3 February 2014

In order to understand Epidural anesthesia, one should know about pain during labour.

What are the causes of labour pain?

There are two main causes of pain during labour; emotional and functional causes.
The causes for emotional pain are “fear and lack of knowledge”. These factors can affect the severeness of labour pain positive or negatively.
Being educated and knowledgeable about labour may not end pain totally, but it helps us how to cope with it. A candidate having had such an education can resist and overcome pain much easier.
The main causes for labour pain are functional ones. Uterine contractions, cervical opening, baby’s downward movement and medical intervention during labour or some of the functional causes. Neural stimulation messages in this area are sent to the brain, which is when pain is felt.

What is epidural anesthesia?

Epidural anesthesia is a type of regional anesthesia which blocks messages from a certain area of the body to be sent to the brain.
It is applied by an anesthetics specialist (anesthelogist). It is the most effective way to relieve pain during labour; yet, it is not solely used for this purpose.
Many major surgical operations such as C-section (below the waist line) can be done under epidural anesthesia.

The principle behind the application is to inject anesthetics to the membrane surrounding the spinal cord (dura) and block messages in the nerves; thus, providing pain relief.
If motor sensory nerves in the region are also supressed, the anesthesia becomes effective also below the region and the ability to move also disappears. The person will neither be able to feel nor move her legs temporarily. This is the type of epidural anesthesia applied in C-section operations.
Since the aim of epidural is only to relieve pain during labour (natural/vaginal birth), epidural regional anesthetics are given in smaller doses accompanied by strong painkillers. Thus, because there won’t be any motor sensory loss, the mother can feel the touch and move her legs although she won’t feel pain.

* By giving a low dose of anesthetic, it is possible for the mother to walk around during labour.

How is epidural anesthesia applied?

In a natural birth, when uterine contractions become regular and cervical opening reaches about 4cm (this period is called the “active phase” when labour pain starts) epidural anesthesia can be applied.
The mother lies on her side or at a sitting position, the area where the catheter (thin tube) is going to be inserted is cleaned with antiseptic solutions and the area is covered with sterile fabric.
Then, the point where the catheter is going to be inserted is sedated by an injection, and then, the catheter is placed on the epidural space which is around the dura membrane by moving and pushing it till the spines at the lower back.

The part of the catheter outside the body is fixed and stabilized by using plasters at the back, so that it doesn’t move or slide.
Thus, the desired amount of local anesthetics can be injected using an injection needle from this external part of the catheter when needed.

In natural birth, about 15 minutes after the medication is injected through the catheter, the mother, although feeling the contractions, won’t feel any pain. If the birth takes long or if the medication starts to wear off and the patient starts to feel the pain, additional doses can be applied. Thus, after birth is completed, there will be no need for additional anesthesia for episiotomy.
Right after vaginal birth and about 24-36 hours after C-section the catheter is removed and the procedure ended.

Inserting the catheter for anesthetic reasons is easy to tolerate and painless.

The patient doesn’t feel any discomfort except for a feeling like an electric shock on the leg when the catheter enters the epidural space. The most important point in the process is the experience of the anesthetics specialist.

What are the advantages of epidural anesthesia?

* It is the most effective way of pain relief regarding labour.
* It is less risky compared to general anesthesia.
* Because the mother is conscious, she can be part of the birth and even hold her baby during the procedure in C-Section.
* If the timing is right, it can speed up vaginal birth.

What are the risks involved in epidural anesthesia?

Contrary to common belief, the risks involved in epidural anesthesia are very small if it is applied by an experienced anesthetics specialist.
The most common side effect is low blood pressure (hypotension). To avoid this condition, right before the application, about a litre of fluid is given quickly through the veins to fill them.
Additionally, after the procedure, headache, one sided anesthetic effect due to insufficient anesthetic agent, mild cases of allergy and skin rash, infection, lengthening the duration of birth by supressing the sense to control push, temporary difficulties when urinating and very rarely paralysis might develop.

When the procedure is done by experienced hands, the possibility of such conditions becomes very low.
Epidural anesthesia is a procedure which has been used for more than 25 years in modern mobstetrics and which provides comfort and pain relief both in vaginal and C-section birth. Every mother should be encouraged to benefit from this application. General anesthesia carries more risks than epidural anesthesia.