Epidural or non-epidural? 20 answers to decide

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Marie-Ange Demory
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Do not feel the pain of childbirth: this is the goal of expectant mothers when they think about the epidural. Still, they still seem to make up a clear cut minority women who use this option in Del Paese.



According to a recent investigation by the Siaarti, Del Paesena Society of Anesthesia, Analgesia, Resuscitation and Intensive Care, the percentage of women undergoing an epidural during a vaginal birth fluctuates between 10% of Marche and Trentino and 35% of Lazio (but over 70% is done in the city), passing through 18% of Tuscany, 20% of Umbria and 26% of Liguria, Veneto and Lombardy (data communicated to mymodernparents.com by professor Edoardo Calderini, director of the Anesthesia and Intensive Care Department of the Center in our city and regional councilor Siaarti for Lombardy).



This partly depends on organizational difficulties: less than half of Del Paeseni birth centers practice epidural analgesia for labor / delivery, and not necessarily for 24 hours a day. On the other hand, guaranteeing an epidural for 24 hours means always having one anesthetist easily available to the delivery room, which starts the procedure in good time for the parturient and returns every one or two hours to make small top-ups of the drug: an availability difficult to obtain in the smallest structures.

In addition to this, however, it must be said that the analgesia of labor and delivery still persist many false beliefs and some false expectations. MyModernParents.com tackled them one by one, with the help of experts and scientific reference material.

In this article

  • Epidural or spinal: what's the difference?
  • How is an epidural done?
  • At what stage of childbirth can an epidural be done? 
  • Is it true that with the epidural the woman loses the ability to actively participate in childbirth?
  • Is the elimination of pain total with the epidural?
  • Is it true that with analgesia the times of labor are lengthened?
  • Does having an epidural increase the use of a suction cup or a caesarean?
  • Does having an epidural increase the recourse to induction of childbirth?
  • Is it possible that the anesthesia is not working?
  • Can an epidural give mom side effects?
  • Is it true that due to the epidural, the mother can have a headache after giving birth?
  • Can the epidural give the baby side effects?
  • Can an epidural interfere with initiating breastfeeding?
  • Can the epidural also serve as anesthesia in the case of a caesarean section?
  • Can it also be used after childbirth if stitches are to be placed?
  • Does anyone intending to request an epidural have to make a preventive anesthetic visit?
  • Are special tests necessary to do the epidural?
  • Are there any cases in which it is not practicable?
  • Is the epidural free or is it paid?
  • As an alternative to an epidural, are there any natural methods that relieve the pain of childbirth?
Here is a list of the facilities that offer epidural analgesia H24, 7/7

1. Epidural or spinal: what's the difference?

They are both two types of lumbar loco-regional anesthesia, that is, involving a puncture in the back. With epidural or peridural (the two terms are synonymous), the anesthetic is injected into the space between the bony canal of the spine and the dura mater (hence the name), the outermost membrane that lines the spinal cord. The effect occurs after about 15-20 minutes. With spinal anesthesia, the drug is injected around the spinal cord, in the liquid that bathes the nerve roots (cerebrospinal fluid), then more internally than in the epidural and acts in just two to three minutes.



The effect obtained is similar in both cases, but with the epidural the effect is a little slower and more nuanced and the amount of drug and the duration of analgesia can be gradually modified as needed. thanks to the application of a catheter. For the spinal, on the other hand, a catheter is not placed, but it is administered with a single injection. Typically, the spinal is used in the cesarean, while the epidural is used for the analgesia of labor and delivery.. There is also a combined anesthesia epidural-spinal which allows you to take advantage of the duration of one and the speed of the other: a single low-dose spinal injection is made, but a catheter is also inserted, for the possible subsequent administration of a new analgesic via the epidural route.

Read also: Caesarean section: how it happens and what risks it entails

2. How is an epidural done?

With the woman in a sitting position and bent forward or lying on her side, first a small local anesthesia is done in the space between the third and fourth lumbar vertebrae (basically at the bottom of the back). Here through a needle, which will then be removed, a small catheter, through which the drugs will be administered for as long as necessary.



The catheter is fixed with adhesive tape to the woman's back and removed at the end of the birth or a few hours later: it generally does not cause discomfort and does not affect movement or position in bed (although some women may instead be annoyed by its presence. ).

3. At what stage of childbirth can an epidural be performed?

Until a few years ago, a dilation of at least 3-4 centimeters was expected before giving birth analgesia and in fact this habit has remained in some centers. However, it can also be done earlier, with a minor dilation, or with labor that has just begun. According to the results of a survey published a few years ago by an international research group, the best time to have an epidural is when the mother asks for it.

 

11 PHOTOS

Birth dilation: pictures

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The dilating phase of childbirth is the second phase, immediately following the prodromal phase (which sometimes goes unnoticed and sometimes is accompanied by preparatory contractions). It's the beginning ...

4. Is it true that with an epidural the woman loses the ability to actively participate in childbirth?

No, that's not true, especially as regards the country. According to the protocols followed by the Del Paeseni hospitals, with the epidural the woman continue to experience uterine contractions, but does not feel (or feel less) the pain associated with the contractions themselves. It is true that the woman could feel more vaguely the sensation of thrust of the head at the perineal level, however she feels the contraction of the belly and, adequately assisted by the midwives, can still push effectively, since her muscle strength remains unchanged. .

This means that he can participate equally in childbirth, as well as being able to walk and assume the positions he wants for the entire duration of labor (not for nothing we are talking about walking analgesia).

5. Is the elimination of pain total with the epidural?

No: with the dosages of anesthetic used in Del Paese the pain never goes away completely. The reduction of pain is noticeable in the dilating period and only partial in the expulsive period. This is because in the expulsive phase they are involved in the transmission of pain of the nerves which, to be blocked, would require a greater amount of anesthetic. This could weaken the leg muscles and especially the abdominal muscles, resulting in the inability to perform effective thrusts at the time of the baby's birth.

Read also: 6 tips to overcome the fear of childbirth

6. Is it true that with analgesia the times of labor are lengthened?

The times of the dilation period do not undergo significant variations, while the duration of the expulsive period is on average a little longer (about 20 minutes). The reasons are not clear, but it is likely that, not having the urgency of pain, the woman pushes a little more "quietly" than she would if she felt pain.

7. Does having an epidural increase the use of a suction cup or a caesarean?

The scientific literature clearly states that the use of an epidural It does NOT increase the risk of having a caesarean section. The issue is slightly more controversial than the risk of operative delivery, i.e. with suction cup: according to a recent Cochrane review, the available data indicate an increased risk of giving birth with a suction cup following an epidural, but in reality a lot depends on the dosage: the phenomenon was therefore more frequent a few years ago, when more anesthetic dosages were used. high, compared to more modern epidurals.

8. Does having an epidural increase the recourse to induction of childbirth?

No. Conversely, if for particular reasons it is necessary to induce birth by administering oxytocin, the epidural can help make the pain more bearable, which is generally more intense than what happens with natural labor.

9. Is it possible that the anesthesia has no effect?

It can happen, although it is a rather rare event. For example, it may happen that the epidural space has anatomical anomalies (congenital, post-traumatic or due to situations such as scoliosis, arthrosis, herniated discs) for which the anesthetic may not spread evenly, leaving some areas uncovered. To remedy this, you could try increasing the dosage of the drugs or moving the catheter slightly (this is a painless maneuver).

Also the position of the child it may make the anesthetic less effective if the baby turns his head down the birth canal to increase the sensation of pain.

Read also: Last month of pregnancy, eight things to know

10. Can the epidural cause side effects for the mother?

While performing both the spinal and epidural, the woman may feel small jolts in the back or legs, which, however, are only temporary, while in the days following the birth, a mild pain in the sting area, similar to a bruise, destined to disappear by itself.

In some women, a slight feverish rise, especially if the analgesia lasts for a long time, beyond 6 hours, but often the woman does not even notice it, 'distracted' as she is from the birth.


As with any other drug, the anesthetic could give allergic reactions, but they are very rare and unpredictable occurrences (except in cases of already known allergies). The most serious complication that can occur during lumbar anesthesia is theepidural hematoma, due to bleeding inside the spinal canal, which, in extreme cases, can lead to paralysis of the lower limbs. This complication - in itself very rare (we are talking about one case every 10-20 thousand analgesias) - can be avoided by checking with a blood test the normality of clotting factors and not administering anticoagulant drugs, such as heparin, in the period before anesthesia (the withdrawal period varies according to the type of drug and the dosage).

The most frequent side effect is instead a particular form of headache, annoying but harmless, which affects 1-6% of women.

11. Is it true that after the birth the mother can have a headache due to the epidural?

Yes, this can happen in about 1-6% of cases, if the needle comes to puncture the subarachnoid space, for example due to an anatomical anomaly or a sudden movement of the mother at the time of the puncture.

It is a very intense headache, which occurs in the 24 hours following the birth and lasts a few days. It can only be felt when sitting or standing (we speak of orthostatic headache), while it subsides noticeably in the supine position, which is why the best therapy is lying in bed, waiting for it to pass by itself. Analgesics and a large intake of fluids can still help. And other drugs (in particular prostigmine associated with atropine) have given excellent results in the experimental setting and could soon be used in the clinic.

12. Can the epidural cause side effects to the baby?

Even if the anesthetics used could theoretically cause neonatal depression, ie phenomena of drowsiness or respiratory failure, the dosages used in the protocols of the Del Paeseni hospitals are so low that they act only locally. Infants therefore do not present any problems related to anesthesia.

13. Can the epidural interfere with the initiation of breastfeeding?

The question of the relationship between epidural analgesia in labor and breastfeeding has always been controversial. The first studies conducted in this regard seemed to suggest an epidural interference with the possibility of breastfeeding, but they were studies with some evident method limitations.

Data today suggests that there are no major differences in breastfeeding success among women who have given birth vaginally with or without an epidural.

In particular, also in this case the same discourse on the dosages of anesthetics applies: low dosages, such as those used in Del Paese, are such as not to interfere with the initiation of breastfeeding. The reassuring conclusions of a clinical protocol of the American Academy of Breastfeeding Medicine also say: the epidural, in fact, does not affect breastfeeding, especially if the dosage of anesthetic has not been too high and if the mother leaves with a good motivation to breastfeed and receives adequate support immediately after delivery and in the weeks following.

Read also: Breastfeeding, how to get started right

14. Can the epidural also serve as anesthesia in the case of a caesarean section?

Yes. In this case it is sufficient to administer a larger dose of anesthetic through the catheter and after a few minutes the surgery can be started. In general, however, spinal anesthesia is used for the caesarean section.

Read also: Caesarean section, when it is really needed

15. Can it also be used after delivery if stitches are to be placed?

If with childbirth they occurred perineal lacerations important that require the application of many sutures, the catheter already applied is used to administer the amount of anesthesia sufficient to completely eliminate the pain. In this case, however, the legs will also be locked for 1 or 2 hours.

16. Should anyone who intends to request an epidural have a preventive anesthetic visit?

Yes, a preventive anesthetic visit is necessary. In any case, regardless of whether the woman wants to have an epidural or not, it is now a widespread protocol in almost all hospitals that pregnant women have an interview with the anesthetist in the last month of pregnancy, to collect information. useful in case they have to resort to any type of anesthesia (even for an emergency cesarean or post partum revision).

During the interview, the anesthetist informs the woman about the various techniques offered by the facility, explains how the epidural is done and what results can be expected, prepares a personal anesthesiological record with the woman's medical history. If, at the time of admission, the woman communicates her intention to have an epidural, the anesthetist will already have all the necessary information.

17. Are special tests necessary to perform the epidural?

To perform spinal or epidural anesthesia in absolute safety, it is necessary that, in the last month of pregnancy, a complete blood count with platelets it's a coagulation examination (prothrombin time and activated partial thromboplastin): these are biochemical tests that are now routinely prescribed to all pregnant women between the tests in the last month. Without knowing these values, the epidural cannot be performed and in the case of a caesarean, general anesthesia could be performed.

As for the electrocardiogram and the cardiological examination, they are not always necessary, unless doubts arise from the visit. Please note that before undergoing the epidural, you must sign a informed consent.

18. Are there any cases in which an epidural is not feasible?

They are very few and very specific. An epidural cannot be done in case of:

  • neurological diseases affecting the spine;
  • pathologies of blood clotting;
  • ongoing infections where the sting should be done;
  • very severe scoliosis;
  • outcomes of major surgeries along the spine.

19. Is the epidural free or paid?

The new Lea, essential levels of assistance, have provided epidurals as a free option for all women who request it, with the Ministry of Health having specified to offer it in particular in centers that perform at least 1000 births a year. Not all hospitals, however, are already actually able to offer the epidural free of charge H24. In some, for example, it is free during the day and paid at night. If the hospital provides for it, it can be requested as a freelance professional: the cost varies according to the specialist's tariff, generally from 800 to 2000 euros. To know the situation of your own territory, you can consult the service cards on the websites of the individual hospitals, where all the services provided by the structure are listed.

20. As an alternative to an epidural, are there any natural methods that relieve the pain of childbirth?

It is intuitive to think that some "natural" strategies can help in managing the pain of childbirth. "Let's think about the importance of emotional support"he comments Marta Campiotti, freelance midwife of the Montallegro Maternity Home, of the city. "Feeling understood, reassured, surrounded by affection and attention, in an intimate and comfortable environment, makes waiting and pain more bearable, while emotional loneliness accentuates fear, which exacerbates pain, in a sort of vicious circle".

According to the midwife, they can also help ability to change position during labor and delivery, in order to accompany the descent of the child, labor in water, which relaxes the muscles and stretches the tissues, massage.


From a scientific point of view, for the moment the available data fully confirm only the effectiveness of epidural and nitrous oxide (even if in this case the recorded effectiveness is less). Water labor, relaxation techniques, acupuncture and massage have shown efficacy in a still too limited number of studies while for other strategies (hypnosis, biofeedback, aromatherapy, TENS) there are not enough data to draw conclusions.

 

Sources for this article: advice from Edoardo Calderini, director of the Anesthesia and Intensive Care Department of the Center in our city; advice of Gianfranco Camilletti, medical director of Anesthesia and Intensive Care at the Salesi Maternal and Infant Hospital in Ancona; advice of Outbound Safe, former director of Anesthesia and Intensive Care of the Vittore Buzzi Children's Hospital of our city (now retired); information booklet "Pain from childbirth: knowing and controlling it" produced by the Polyclinic of our city; video produced by the Polyclinic of our city; information material from the site The Midwife Review.

 

Read also: Epidural or not? Comparison of opinions

TAG:
  • epidural
  • epidural
  • spinal
  • partoanalgesia
  • childbirth pain
  • Natural childbirth
  • Caesarean section
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