An epidural is great for pain in labor, but women still don't know much about an epidural in labor - and their fears are exaggerated. We talk to Dr. Krystyna Gralińska, an anesthesiologist, about this method of relieving labor pain.
- Such fears arise from a lack of knowledge. For gynecological and obstetric purposes,epidurale is performed in the lumbar spine, at the height of the L3-4, L4-5 vertebrae, i.e. below the spinal cord. Most often, husbands ask, "What if your hand shakes and the needle goes deeper than you intended?" My answer is that there is no spinal cord at this altitude, so there will be no injury to the nervous system, only some cerebrospinal fluid will leak out - similar to a laboratory test (lumbar puncture). Epidural anesthesia is a safe method, provided certain conditions are met. First of all, in order to avoid undesirable symptoms during anesthesia, a woman should see an anesthesiologist before delivery. During the visit, the doctor collects an interview regarding the past illnesses, medications taken, laboratory tests and the current state of the patient's he alth. After such a meeting, the anaesthesiologist decides on the method of anesthesia.
- Of course. The doctor looks at the results of the tests that the pregnant woman has already done and recommends any additional tests. The blood coagulation test is the most routine and useful. Any bleeding abnormalities should be explained as they may contraindicate the use of an epidural. Other contraindications are diseases of the central and peripheral nervous system. For example, if the patient has or has had severe headaches, migraines, the anaesthesiologist may ask for an examination by a neurologist. Neurological diseases are sometimes discreet, without obvious symptoms, so the anaesthesiologist should know about the patient's complaints and decide how to prepare her.to childbirth and the method of anesthesia.
- The drugs that we currently use in the epidural method cause allergies very rarely, almost never at all. Of course, the question of tolerance to anesthetic drugs during dental procedures is helpful. If a woman responds well to anesthesia at the dentist's, there is usually no risk of allergy during epidural anesthesia, because it is a similar group of drugs. But even in people prone to allergies, we use regional anesthesia instead of general anesthesia.
Epidural - what should you know about it?
ImportantDr. Krystyna Gralińska , 2nd degree specialist in anaesthesiology and intensive care, long-term educator, assistant and assistant professor at the Department of Neurosurgery and Department of Anesthesiology, Medical University in Warsaw, deputy head of the Department of Anaesthesiology and Intensive Therapy at the Institute of Mother and Child in Warsaw. Currently, he works in a private hospital, Damian Medical Center in Warsaw. She co-organized the first Polish course in anaesthesiology in obstetrics, is a lecturer on training courses for anesthesiologists and obstetricians, the author of articles and publications in the field of anesthesiology in obstetrics.
- Complications are very rare and usually result from the fact that the anesthetist was unable to meet the patient two to three weeks before the due date and interview the patient. The history of labor may not be sufficiently accurate due to the patient's pain or anxiety. There may be complications due to disorders of the coagulation system or hidden neurological disease that the anesthetist was not aware of. Therefore, the patient's antenatal visit to the anesthesiologist is extremely important. The percentage of observed complications is really very low. The method is recommended especially for pregnant women and in childbirth and is considered safe for women and babies.
- In the 1970s, when I started using this method, I warned my patients that after this anesthesia, my spine could hurt, but since the 1980s I have not done it anymore. However, I ask my patients if their spine hurt before pregnancy and if they got worse during pregnancy. If back pain occurred before pregnancy, it may return or even get worse after delivery. The cause of these ailments is usually differentreasons, not epidural. Americans have carefully researched this topic and found that as many women who have had epidural as well as those who have never had any conduction anesthesia complain of recurrent back pain after childbirth. When it comes to headaches, my experience shows that they occur in 0.1-0.2 percent of people. an annotated women. They can occur when the so-called lumbar puncture, i.e. puncture of the dura mater. However, this happens rarely, and we can treat them effectively. Usually, after a few or several hours, these pains disappear. It is not an ailment that affects the patient's he alth in the future.
- It was like that a long time ago. When we introduced this anesthesia in Warsaw in the 1970s, the woman, after receiving it, did not feel any pain during uterine contractions in the first and second stage of labor. The woman in labor most often remained in bed in the supine position. However, already in the 1980s, obstetricians completely changed the rules of childbirth and now immobilization during labor is considered a mistake. A woman in labor should be mobile as an upright position is most favorable for the course of labor. It lasts longer in the supine positions and the child's heart rate disturbances appear more often, therefore the woman in labor should be active. And despondency must make it possible for her to do so.
- Of course, the midwife listens to the pulse from time to time, it does not have to immobilize the woman in labor. In special situations, when it is necessary to record the fetal heart rate monitor, the patient remains in bed lying on her side.
- Currently, anesthesia in labor does not mean that the patient will not feel anything. She will feel contractions, but only up to a certain level. It can be said that her pain sensations are only a fifth or a sixth of what she would have felt if the desensitization had not been applied. Anesthesia in childbirth is supposed to alleviate pain, not eliminate it completely.
- I used to say that, too, but the last time was in 1994. I suggestedthe patient had an anesthesia before, but she did well and only asked for it when she was 8 cm dilated. Then I said that it was not worth insulting anymore, because she would give birth anyway. After about two hours, I came to tell her that she gave birth alone, and she was still 8 cm! Then I put anesthesia on her without a word, and within 20 minutes it was postpartum. Since then, I never say it's too late. It is not true that late administration of anesthesia will inhibit labor. And the custom of putting it on at the 3-4 cm stage is only due to the fact that statistically most women ask for it then. However, this does not mean that they all ask for it then. There are women who are 5-6 cm and still tolerate pain well, and there are also those who give birth all night long, suffer a lot, and their dilation during this time is only 2 cm. In such situations, it is impossible to wait 4 cm, only to despise. It happened that I came to the hospital in the morning, and the obstetrician said that the woman in labor had had a dilatation of 2-3 cm for several hours, and if there was no progress in labor within two hours, she would do a caesarean section. Then I put on anesthesia and after 2-3 hours the baby was born. There was no cut, there was a natural birth. After these many years of observation, my answer is this: I do not weigh down the centimeters, but the patient, because she is suffering and this suffering must be soothed. The indication for anesthesia is pain that is not tolerated by the woman in labor. They can be used at any stage of the first stage of labor.
- The duration of the first period is definitely shorter: women give birth with anesthesia faster than without it, especially for women giving birth for the first time. However, as for the second period, there is no significant difference in its duration, but it may be slightly longer. There are births in which the pressure period lasts 40-45 minutes, which is not abnormal at all, but often it is 10-15 minutes or even shorter.
- 30 years ago, when she was completely anesthetized and the woman in labor felt absolutely nothing, there was a rule that in order to get the baby out, forceps had to be applied. Nowadays, when we despise the woman so that the woman has full control over the course of labor and gives birth on her own, the statement that anesthetic births more often end with surgery, is not true. When I worked at the Institute of Mother and Child, I kept statistics on births there,and every year we despise about a thousand of them. It turned out that deliveries with epidural anesthesia ended surgically much less frequently than deliveries without anesthesia. There were fewer cesarean sections among them and fewer interventions with the use of forceps or a vacuum.
- No. There is a view of pediatricians, confirmed by behavioral research, that in the case of caesarean sections, the condition of children of epidural anesthetized mothers is better than that of those born under general anesthesia. Also, if we compare the condition of naturally born infants with and without anesthesia, the former require the intervention of a pediatrician much less frequently. The acute pain associated with childbirth leads to narrowing of the blood vessels and a reduction in blood flow through the uterus and placenta, worsening the baby's intrauterine conditions. By minimizing pain, we ensure that the baby has better birth conditions and is born in a better condition. Another advantage of this method of anesthesia is that it enables - very important - early mother-child contact, immediately after delivery, as well as immediate breastfeeding.
Anesthesia for childbirth
What forms of pain relief can the woman in labor take advantage of? Listen to our expert.
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