Epidural anesthesia and its use in the modern world
Epidural anesthesia (EA) and its appropriateness during childbirth is a question that comes up every day in my clinic. Many people ask me about my personal experience of pain relief during labor, and I share more of my own beneath. In Ukraine, the use of epidural anesthesia during childbirth is 18-23%, in the UK it is 20%, and in the US it is 60%. I should also note that in private clinics, this figure increases to almost 90%. This is since obstetric practice has managed to appreciate the benefits of this technique, which allows preventing traumatic experiences for women.
But more and more often in our society we hear the question “how did women give birth before, they had to endure it somehow”. Some state that women are created to experience “labor pain and ensure that the child passes through the perinatal matrices correctly”.
Yes, we were created and yes, we have been enduring this for centuries.
Epidural anesthesia: myth and reality
So, now let’s talk about reality. If a woman has a naturally low pain threshold, has difficulty tolerating pain, and has always taken painkillers during menstruation, then of course this is an indication for epidural anesthesia.
Epidural anesthesia does indeed ease the mother’s feelings during the birth process. However, it does not deprive her of labor activity, she still breathes and strains to make the contractions productive. The fetus passes through the birth canal in the same way, and thus goes through all the “intrapartum trials” that are inherent in nature.
To assess the degree of “authenticity” of motherhood by the criterion of natural childbirth is a sign of a mythical type of thinking.
And now, medical facts about epidural anesthesia that will help you decide about pain relief in childbirth by epidural anesthesia because, as you know, a #happy_woman_is healthy_and_educated.
The benefits of epidural anesthesia
- Allows you to rest in case of prolonged labor;
- The absence of pain helps a woman to perceive childbirth more positively;
- This method of anesthesia allows you to remain conscious and actively participate in the labor process, even if you give birth by cesarean section;
- Epidural analgesia will help you to cope with exhaustion, irritability and fatigue, and will allow you to rest, focus and give you the strength to move forward as an active participant in the labor process. When I worked in a maternity ward, I had experience with exhausted women. Instead of pushing, they just asked for help to get the baby out of them faster;
- EA helps doctors reduce certain complications like cervical spasm or high blood pressure.
But let’s remember that epidural anesthesia is still a medical intervention. It has not only advantages, but also contraindications and certain complications.
Risks of using epidural anesthesia
1. EA can lead to a sudden drop in blood pressure.
Therefore, you will be given intravenous medications. Monitor your blood pressure periodically. In general, it is normal to have a venous catheter inserted when you get to the delivery room. It helps to have access to the circulatory system at any time. If you don’t need it, it will be removed after the delivery.
2. Postpuncture headache caused by a slight loss of fluid.
Less than 1% of women have this side effect. Several of my patients had this syndrome with varying degrees of intensity. And some of them had to get treatment in a neurologist for up to 3–6 months.
3. After the epidural catheter is inserted, you should change sides while lying in bed and monitor the baby’s heartbeat.
The midwife will do a CTG (cardiotocography), a procedure for monitoring the baby’s heartbeat, which most pregnant women routinely get acquainted with after 36 weeks. Lying in one position can cause contractions to slow down or even stop.
4. Some women experience the side effects:
Trembling, ringing in the ears, back pain, pain at the injection site, nausea, and difficulty urinating. However, this does not affect the intrauterine condition of the baby.
5. Numbness
A few hours after delivery, you may feel numbness in the lower part of your body, which will force you to move with assistance.
Rare complications
1. In rare cases, a nerve may be damaged in the area where the catheter is installed.
2. Certain studies suggest that some newborns may have problems with nipple latching, which can cause difficulties with breastfeeding.
3. Very rarely, during EA, fetal rhythm disturbances and hypoxia (lack of oxygen) occur. This, in turn, requires either a cesarean section or an incision in the perineum (episiotomy), or the use of a vacuum extractor to deliver the baby faster.
And now, a blitz of the most common questions that you, my dear women, and your partners ask your obstetrician-gynecologist:
I’m afraid of pain, can I have an epidural anesthesia with the first contraction?
This method can be used from the moment the cervix is 4 cm or more dilated. It is the opening of the cervical canal by more than 4 cm that indicates the transition to the active phase of labor. This allows the anesthesiologist to start the EA procedure.
Is it true that EA leads to weakness of labor?
Yes, sometimes EA weakens labor activity, and this is corrected using oxytocin.
How will this anesthesia affect my baby during labor and the first day after birth? And possibly for the rest of his or her life?
The health of the baby during labor and after birth depends on many factors:
The time of delivery, the high blood pressure and sugar problems in the woman in labor, the condition of the placenta, and the course of pregnancy in general. And, of course, the genetics that the parents passed on to the baby. And as I wrote above, EA can lead to fetal hypoxia, which may require either a cesarean section or vacuum extraction. But again, it is difficult to single out epidural anesthesia as the main factor in the development of complications for the baby.
Many factors affect the labor process and the intrauterine condition of the baby. But it has been proven that a mother’s anxiety and constant self-digging definitely leads to an increase in stress hormones, which rapidly enter the baby through the placenta. That’s why it’s important to write down all your questions and fears and talk to the doctor who is monitoring your pregnancy.
My friend asked for an EA, but she was denied. Why didn’t she have an epidural anesthesia? Was there no doctor who knew the EA technique?
Like any medical intervention, EA has its contraindications. And I ask you not to transfer the experience of another woman’s childbirth to yourself. You do not know all her diagnoses, the course of her pregnancy, etc. It is better to prepare for childbirth with your doctor and take courses for pregnant women.
When you can’t have epidural anesthesia
- Low platelets (cells that prevent hemorrhage and work as a welding machine in the puncture site);
- You are in rapid labor or have arrived at the maternity ward with cervical dilatation of 8 cm or more. The doctor expects the baby to be born in the next 60–90 minutes;
- You have an infection or injury around the needle puncture for anesthetic use;
- You are taking anticoagulants, which are medications that thin your blood;
- You are bleeding;
- Your cervix has not yet dilated to 4 cm;
- You are allergic to drugs used by the anesthesiologist.
The technique of using epidural analgesia is constantly being improved, and a significant part of its success depends on the skill of the doctor. But this rule applies in any field.
If you have any doubts about the use of EA, you should schedule an appointment with an anesthesiologist and discuss all your concerns with him or her.
My personal experience of childbirth
All three times, I gave birth without the use of an EA. Yes, for me, it was a pain that I could live with and forget a few days after giving birth. But I am convinced that this does not characterize me as a woman and a mother in any way. That is, refusing an EA does not make me more or less feminine, sexy, or better than a woman who gave birth with an EA or cesarean section.
My beautiful women, let’s stop the tradition of measuring our values with the number of children, the “naturalness” of childbirth and the duration of lactation! It is a sense of inner dignity, the ability to enjoy life, and respect for another woman makes us real women!
To all 💗 and remember: if you have gained knowledge, pass it on to a friend. After all, the information from this article will allow other pregnant women to make the right choice for themselves. In addition, some women will finally get rid of the burden of inferiority as a result of the debunking of the myth of “physiology and pain relief”.
If you have any questions about your health, you can contact the Lior Medical Center.
Learn more about pregnancy and childbirth in my course Pregnancy and Preparation for Childbirth. Detailed info about the first year of a child’s life after birth is in the program Postpartum period up to 1 year of life.
I’m eager to file all of these courses in English, just send me a request to dr.silinaeducation@gmail.com.
My respect and love, your Natalia Silina,
gynecologist-endocrinologist,
UNFPA and UNICEF sexuality education expert
Sources:
1. American Academy of Family Physicians
2. William’s Obstetrics Twenty-Second Ed. Cunningham, F. Gary, et al, Ch. 19.
3. Mayo Clinic Guide To A Healthy Pregnancy Harms Roger W., M.D., et al, Part 2.
