through which the medicine will flow into the spinal canal. After inserting the catheter, the needle is removed, and the expectant mother can move freely, change her body position, lying on her back or turning from side to side. The outer part of the catheter is attached to the skin with an adhesive patch, and an aseptic dressing is applied to the puncture site. During labor, the doctor may add a dose of anesthetic through the catheter as needed.

Myth No. 5. If a cesarean section becomes necessary during labor, the epidural will have to be interrupted and anesthesia administered.

Quite the opposite: in modern obstetrics, epidural and spinal anesthesia are the main and most preferred method of pain relief for various surgical interventions, primarily with surgical delivery via cesarean section.

Myth No. 6. Epidural anesthesia affects the consciousness of a woman in labor.

And again there is a misconception: the “epidural” does not affect the patient’s consciousness in any way, does not cloud it, does not cause artificial drowsiness or apathy, and maintains clarity of thinking, cutting off only pain. As a result of such anesthesia, pain signals from the uterus to the brain are “cut off” during childbirth. That is, in fact, the pain remains, but the “distress signal” sent pain receptors during contractions of the uterus, it does not reach the pain center of the brain, since as a result of the introduction of an anesthetic into the spinal canal, the transmission of the nerve impulse is blocked. The state of health of the expectant mother, anesthetized in this way, differs significantly from the effect of conventional painkillers. This has its pros and cons. The advantages include the absence negative influence to the central nervous system. Medicines used for anesthesia do not have a hypnotic effect, do not change the consciousness of the expectant mother in any way, and do not cause a gag reflex. During the period of anesthesia, the woman in labor still feels contractions, but only as muscle contractions, but there is no pain. The disadvantages include the forced position of the woman in labor: after the administration of the medicine, she cannot get up - sensitivity below the injection site disappears, sometimes not only painful, but also any other.

Myth No. 7. Anesthesia has no effect on the course of labor

Unfortunately, this is also a false statement. Another problem associated with the use of an epidural is its effect on the rate of development of the labor process. In some cases, after the use of anesthesia, contractions weaken, the dilation of the cervix and the movement of the fetus along the birth canal are delayed, and in the future doctors have to use drug labor stimulation (intensified contractions). Sometimes, on the contrary, immediately after the onset of epidural anesthesia, labor develops too rapidly, and childbirth occurs over the next few hours. Such births are considered complicated, since the birth of a baby too quickly is associated with the risk of serious ruptures of the birth canal and birth injuries to the fetus. In addition, when using anesthesia, it can be difficult to accurately calculate the end time of the drug; but it is important that by the time she pushes, the woman in labor has regained sensitivity and can control her abdominal muscles in order to fully push.

Myth No. 8. Epidural anesthesia can be given to all women in labor.

Actually this is not true. There are a number of women’s health conditions in which the use of this type of pain relief is contraindicated. Here is an example of the most common contraindications to the use of epidural anesthesia during childbirth from the health of the expectant mother:

high intracranial pressure due to injuries, tumors, aneurysms (dilation of blood vessels) and cerebral hemorrhages;
severe osteochondrosis in the area of the proposed puncture;
the presence of hernias or protrusions (protrusions) of the spinal cord in the manipulation area;
curvatures of the spine that disrupt its normal anatomical structure and preventing puncture of the intervertebral space;
infectious processes on the skin of the back in the area of the intended puncture (boils, rash, eczema).

Due to the fact that in last years The indications for the use of epidural anesthesia during childbirth have significantly expanded; during pregnancy, it is advisable for all expectant mothers to consult a neurologist to identify possible contraindications. This can significantly reduce the risk of complications from anesthesia.

How is epidural anesthesia better than general anesthesia?

The advantages of this method of anesthesia during childbirth over general anesthesia are obvious:

does not have a pathological effect on the fetus (during general anesthesia, drugs have a narcotic effect on the fetus, the newborn is born with inhibited reflexes and has a harder time withstanding the period of postpartum adaptation);
does not affect the vital functions of the woman in labor (unlike general anesthesia, there is no need for ventilation using a device artificial respiration and in medicinal maintenance of work of cardio-vascular system);
during surgical childbirth, the woman in labor remains conscious, sees the child immediately after his birth, and can immediately listen to an assessment of his health;
problems with “coming out of anesthesia”, which are not uncommon when using general anesthesia, disappear and artificial ventilation lungs, when the patient does not regain consciousness for a long time and does not breathe on her own;
During the postoperative period, the length of stay in the ward is significantly shortened intensive care. The woman regains her strength much earlier, becomes more active and can independently care for the newborn.