Epidural
Giving birth without pain, or at least with limited pain is the aspiration of every woman who approaches the moment of giving birth, an aspiration that can actually be achieved throughepidural analgesia, considered the most effective method of limiting the pain of childbirth.
In this article
- The epidural in the country and abroad, the data
- Epidural and spinal
- Epidural: how it is done, when it is done
- Does the pain go away?
- Epidural requirements
- Consequences and risks
- Epidural and breastfeeding
The epidural in the country and abroad, the data
In Del Paese, however, the so-called "painless childbirth" is still relatively not very widespread. There is a lack of complete and updated data for the whole country, but according to a recent survey by Siaarti, the Del Paesena Society of anesthesia, analgesia, resuscitation and intensive care, the percentage of women who in the last two or three years have had an epidural during a vaginal birth oscillates between 10% of Marche and Trentino and 35% of Lazio (where, however, 77% of epidural births occur in the city), passing through 12% of the city, 18% of Tuscany, 20% of Umbria, 26% of Liguria, Veneto and Lombardy and 27,7 , XNUMX% of Emilia of the city (data communicated to mymodernparents.com by professor Edoardo Calderini, director of the Anesthesia and Intensive Care Department of the Clinic in our city and Siaarti regional councilor for Lombardy).
Data significantly lower than those recorded in other countries: again according to what reported by Siaarti, epidural analgesia would affect 67% of vaginal deliveries in the United States, 65% in Japan, 56% in Spain, about 60% in France. .
One of the main obstacles to a wider spread of the epidural is an organizational one. "Guaranteeing this form of analgesia H24 seven days a week to women in labor is a very demanding activity for a structure because it needs a certain staff of anesthetists, and this usually happens only in the largest birth centers" explains Calderini. "On the other hand, it must be said that some regions such as Lombardy have made a great effort in recent years to go in this direction, and that since last year the epidural has been included in the essential levels of assistance. guaranteed everywhere, I expect that in a few years the situation will improve more and more ".
Here is a list of the facilities that offer epidural analgesia H24, 7/7
Epidural and spinal
Epidural and peridural are synonymous and refer to a form of lumbar loco-regional anesthesia or analgesia, which involves a puncture in the back. The drug is injected, usually through a catheter, into the epidural space, the space in the bony canal of the spine just outside the last membrane that surrounds the spinal cord (dura mater).
With the 'spinal anesthesia or analgesiaInstead, the drug is injected into the subarachnoid space, a space located between two of the membranes that line the spinal cord, filled with a fluid called the cephalorachidian. "The effects are similar, but in the case of the epidural they are a bit softer and diluted over time, while with the spinal they are more immediate" explains Calderini. "In general, the spinal is used for the caesarean, while the epidural or epidural for the analgesia of labor".
In some cases it is even possible combine the two techniques, with analgesia spino-epidural. "If, for example, a woman at the onset of labor has extremely violent pain, it is possible to intervene with a spino-epidural, which allows on the one hand an immediate intervention and on the other the possibility of continuing in a softer way by injecting analgesic drugs through the catheter. in the epidural space for the duration of labor ".
If the hospital does not offer it, can I ask for it privately?
The new Lea, essential levels of assistance, have foreseen the epidural as free option for all women who request it, with the Ministry of Health that has specified to offer it in particular in centers that perform at least 1000 births a year.
Not all of these hospitals, however, are already actually able to offer the epidural free of charge H24. In these cases, if the hospital provides for it, it can be requested in freelancer: 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.
Epidural: how it is done, when it is done
The procedure first of all provides for a'local anesthesia for introducing a needle into the lumbar epidural space. A thin catheter is inserted through this needle into which drugs are administered, which can be infused several times depending on the duration of labor. The placement of the catheter takes a few minutes and there is no pain. Typically, the catheter is removed as soon as the mother leaves the delivery room, but sometimes it can be left in place for even longer.
When can it be done?
Until a few years ago, before giving birth analgesia was expected to have one dilation of at least 3-4 centimeters and indeed in some centers this habit has remained. However, it can also be done earlier, with a minor dilation, or with labor that has just begun.
According to the Guidelines of the British Institute for Clinical Excellence (Nice), for example, a woman's request to have an epidural must be met at any time, including prodromal period of labor which is typically latent but can be painful in some cases.
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Does the pain go away?
"Although the terms are sometimes confused, the epidural used for labor and delivery is not anesthesia but an analgesia. It means that there is no total elimination of pain but its reduction. The woman warns them contractions, albeit in a muted way, and maintains the ability to move and push"Prof. Calderini points out. Underlining that the fact of containing pain reduces stress in both women and children, increasing well-being of both.
In some specific cases the usefulness of the epidural goes beyond the reduction of pain. "For example, in the presence of a difficult childbirth, of a dystocia, relaxing the muscles can help the progression of the fetus. Or it can be useful if the woman suffers from heart disease, so it is better to avoid that she goes through too much stress such as that related to pain in childbirth ".
Of course, it can also happen that the epidural does not take effect, even if it is a rather rare event. "It may happen, for example, that the epidural space presents anatomical anomalies so that the anesthetic may not spread homogeneously, leaving some areas uncovered", explains Calderini.
Epidural requirements
Those who intend to request an epidural must do one anesthetic visit preventive. It also has to perform in the last month of pregnancy a blood test to evaluate the blood count and some parameters related to coagulation (prothrombin time and activated partial thromboplastin). You also need to sign a informed consent.
Read also: Pregnancy, all the exams you can do for freeConsequences and risks
Many studies have now investigated the possible effects of the epidural on the progress of childbirth and the possible risks for mother and baby. We know for example that with this analgesia they can lengthen slightly - about 20 minutes on average - the times of the expulsive period of childbirth. "Perhaps because, being more relaxed and calm, the woman pushes less urgently" says the specialist.
We also know that does not increase the risk of incurring Caesarean section. Instead, there seems to be a slight increased risk of operative childbirth, that is with suction cup, but be careful: according to a recent review of the scientific data available, this effect is no longer seen in studies after 2005, probably because they refer to more innovative epidural techniques or to a lower dosage of drugs.
For the mother, a frequent side effect is the onset of fever in the first hours after childbirth (which tends to disappear quickly on its own). Much feared is the onset of a particular form of headache very intense called orthostatic because it is felt while sitting or standing, while it is considerably attenuated when lying down. "It can occur in 1-6% of cases, for example if during the execution of the epidural the needle comes to puncture the subarachnoid space" explains Calderini. It usually lasts a few days and can be treated with traditional pain relievers. "However, some new studies suggest the particular efficacy of a prostigmine treatment combined with atropine in the treatment of this headache," says Calderini.
Epidural and 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 method limitations. Other subsequent studies no longer highlighted these effects.
A situation also underlined by a recent document from the American Academy of Breastfeeding Medicine on analgesia and anesthesia of childbirth and breastfeeding. The paper concludes that the epidural most likely has limited effects on women who have one good motivation to breastfeed and receive a adequate support for breastfeeding immediately after giving birth and in the following weeks.
When it can't be done
Contraindications to epidural are very few and very specific. In particular:
- neurological diseases affecting the spine
- blood clotting pathologies
- ongoing infections where the sting should be done
- very serious scoliosis
- outcomes of major surgeries along the spine.
Sources for this article:
- advice of Edoardo Calderini, director of the Anesthesia and Intensive Care Department of the Clinic (IRCCS Cà Granda Foundation Ospedale Maggiore Policlinico) in our city;
- information booklet "Pain from labor in 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;
- Revisione Cochrane Epidurals for pain relief in labour
TAG:
- epidural
- give birth
- labor
- contractions
