Almost all women who will soon become mothers experiencing some fear and anxiety in front of the pain that almost inevitably accompanies the birth of crumbs. And, of course, all pregnant women, without exception, are concerned about how to alleviate this situation and reduce the intensity of pain.
To date, medicine offers quite a lot of variety of ways labor analgesia. However, not all of them are equally good and popular - something most doctors use something - often. And increasingly applied epidural anesthesia during childbirth. That's about it and will be discussed in today's article - in fact, like any medical procedure, it is not only the positive aspects but also negative side effects and contraindications. And that means that its use is not appropriate in all cases.
The operating principle of this method
So what is the epidural? Let's try to understand the mechanism by which the effect epidural. The essence of this method of pain relief is to introduce into the epidural space of the potent pain medication. The epidural space - this is the gap which is located immediately below the dense skin of the spinal cord, the spinal canal lining on the inside.
It is in this gap is a huge amount of spin - nerves that are responsible for the delivery of pulses of various internal organs in the central nervous system - the brain and spinal cord to the brain. The same thing happens in reverse - it allows you to optimally coordinate the work of all organs and systems.
The doctor makes a puncture spinal membranes and enters a special anesthetic drug. A puncture is made in the lower part of the spinal column at lumbar level. This is an area ends with the spinal cord itself, and in the epidural space located just spin - brain roots. It is these roots and transmitted to the central nervous system pain impulses not only by cutting the uterus, but also from all the agencies, which are located in the pelvis.
As mentioned above, recently epidural anesthesia in obstetrics occupies an increasingly strong position due to their numerous advantages. For example:
- The woman is always in mind to adequately respond to what is happening around, to implement the recommendations of physicians - obstetricians.
- If necessary, the degree of intensity of anesthesia can be adjusted, thereby allowing the woman to fully move.
- The medicine comes in very small doses, so the time to break the liver almost full. This means that the drug has no negative impact on the child's body.
- The lack of recovery from anesthesia, which is quite a serious problem for many women.
Indications for epidural anesthesia
However, despite all the positive aspects of epidural anesthesia, it is not carried out for all women, without exception, because naturally occurring labor does not require active intervention from the outside. Therefore, in order to apply an epidural during childbirth, there should be strict contraindications. These include:
In that case, if the child is born prematurely, the doctor can decide on the need for an epidural. It may be necessary to ensure that the pelvic floor muscles relaxed as much as possible. This will reduce to a minimum the possible resistance that in the process of moving through the birth canal will meet the head of the crumbs. This promotion will be soft and gradual, so many times will decrease the probability of getting a child birth injury.
Sometimes a generic process requires surgical intervention, such as breech delivery, or in multiple pregnancies. And in this case, of course, would be the best solution is the use of epidural anesthesia.
- Chronic diseases of mother
There are a number of chronic diseases of the mother, which reduce pain tolerance. Furthermore, because it becomes impossible to carry out these various methods of anesthesia. For example, some diseases of the respiratory system eliminates the possibility of inhalation anesthesia, and a tendency to allergic reactions - the use of drugs for intravenous anesthesia.
Sometimes it happens that a woman giving birth to experience strong pain, and fights very unproductive - the cervix is not disclosed. As a rule, this is due to the fact that the work of the uterine muscle diskoordinirovana - they cut out of sync, and lack of coordination. A epidural anesthesia in 98% of cases very quickly lead this process to normal, and allows the woman to take a break from an extremely painful contractions in such cases.
How is an epidural?
Despite the fact that almost all women have heard about the benefits of epidural anesthesia, many of them pathologically afraid of the procedure. And most often it occurs because of the banal lack of information about how this procedure takes place. Ideally, before it is performed by a physician - anesthesiologist should be in detail and in plain language to explain the laboring woman, that he intends to do and what results it expects to achieve.
Incidentally, epidural anesthesia during childbirth can be carried out only with the consent of the woman in labor. She should sign the papers, in which it expresses its consent to the procedure of anesthesia.
After all the formalities are settled, the doctor will proceed directly to the epidural anesthesia. For this woman should ever sit on a chair, facing the back, or lie on your side, legs pulled up as close to the stomach. Thus, the physician will receive the necessary access to the area, which will be administered an anesthetic drug.
Fitting intended puncture carefully treated with an antiseptic solution, such as alcohol or iodine. After this is done local anesthesia - anesthetic is entered under the skin, whereby the nerve endings of the skin and subcutaneous tissue lose their sensitivity. And only after that the doctor will proceed to the introduction of a needle into the meninges. Thus, a woman will not experience pain - and it is precisely this fear and many new mothers.
Once the needle enters the meninges, the physician will feel quite substantial resistance. The doctor will stop the introduction of the needle and it is through a wire enters the catheter - a soft silicone tube, which will not damage the meninges. According to her, it will be supplied for pain medicine, as it is needed. Anesthesia will operate fast enough - about 15 - 20 minutes.
Generally, epidural anesthesia is used to numb it is the longest and most painful stage of labor - the first period of cervical dilatation. As a rule, to carry out an epidural before the cervix opens up to four centimeters, it is impractical. However, in the case in question, and incoordination of labor, the doctor can hold it in the past, to normalize the process and reduce the suffering of a woman giving birth.
As soon as the anesthetic drug begins to act on the spinal roots, contractions become virtually useless. And, in addition, in almost all cases, doctors have noted that under the influence of epidural anesthesia the cervix begins to open up much more intense. This means that the first period will take much less time. But, nevertheless, almost always it lengthens second stage of labor - bearing-down. That is why often about half an hour before the start of the alleged attempts doctors - an anesthesiologist or completely stop administering pain medication or reduce the dosage to limit its minimum.
In the same case, if during childbirth in women formed any breaks or cuts of the perineum, after the appearance of crumbs to the light dose of the drug will be increased again, and doctors can safely impose on the joints breaks. However, in some cases, discontinuation of the drug delivery is not made at all - for example, during cesarean section, or, if necessary, to exclude completely bearing-down period - for example, in heart diseases in the mother, myopia, the use of forceps.
Contraindications to the use of epidural anesthesia
Whatever positive effects did not have an epidural during childbirth, she, like any other medication, has a number of contraindications - factors for which the conduct of this method of pain relief inadmissible. Contraindications include:
- Loss of consciousness giving birth to the start of the epidural anesthesia.
- Significantly low blood pressure - 100 mm Hg. Art. and below.
- Significant deformation of the spinal column.
- Problems from the circulatory system - blood clotting, extensive bleeding, infection of the blood.
- Individual intolerance to the drug, used for epidural anesthesia.
- Exacerbation or severe course of neurological and psychiatric diseases.
- The refusal of the patient - the above mentioned, it is a prerequisite.
Epidural anesthesia during cesarean section
Not so long ago, if a child is born by Caesarean section, Mom could not see him in the first moments of life, since it is under the influence of general anesthesia. In recent years, more and more operations performed under epidural anesthesia. And it's a very good way of anesthesia, as my mother could see her crumbs in the first seconds after birth, and to the chest can also make.
Unfortunately, many women refuse to cesarean section with epidural anesthesia, because they are afraid that experience severe pain. However, this is not so - the concentration of the drug in this case will be much higher, and anesthesia will be one hundred percent, the woman did not feel anything.
Side effects and complications of epidural anesthesia
In some cases, fortunately, quite rare, epidural anesthesia during childbirth can cause certain side effects. One of the most common - a significant reduction in blood pressure. As a result of a strong reduction of pressure reduces the quality of the blood flow in the placenta, and, as a consequence of hypoxia. In order to avoid this, physicians intravenously infused with saline.
Another danger that can lie in wait for the woman - an allergic reaction to the drug used in epidural anesthesia. To avoid this undesirable reaction doctor - anesthesiologist before the epidural will introduce a small amount of drugs. After that, for some time the doctor will closely monitor not it follow from the body of a pregnant woman's unwanted adverse effects.
In some cases, a certain number of complications directly related to the complexity of manipulation. In the event that the inner sheet of the dura mater was accidentally punctured, and as a consequence, the drug got into the spinal canal, can dramatically and critically reduced blood pressure, complicating the process of breathing.
Very often, a woman who will have an epidural, is afraid that the doctor needle traumatize the spinal cord. In fact, this is not possible, since it is far above the puncture site. The only thing that you can catch with epidural anesthesia - a nerve roots. In that case, if the catheter touches the nerve root, a woman feels sharp shooting pain in one of the legs. It should immediately tell your doctor, who immediately changed the position of the catheter.
In very rare cases it happens that the pathogenic microflora gets to a place where the puncture was performed. Sometimes this leads to the development of local inflammation, and sometimes - to meningitis, inflammation of the meninges. Fortunately, this is rare - and successfully amenable to medical treatment.
Discussing a sensitive issue, as the epidural anesthesia for and against, it is impossible to mention the phenomenon of headache. Indeed, many women do on the second - the third day after birth can start a headache. There is due to the fact that the cerebrospinal fluid enters the epidural space. Usually the pain disappears on its own, without any interference from outside, about two - three weeks.
In fact, all of these side effects are extremely rare, so they should not be afraid. At the same time, a decision on the feasibility and advisability of epidural anesthesia in each case must take a doctor - anesthesiologist. He will select the most optimal variant of pain relief during labor, suitable for you.