A few days ago we informed you in detail about the main analgesic techniques (pharmacological or not) to better cope with the time of delivery, and today we want to do the same with anesthesia.
They are many women who resort to the use of the epidural when giving birthBut are there other possible alternatives? What do they consist of and what are their implications? Today we talk about it, although we remind you of the importance of consulting all the doubts you have about it with your midwife or gynecologist.
What is anesthesia?
Anesthesia is the use of medications that are used to avoid feeling pain during surgery or a painful procedure. There are different types of anesthesia, but they all aim to block nerve impulses and, therefore, pain.
At the time of delivery there are different kinds of anesthesia, and each of them is indicated in a specific case or for a specific procedure. We will analyze them below:
Epidural anesthesia
It is the type of anesthesia best known and used by most pregnant women. Not surprisingly, and according to data prepared by the hospitals themselves, eight out of ten women turn to it at the time of delivery.
Epidural anesthesia consists of the reversible blockage of nerve roots that cause pain. To do this, it is applied through an injection into the epidural space, leaving a thin tube called a "catheter" through which more anesthesia will be applied in a controlled manner and without the need to puncture again.
When it is administered
It is the doctor or midwife who will indicate the most appropriate time to administer this anesthesia, since in the case of a very advanced state of dilatation, it may not be advisable to put it in, since it takes time to take effect (between 15 and 20 minutes), and in those cases the risks could outweigh the benefits.
It feels?
Normally, after the application of anesthesia, the contractions feel more bearable, and the legs are tingling and somewhat heavy to the movement. However, not all women react equally to the epidural: there are times when the legs remain completely immobile, while in other cases it is not as effective as expected.
Side effects
A review of studies published in 2009 by Cochrane concluded that, although It is effective for pain relief during childbirth, the epidural also increases the risk of instrumental delivery (use of other drugs, forceps, suction cup, episiotomy, etc.), because in many cases the woman loses the reflex of the thrust and needs help to get the baby out.
Among the main adverse effects caused by the use of epidurals, there has been a drop in maternal blood pressure, headaches as a result of accidental puncture of the dura, and post-puncture low back pain. In addition, other adverse effects such as lengthening of the dilation phase, tremors, itching, or other more serious complications have also been associated.
Contraindications
As we can read in this fact sheet prepared by the University Hospital of Fuenlabrada (Madrid), epidural anesthesia is absolutely contraindicated in those patients who present with puncture point infection, significant hypotension, endocranial hypertenction, severe infrecient syndrome, coagulation disorders and anticoagulant treatments.
Spinal disorders and obesity are not contraindications, but they can make the technique difficult and even prevent it
Its use is widespread by all hospitals, so consultation with the anesthetist in the last phase of pregnancy is usually highly recommended to clarify doubts and analyze the risks and benefits of using epidurals.
Epidural walking
As we have just seen, one of the main disadvantages of the epidural is that it usually numbs the legs, so most women must remain lying on the stretcher and without the possibility of movement during the duration of their delivery.
The walking epidural or epidural walking, is an anesthesia that gets control the pain of contractions but without leaving the paralyzed woman from the waist down, which allows you to have freedom of movement, walk and thus help the child to prosper.
It has been administered for a decade in some hospitals in our country, although it has been in recent years when it has begun to gain popularity.
It is applied the same as epidural anesthesia and the novelty is in its composition and in the combination of several drugs. This ensures that only the sensory fibers fall asleep, while those that control the movement remain awake.
The traveling epidural It is contraindicated in the same cases as epidural anesthesia, and we must also take into account the main problems that may arise and that are:
It lasts a short time, so it only works in short deliveries.
It is not indicated in advanced deliveries, since higher concentrations of drugs that can cause motor blockage are required.
It is important to ensure that the mother can feel and move her legs correctly to avoid accidents and falls.
It usually has side effects very similar to epidural, although itching occurs more frequently With the use of this anesthesia.
Not all hospitals offer it, as qualified personnel are required to care for pregnant women who receive it.
Spinal Anesthesia
Is a type of anesthesia similar to epidural but with immediate effect, of a fixed duration (usually two hours) and indicated in short procedures, such as caesarean section.
Its administration is very similar to epidural anesthesia, except that it is done with a small gauge needle and the anesthetic is injected directly into the cerebrospinal fluid, without the need to use a catheter.
The adverse effects of spinal anesthesia and its contraindications are the same as in epidural anesthesia.
General anesthesia
General anesthesia in childbirth It is only indicated in cases of emergency C-sections without prior catheter, or in those who do not have time to apply spinal anesthesia or is contraindicated.
General anesthesia leaves the patient unconscious, unable to move and generally intubated and connected to an artificial respirator, and its use has significant complications for both the mother and the baby, hence it is indicated only in cases of extreme urgency.
Side effects
To the typical risks involved in the use of this type of anesthesia for the patient, one must also add the risk of neurological and / or respiratory depression of the newborn, as well as a delay in skin-to-skin contact between mother and baby.
Local anesthesia
Local anesthesia is injected into a specific area to provide pain relief during labor, when the patient does not have the epidural on. It does not eliminate the pain of contractions, but it is effective in mitigating discomfort during the expulsion phase.
When it's used
It is used at the final moment of birth to relieve pain caused by stretching of the perineum, as well as numbing the area if an episiotomy is needed or a tear occurs. It can also be applied immediately after birth, injected into the skin, muscle or cervix for rapid and temporary relief of pain in the perineal area.
Risks of local anesthesia
As we can read on the website of the American Pregnancy Association, there are no significant risks when using local anesthesia, except for rare allergic reactions. However, some experts believe that local anesthesia could cause inflammation in the perineal tissue, thus increasing and the chances of rupture or needing an episiotomy.
A few days ago we saw some measures that we can take during pregnancy to avoid, to the extent possible, this type of associated risks.
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