The feeling of motherhood starts in the first months of pregnancy and reaches its highest level at the time of birth. Birth, a process that every expectant mother wants to live to the fullest, is an extraordinary feeling defined by mothers.
How Does Epidural Birth Happen?
Regional anesthesia for epidural birth was first introduced in 1900. used. As with every new application, some negative effects were seen at the beginning, but as a result of clinical studies carried out over time, painless birth has become widespread as a safe option thanks to new drugs, methods and techniques and anesthesiologists specialized in painless birth.
The epidural space is the millimetric space between the membrane around the spinal cord and the connective tissue between the vertebrae. It is possible to perform many operations, relieve post-operative pain and treat chronic unrelieved pain by applying drugs from various levels of the spinal cord in accordance with the purpose in this range.
What is the Difference Between Analgesia and Anesthesia?
Explain the concepts of analgesia and anesthesia. should be well separated from each other. Analgesia means painlessness and anesthesia means insensitivity. During normal delivery, epidural analgesia from the lumbar region, that is, pain relief, is sufficient, while epidural anesthesia is required during cesarean delivery. Both applications are the same in terms of procedure, the difference is only in the doses of drugs given.
Birth with epidural analgesia, which is known as "painless birth" among the people, is becoming quite common nowadays. With a medication applied through a catheter, which is a millimetric tube placed at waist level, the transmission of pain signals coming from the lower half of the body is temporarily stopped and pain is not felt in the area where the painful stimulus originates. The dose chosen here is adjusted to eliminate only the pain during uterine contractions, but not to reduce uterine contractions and not affect the normal course of labor.
In this method, only pain transmission is blocked, tactile sensation and movement are not restricted. After the application, the expectant mother can get up and walk around the room during the birth process and see all her needs. The contraction of the uterine muscles and the active participation of the mother in labor are not affected, the mother is physiologically free from pain at the time of birth. k will have her baby.
To Whom Can Epidural Anesthesia and Analgesia Be Applied?
Generally, there is no limiting reason for epidural applications for young and healthy expectant mothers, that is, epidural anesthesia-analgesia can be applied to almost every mother. However, although rare, there may be some reasons that make implementation difficult or impossible. Problems that will prevent the application in the lumbar spine, the presence of infection in the application area, bleeding and coagulation disorders are examples of these.
After it is decided that there is no obstacle for the application in the controls, the final decision belongs to the expectant mother. The mother should be knowledgeable, conscious, willing and psychologically ready about epidural. The anesthesiologist should answer all questions of the mother and enlighten her in the best way possible. However, persistent persuasion efforts do not yield positive results, and the mother may not accept epidural application in any way.
In this case, general anesthesia would be a better option. Sometimes, although the mother does not feel pain at one stage of the operation, which starts with the epidural, she may be uncomfortable, she may not want to see what is around her, and rarely the anesthesia may not hold well. In this case, it is possible to complete the operation under general anesthesia since the general anesthesia conditions are already ready. However, this is a rare condition.
What is Epidural Anesthesia?
While expectant mothers generally want their baby to be delivered normally, cesarean delivery may be required in some cases. In this case, epidural anesthesia is applied. What is done when normal birth returns to cesarean section is to create epidural anesthesia by administering additional medication through the same catheter. The mother lies on the operating table with her lower back completely numb, but she can move her feet where she lies, that is, there is no loss of movement in the legs after epidural anesthesia. . Spinal anesthesia is also a commonly used method of anesthesia today. Sometimes, epidural anesthesia and spinal anesthesia are combined and applied together.
The advantages of spinal anesthesia are that it is technically easier to apply than epidural anesthesia, and the onset of action is much shorter, although the movement of the legs lasting 4-5 hours. It has some undesirable effects such as nausea, headache, nausea and blood pressure drop, which are sometimes seen after the application. Here, the anesthesiologist doctor will determine the most suitable method for the patient in line with his own experience and skills and recommend it to his patient.
When the epidural normal birth starts to disturb the birth pains, that is, when the birth canal opening is 4 cm, the mother is taken to the operation room. Serum is placed in the arm, blood pressure, pulse and oxygen status are monitored from the fingertip. In general, the application is done in a sitting position and while the body is leaning back slightly when the body is in an upright position, the body is bent forward from the waist to separate the vertebral prominences from each other, the chin is leaning towards the chest and both shoulders are left down.
After the position is created in this way, an antiseptic drug is applied to the back and waist area, the area is made germ-free and the area is covered with sterile covers. At the level where the application will be made, the skin and subcutaneous tissues are anesthetized with a thin needle.
Only the entry of this thin needle is felt during the procedure. Then, with another special needle, the epidural space is entered, a thin tube called a catheter is placed here and fixed to the body with the help of plasters. After a short time after the administration of the drugs through the catheter, the pains end, but the uterine contractions are not prevented and continue in the same way. Painlessness is maintained by using a patient-controlled analgesia method with a pain pump connected to the catheter. From this moment until the birth, everything is the same, but the pain will not be felt.
Epidural cesarean delivery Witnessing a miracle, this must be the shortest definition. How Does? You are fully conscious, covered over your shoulders, a veil in front of you, your lower half numb, aware of everything but pain or pain during surgery. Everyone in the operating room is with you and supports you, you are informed about every detail, and even the father can be given birth if the conditions are suitable. In this state, it is a miracle to feel the birth of your baby and to smell its smell while your surgery is going on. Then, while your doctor continues the surgery, you can chat.
Epidural anesthesia is indeed a very suitable method in cesarean delivery when applied correctly. In terms of the way it is applied, it is no different from the normal delivery. The difference is only in the dose of the drug given. It is necessary to give more medication than is used in normal painless delivery in order to avoid the pain of surgery. The drug given is exactly the same, that is, only a local anesthetic. This time is up to 15 minutes. At the end of this period, the operation does not start immediately. First, you are given a small warning and asked if you feel any pain. After making sure that the anesthesia is completely set, the operation is started. The time between the start of the operation and the removal of the baby from the uterus is about 5 minutes. This period is the most exciting part of the operation. With the birth of the baby, the excitement turns into happiness. After our doctors from our Child Health and Diseases Center in the operating room do their first check-up, the mother has the opportunity to kiss and smell her baby for the first time.
After that, there is a waiting period of about half an hour. There is the process of completion of the surgery. After the surgery is completed and the last skin stitches are placed, the last checks will be made and the mother will regain her consciousness completely. In the first 48 hours after the operation, which is normally painful, a low dose of medication is administered continuously with the help of a pain pump through the catheter (a thin tube) placed during the epidural application, and this period is completely painless. If the drug dose is low and the pain starts again, the mother can apply the predetermined additional dose to herself by pressing the button of the device. We call this patient-controlled analgesia.
With epidural anesthesia, the mother does not sleep after cesarean section, she can see the birth of her baby, the baby can be given to the mother as soon as she is born, and even the father can be taken to delivery if the conditions are suitable. Since such situations and emotions are also available, they can be presented as a more preferable method. Thus, with the addition of a new individual to the family, a new era begins with joy.
What are the Possible Complications in Epidural Birth?
When the lumbar vertebrae are mentioned, the spinal cord region naturally comes to mind as 'Nervous Will I be devastated, will I be paralyzed?' Such questions may come up. When applied by physicians who are experts in their fields under appropriate conditions, there is no room for these concerns. The most common side effect is sudden drop in blood pressure. It is noticed by symptoms such as dizziness, blackout, and feeling bad. It can be easily prevented by giving sufficient fluid (-serum) through the vein beforehand or by some vasoconstrictor drugs. There may be a decrease in heart rate and blood pressure during or after surgery. Your anesthesiologist, who is always with you, will intervene when necessary. Therefore, it is rarely seen except under extreme stress.
2) Headache: It may occur after spinal anesthesia applications. It is not a side effect of epidural anesthesia, it is rarely seen as a result of accidental perforation of the dura membrane, usually when moving during the procedure or when applied in not very experienced hands. It is thought to occur due to the leakage of fluid out of the dura due to the perforation of the dura membrane. It has a character that increases when it moves and stands up, which can sometimes be quite violent. It may also be accompanied by nausea. It can be eliminated by taking drinks containing a lot of liquids and caffeine, applications to increase intra-abdominal pressure, bed rest as much as possible, and various drugs if necessary.
3) Low Back Pain: After some births, low back pain is seen whether epidural is applied or not. There are some who attribute it to the fact that the center of gravity of the body shifts forward over time due to pregnancy, and that the waist muscles meet this abruptly after birth.
4) Nausea and vomiting: It may rarely occur during or after the surgery. Necessary intervention will be done by your anesthesiologist.
5) Infection: As with any injection, infection may occur in these interventions. Care is taken to prevent it from occurring. Side effects may occur due to the drugs used. Mild allergic reactions may occur in some patients. Regional, temporary itching resolves spontaneously or with the help of a simple drug.
6) Nervous complications: Temporary or permanent nerve damage after regional anesthesia is rare.
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