Epidural anesthesia is the “standard” mode of painless delivery, so when we talk about “painless delivery,” we are referring to perinatal epidural anesthesia unless otherwise indicated. In the United States, about 2/3 of mothers-to-be use epidural anesthesia during labor and delivery. (Note: too specialized categories such as lumbar epidural are not specifically discussed here.)
(a) Why choose painless delivery (epidural)?
The advantages of epidural anesthesia are
1. Good analgesic effect.
2. The mother can get enough rest (especially for the first time mothers who have a long first stage of labor).
3.No side effects such as drowsiness and confusion, and you can experience the whole birthing experience except for pain in all directions.
(2) What kind of mothers-to-be are suitable for epidural anesthesia?
Most mothers-to-be can enjoy this treatment as long as their hospitals provide it. There are a few exceptions.
1. Coagulation disorders due to various reasons.
2. Severe spinal deformities or certain lumbar spine surgeries.
3.The presence of local infection.
4.The mother-to-be is unable to cooperate with the operation due to various reasons such as nervousness, etc.
(C) What kind of risks exist in epidural anesthesia?
1.Punching crooked. There is a possibility of failure in any operation, and the epidural is no exception, there may be no effect, or half effective.
2.Piercing. There is about a 1% chance that there will be varying degrees of headache after the epidural. Even if the symptoms of headache appear, most people are relatively mild and get better after a few days on their own, a few need special treatment.
3. Bleeding during the epidural. It is normal to have a small amount of bleeding when hitting the epidural, but extremely rarely, it may be complicated by serious complications such as lower limb paralysis due to epidural hematoma or abscess. The general figure we communicate to patients is about a 1 in 200,000 chance.
(d) How many fingers of uterine opening is required to request an epidural?
The earliest studies showed that epidurals had the potential to prolong labor and increase the chances of cesarean section. Therefore, the internal opinion of obstetrics and gynecology at that time was that epidural should be considered only when the opening of the uterus was more than 5 fingers. However, a comprehensive analysis of the literature later revealed that epidurals did not significantly prolong labor and did not increase the risk of cesarean delivery. The American College of Obstetricians and Gynecologists, in conjunction with the American Society of Anesthesiologists, issued a joint expert opinion in 2004: when choosing an epidural for labor, the mother’s pain is the indication, and there is no need to wait for an indicator of how much the opening of the uterus is.
(v) Effects of epidurals on the baby
There are two main categories of drugs used in epidural anesthesia.
1, local anesthetics. The amount of local anesthetic used in epidural anesthesia is very small, although theoretically there is a possibility that local anesthetic drugs can penetrate the maternal blood-placental barrier and reach the fetus, especially in cases of intrauterine distress, there is a possibility of accumulation of local anesthetic drugs in the fetus. However, the current routine use of epidural local anesthetic drugs, if there is no special case of direct entry into the blood, the dose reaching the fetus is negligible, and its effect can be almost negligible.
2, morphine-based. Most epidural anesthesia will add a small amount of morphine drugs to improve the analgesic effect. Like local anesthetics, morphine-based drugs have the potential to penetrate the maternal blood-placental barrier and reach the fetus. However, again, the dose of morphine-like drugs that reach the fetus is so small that its effect is almost negligible.
(vi) Effects of epidural anesthesia on the mother-to-be
Does epidural anesthesia cause postpartum back and leg pain? Does epidural anesthesia cause postpartum concentration loss? Will epidural anesthesia affect postpartum breastfeeding? (Please see the sequel: A few misconceptions about epidural anesthesia.)
(vii) The effect of epidural on the father-to-be
Emma, the epidural is not a needle in the father-to-be, so what does it matter to them? In our hospital, when giving epidurals to pregnant women, the fathers-to-be are encouraged to stay with the mothers-to-be because their presence will help relieve their anxiety and tension. Of course, some fathers-to-be are even more nervous than their mothers. In our hospital, there was a case where the father-to-be fainted on the spot after seeing the thick needle used for the epidural, so we usually ask the father-to-be to take a break outside the delivery room and come back after the epidural.