Epidural analgesia is a regional pain management method that relieves pain only in a specific area of the body. This procedure is performed by an anesthesiologist. The essence of the method is the blockade of the nerve roots of the spinal cord at the level of the lumbar region and loss of sensitivity in the blocked area (uterine area). To do this, a catheter is installed in the space near between the lumbar vertebrae into which an anesthetic (local anesthetic) is injected. At the same time, the pain during contractions significantly weakens or disappears. Childbirth is tolerated much more comfortably, and the woman in labor rests.
Why is pain relief needed?
Since ancient times, humanity has been trying to find a way to reduce pain in women in labor. In ancient times, decoctions of herbs and smoking were used for this; later, synthetic painkillers appeared. Childbirth is one of the most painful processes, and the medieval concept of the need for female suffering is, fortunately, a thing of the past.
Research by modern scientists directly suggests that excessive pain during childbirth sharply increases the level of adrenaline and norepinephrine in the blood, and this can lead to disruption of oxygen transport in the body. As a result, the frequency of contractions may decrease with the possible development of fetal hypoxia.*
What is epidural anesthesia
The epidural space surrounds the outside of the dura mater, which covers the entire spinal cord. In the epidural space of the lumbar region there are nerve endings that conduct pain impulses from the uterus. An injection is made in the lumbar region and an anesthetic is injected.
When painkillers are administered, sensitivity is temporarily switched off, which allows the woman in labor to stop feeling pain. The dose of the anesthetic drug is selected and adjusted for partial or complete pain relief.
Unlike general anesthesia, epidural anesthesia allows the woman in labor to remain conscious at all stages. Most often, such anesthesia, unless there are special indications, is used only for the period of contractions, which can last for several hours, and the woman gives birth without anesthesia.
Spinal or epidural?
These two types of pain relief are very often confused, because they are really similar in appearance, especially for those who are far from medicine. However, there are differences between them.
Spinal . This anesthesia uses a thin needle through which an anesthetic is injected into the cerebrospinal fluid. Nowadays, this method is used less and less, because if performed incorrectly or if contraindications are not identified, it can lead to serious consequences.
Epidural . For this type of anesthesia, local anesthesia is first performed, after which a puncture is made at the puncture site with a special needle that penetrates to the dura mater. When performing this manipulation, it is very important not to move so that the doctor’s hand does not tremble. A catheter is inserted into the puncture through a needle, through which anesthetics enter the epidural space. His tube will remain in your back as long as necessary to maintain the pain-relieving effects of the medications. After removing the catheter, only a small puncture will remain, which will be treated and covered with a bandage.
Effect of anesthesia on a child
Proponents of “natural childbirth”, without any anesthesia, insist that drugs can negatively affect the fetus. However, modern research refutes this fact: as a result of the tests, it was found that epidural anesthesia does not affect the child in any way, but greatly facilitates the birth process.** In addition, for this type of anesthesia, drugs are used that do not penetrate the placental membrane of the fetus .
The main advantage of epidural anesthesia during childbirth is that a woman can relax, calm down and confidently move on to the process of expulsion of the fetus without neurosis and stress.
Advantages of treatment at the ISC
In our clinic, 100% of surgical interventions on the lower extremities and terminal abdominal aorta are performed using regional anesthesia. 95% of surgical interventions are performed under epidural anesthesia. Epidural anesthesia is also performed after surgical interventions, prolonged postoperative analgesia, and in the preoperative period in patients with critical ischemia of the lower extremities for preoperative preparation. Today, this is the optimal method of anesthesia for operations on the lower extremities and lower abdominal cavity. In addition to anesthesia during operations, epidural anesthesia is used to relieve pain in the legs during critical ischemia. In our clinic, patients with critical ischemia and gangrene are immediately placed with an epidural catheter and given a continuous infusion of anesthetic to completely relieve pain.
Indications for pain relief
Unfortunately, not all medical institutions can yet make an independent decision about the use of anesthetics. In most cases, the following situations are indications for the need for epidural anesthesia.
Premature pregnancy. Relaxing the pelvic floor muscles allows the baby to pass through the birth canal more easily without encountering resistance. For babies who were born prematurely, unnecessary stress is contraindicated, so if there are no indications for a caesarean section or other individual characteristics of the pregnancy, it is recommended to give birth with epidural anesthesia.
Discoordination of labor. This is the name of a condition in which contractions last longer than expected, but the dilation of the cervix is not sufficient. In this case, epidural anesthesia will relieve spasm and help labor.
High blood pressure. If you have hypertension, childbirth can lead to strokes or other dangerous consequences, so doctors may prescribe either a cesarean section or use an epidural, which will help normalize blood pressure levels.
The need for surgical intervention. In cases where general anesthesia cannot be used, but surgical assistance is required, epidural anesthesia is used as an alternative option.
How can I help my child get into a forward position?
You may have heard about so-called methods to give the fetus an optimal position. These are techniques that can help your baby achieve a forward position by changing your posture, especially when sitting. Remember: you want your pelvis to tilt forward, not backward. Therefore, when you sit, make sure that your knees are always lower than your hips.
Try the following:
- Pay attention to the design of your favorite chair. It should not be such that your knees rise above your hips when you sit down. If this happens, try turning the chair 180 degrees, kneeling on the seat and leaning forward, leaning over the back.
- Clean the floors. Our grandmothers liked to repeat that cleaning the kitchen floor is the best way to prepare for childbirth. And they were right! While you are on all fours, your baby turns the back of his head towards your stomach.
- When driving a car, place a pillow on the seat so that your pelvis is elevated in relation to your legs.
- While sitting in front of the TV, lean forward, leaning over the fitball.
When you go to bed, you don't have to worry about your baby's position. However, the optimal sleeping position in late pregnancy is lying on your side, not on your back.
When not to use
Any medical intervention has its contraindications, and this includes epidural anesthesia. However, even the presence of contraindications is not a reason to give birth without anesthesia. In this case, doctors can choose alternative ways to reduce the pain threshold.
Low blood pressure. With low blood pressure, the administration of painkillers can cause a sharp drop in blood pressure.
Spinal deformity. If a woman has degenerative disorders in the spinal column, it is extremely curved or abnormal, access for a boat will be difficult. This means that when the drug is administered, it may end up in the wrong place or may not block pain.
Inflammation in the puncture area. In case of any inflammatory processes in the lumbar region (the site of epidural anesthesia), injections are prohibited, as they can provoke suppuration or other unpleasant consequences of infection in the blood.
Blood clotting disorder. Some painkillers can thin the blood, which is especially dangerous if uterine bleeding occurs during childbirth.
Intolerance to a certain group of drugs. Usually analogues are simply used, but in rare cases epidural anesthesia becomes impossible
Unconscious state. Firstly, an unconscious woman, in principle, does not feel pain, and secondly, she cannot give her consent to the use of anesthesia, which is required when prescribing a certain group of drugs
Figure restoration
To return your figure to its previous state, it is first of all important to improve your diet. Since physical activity is allowed only after the suture has healed. You should not trust the reviews of other mothers in this matter; you should get permission from your doctor.
Nutrition
On the first day you should avoid solid foods. Most likely, a woman will have to make do with just water, which can be diluted with fruit juice in a ratio of 100 ml to 1 water.
It is better to choose lemon, as it will help restore lost strength, strengthen the immune system, and have an anti-inflammatory and disinfecting effect. The woman receives all other nutrients needed for recovery from IVs.
On the second day, the list of foods that you can eat expands. These include:
- meat broth with chicken or beef;
- skim cheese;
- juice, tea, rosehip decoction, jelly, compote;
- lean meat;
- homemade yogurt without additives.
Adhering to such a diet, a woman helps her body quickly rehabilitate after suffering stress. On the third day, the menu becomes even more varied. In addition to all of the above products:
- steamed cutlets or meatballs;
- cheese;
- meat and vegetable purees;
- porridge with water;
- baked apples;
- kefir if you have problems with stool.
Naturally, all products on the menu must be agreed upon with the attending physician. They should not irritate the intestines or cause gas or constipation. The dishes should be kept warm, and after 3 days the nursing mother should be given a full diet.
Yoga
You can start practicing yoga 42 days after a caesarean section. Throughout this period, physiological recovery occurs:
- tissues become scarred;
- swelling of the external genitalia subsides;
- the uterus contracts and returns to its original size;
- internal organs take their previous position.
These days are the most difficult period after surgery, when exercise should be avoided so as not to overstrain the muscles. Yoga cannot be practiced after cesarean section if you have the following diseases:
- uncompensated heart disease;
- arthritis, arthrosis;
- severe fatigue;
- increased body temperature;
- exacerbation of ulcers;
- spinal injuries;
- blood pathologies, etc.
You should not do yoga immediately after eating. The optimal time between meals and training is 2 hours. Another limitation is visiting the sauna. If the training is carried out correctly, the woman will observe only positive changes:
- muscle elasticity will increase;
- flexibility improves and muscles tighten;
- weight loss;
- the uterus is strengthened;
- breathing is restored;
- depression goes away;
- pain in the lumbar region is eliminated;
- the functioning of the gastrointestinal tract improves.
Exercise overview
A few hours after the operation, you can perform simple gymnastic exercises, as well as chest and abdominal massage:
- Place your hands behind your back and stroke the lumbar region with the back and palmar surfaces of your hands from top to bottom and to the sides.
- Holding the area of the sutures, perform deep breathing with your stomach - inhale for 1-2 steps, inflating your stomach, exhale for 3-4 steps, drawing in your stomach as much as possible.
- Stroking the front and side surfaces of the chest from bottom to top towards the armpit area. The left side is massaged with the right hand, the right side with the left.
- Cough while supporting the suture area with your palms.
There are exercises that can be performed the very next day after surgery. Starting position - sitting with emphasis on your back, perform the exercises slowly up to 10 times:
- pull socks toward and away from you;
- rotate your feet in and out;
- press your knees together and then let go;
- tense and relax the gluteal muscles;
- bend one leg and stretch it forward, lower it and repeat the exercise with the second.
Also useful are Kegel exercises to strengthen the muscles of the perineum and pelvic floor. You need to squeeze the muscles of the perineum in such a way as if you wanted to hold a stream of urine and hold it in tension for a few seconds, then relax. You need to perform 10-20 repetitions at a fast pace 3-4 times a day and gradually increase the tension time by 1 second, reaching 20 seconds or more.
If you perform this exercise regularly, you can avoid problems with urinary incontinence.
After the stitches are removed, you can begin light exercises for the abdominal muscles:
- Take a sitting position and bend your back slightly, inhale and exhale, and as you exhale, draw in your stomach. Stay in this position for 1 second, then relax your stomach and exhale. Perform 10-15 repetitions several times a day.
- Lie with your back on a hard surface and bend your knees. Lift your pelvis up without lifting it and lower it down. Perform 15-20 repetitions several times a day.
Consequences and complications
In most cases, epidural anesthesia is well tolerated without negative consequences for mother and child. However, there are situations when unpleasant complications actually occur, usually in the woman in labor.
Entry of drugs into the venous system. If the doctor gets into a vessel during a puncture, and the anesthetic ends up in the bloodstream, the woman will feel weakness, dizziness, and numbness of the limbs. Fortunately, this is all fixable: usually such reactions occur instantly, even when the catheter is installed, and if the anesthesiologist is notified in a timely manner, unpleasant consequences can be avoided. Therefore, if you experience any of the above symptoms during epidural anesthesia, you should inform your doctor.
Allergy. Unfortunately, no one is protected from possible negative reactions of the body to the anesthetic. If you have allergic reactions (especially to medications or, for example, anesthesia administered during dental treatment), you must tell your doctor about it. This will greatly help the doctor, who will select the correct drug and its dosage, and will protect you from allergic reactions and anaphylactic shock.
Back pain. Some women, in reviews of the use of anesthesia during childbirth, complain that after an epidural the lumbar spine hurts. This happens at the site of puncture and installation of the catheter. This pain usually goes away quickly in the postpartum period. But you should definitely tell your doctor about it.
Fall in blood pressure. Most painkillers actually lower blood pressure significantly. To avoid dizziness, doctors usually recommend that their patients lie down and drugs are administered through a catheter in small doses.
Rehabilitation of the body after cesarean section
After childbirth, very big changes occur in the woman’s reproductive system, and for a long time the body comes to its senses and recovers. However, it should be understood. That such a process can drag on for months, and sometimes even a year or two.
Uterus
Immediately after the procedure, the uterus resembles a continuous bleeding wound - its bottom drops 4-5 cm below the navel, the diameter is 10-12 cm. Contractions of the cervix are very weak and gradually intensify.
The postpartum period lasts about two months. But the uterus is in no hurry to contract so quickly, since the operation disrupts the integrity of the muscle fibers of the uterus, blood vessels and nerve endings.
If necessary, a woman may be prescribed additional drug therapy, which will stimulate the contractile activity of the uterine muscles and reduce bleeding.
After the operation, the woman remains in a special ward for the first 24 hours and is under the constant supervision of doctors. The nurse should clean the suture every day with an antiseptic solution and change the dressings.
An ice pack is placed on the woman's stomach as this helps the uterus contract and stop bleeding. Painkillers are also prescribed to stimulate contractions and drugs to restore the gastrointestinal tract.
It is important for a woman to fully recover, so some restrictions will appear in her life that will not prevent the uterus from healing. The scar is completely formed by the end of the first year after cesarean.
Visit your doctor and get an ultrasound to stay informed about how the recovery process is going. If you are planning another pregnancy, take x-rays in frontal and lateral projections, and also undergo hysteroscopy - a visual examination and examination of the scar by inserting an endoscope into the uterine cavity 8-12 months after surgery.
The rate of healing of the uterus also depends on how the pregnancy proceeded, at what age the woman gave birth, and on the conditions of the operation.
The seam
The incision on the uterus is usually sutured with a single or double-row suture without interruption - for this, special materials are used (Dexon, monocryl, caproag, etc.), which can resolve on their own from several weeks to 3-4 months.
After suturing, doctors will monitor their condition so that inflammation does not start. A postoperative scar takes the longest to heal – from 6 months to a year. This is due to the fact that when making an incision, the integrity of the nerve endings is disrupted.
The woman needs to take painkillers for several days after the operation, as the stitch will be very painful. The skin scar forms after about a week. To relieve discomfort, it is recommended to wear a postpartum bandage or bandage the abdomen with an elastic bandage.
To prevent the seam from becoming inflamed, you can lubricate it 1-2 times a day with lavender or tea tree oil, having previously dissolved it in vegetable oil in a ratio of 1:10. Pharmacy calendula ointment is also suitable.
Menstruation
The return of the cycle after surgery is influenced by many different factors:
- age;
- combination of load and rest;
- nutrition;
- complications during pregnancy;
- lifestyle before and after childbirth.
However, the main factor that can affect the return of menstruation is lactation. This is due to the fact that during breastfeeding, the hormone prolactin is actively produced, which does not have the best effect on the ovaries, and the more the body produces this hormone, the more sluggish the ovaries become.
Therefore, while a woman puts the baby to her breast, the appearance of menstruation is unlikely, but if initially there was no milk, then already 2-3 months after the operation, menstruation can begin again, a couple of weeks after lochia.
The first critical days after a cesarean section will be characterized by severe bleeding - this situation should last no more than 2 months. However, if this situation continues to bother you for a long time, you will need to consult a doctor, since strong discharge may indicate the presence of hyperplasia or other diseases.
For the first 3-4 months, the cycle will be inconsistent, which is not something to worry about, as well as the absence of ovulation in the first month - this is a completely normal phenomenon, given all the characteristics of the body. After this period, the cycle should normalize - between periods should pass from 21 to 35 days, and the duration may go beyond 3-7 days. If this does not happen, you should consult a doctor.
Scanty, not abundant menstruation is not a good sign; most often it indicates that the uterus is not contracting enough, which means the development of stagnant discharge and inflammation is possible. Spotting blood before or after menstruation indicates endometritis.
If the discharge resembles a curd mass and is accompanied by itching, it means that the drugs taken during the recovery period caused thrush, which is dangerous in the postpartum period.
To quickly restore your menstrual cycle, you need to:
- observe the regime;
- abstain from vaginal sex for at least 3-4 months;
- limit hygiene procedures - avoid hot showers and the use of tampons;
- protect yourself.
Intimate life
You should not resume sexual activity immediately after a cesarean section, no matter how much you might want to - the wounds are still healing, the stitches may bleed and hurt. The body needs time to recover and recover to avoid suture ruptures.
Despite the fact that it takes about 2 months to restore the body, this is still a fairly arbitrary period, since everything depends on the individual characteristics of the woman.
Doctors say that you can start intimate life when postpartum bleeding has stopped and there are no problems with the stitches. But in order to make sure of this, you should undergo an ultrasound. After the examination, the doctor will tell you whether you should wait longer or not.
In order for intimate life to be enjoyable and not end in complications, several rules should be taken into account:
- all movements of the partner must be careful and smooth - sharpness, roughness and deep penetration are excluded;
- think over the issue of contraception so that another pregnancy does not happen;
- for six months you can use only classic positions that do not involve deep penetration;
- give your body time to regain its tone.
An important nuance is that by the time a woman is physically ready, her partner will also have to undergo an examination and make sure that he is healthy and will not cause any harm to the woman.
Other disadvantages of anesthesia
Most of the consequences depend on whether the anesthesiologist performs his manipulations correctly and whether the woman in labor follows all the doctors’ recommendations. The fact is that if the drug is administered incorrectly, pain relief may occur partially (in 15% of cases) or not at all (5%). Often, incorrect insertion is due to a woman’s excess weight or abnormalities in the development of her spine.
Another rare phenomenon is “mosaic” anesthesia. It occurs due to the fact that there are partitions in the epidural space that do not allow the medicine to be evenly distributed throughout the fluid. Loss of sensation on one side of the body should be immediately reported to the anesthesiologist, and he will adjust the dose of drugs.
Prevention
Preventive measures are as follows:
- you should keep your weight within normal limits through nutritional correction - this is especially true for pregnant women, since large body weight is considered a high risk of complications;
- strengthening the back muscles with the help of exercise therapy elements;
- regular examinations (dispensary examination);
- choosing a qualified specialist to carry out the procedure;
- refusal to lift weights (applies to women).
It is important to remember that preventing the development of pathology is much easier than later dealing with its manifestations. After all, restoring the functioning of the musculoskeletal system can sometimes be quite difficult.
Cons of the procedure
Most opponents of epidural anesthesia insist that during childbirth, a woman produces large amounts of the hormone oxytocin, which causes attachment to the child. And if you “block” pain with painkillers, its production will stop, and the “maternal instinct” will not work. Women who have given birth with an epidural and are raising children will easily destroy the myth of absent attachment.
Possible negative consequences are complications from inappropriate medications. Therefore, questions about allergies need to be addressed in advance. So there are practically no downsides to epidural anesthesia, and conclusions about “irreparable harm” that are not supported by facts should not be taken into account.
Pros of the procedure
We live in a modern world in which everything is done for maximum comfort. Outdated ideas that a woman in labor must suffer in order to have the right to be called a mother are today considered extremely inhumane. The advantages of epidural anesthesia are:
- pain relief during labor, which can be truly unbearable for the mother
- the opportunity to take a break when contractions have been going on for several hours, and even sleep
- lowering blood pressure in hypertensive patients
- preventing the negative consequences of excessive pain, which can provoke fetal hypoxia
- normalizing uterine contraction, relaxing the cervix and helping the baby pass through the birth canal
- relief of nausea and vomiting
- absence of depression of the respiratory centers in the mother and newborn
In addition, if an emergency caesarean section is necessary, the anesthesiologist will simply increase the dose of drugs and the operation can begin immediately.
How else to make childbirth easier
Not all women necessarily want to give birth using anesthesia. However, even in this case, you can make the birth process easier for yourself.
- Pregnancy needs to be planned well in advance, giving up all bad habits, building a diet and daily routine, seeing a doctor and trying to avoid stress if possible.
- Before giving birth, you need to attend training courses in it, where you will be told in detail about how to breathe correctly and what to do when contractions begin. Such lessons are needed in order to prepare not only physically, but also emotionally.
- During contractions, you can use some massage techniques: they are usually discussed in courses. In addition, it is very important to breathe properly and try not to scream, as this takes oxygen away from the child
Causes of labor pain
According to many years of observations by doctors and data from physiologists, many women experience almost no pain during contractions and pushing, behave quite actively or can even sleep. This cannot be called a phenomenon, since the source of labor pain is based in the cerebral cortex and is often activated by fear or confidence that pain is about to come.
In fact, when psychological factors are eliminated, expectant mothers experience only a pulling sensation in the lumbar region, where the nerve node is located. It innervates all the endings responsible for the female internal organs. Also, unpleasant mild pain appears in the lower abdomen at the moments when contractions occur. The reasons that more than seventy percent of women experience severe pain during labor lie in the structure of the female body, a sedentary lifestyle and prejudice.
Scientists who studied the life of small peoples of the Amazon and the Far North, where signs of civilization are practically invisible, were amazed at the ease with which native women give birth to children. They work physically, quite hard, until the onset of contractions, then retire for a while and return with the child in their arms. There are no signs of suffering on their faces. This happens, according to researchers, due to physical activity and the lack of psychological impact on girls.
In the cultures of such peoples, the process of pregnancy and childbirth is perceived as a taken-for-granted act, to which no special significance is attached. And every girl knows from childhood that, just like her mother, aunts and sisters around her, she will become pregnant and give birth to a baby. Of course, if complications arise, the woman most often dies, but in those cultures death is an absolutely natural phenomenon that is not given much importance.
In civilized countries, girls are taught from childhood, on a subconscious level, from the TV screen and from the pages of books, that pregnancy and childbirth are fraught with many dangers and the process of giving birth to a child is accompanied by enormous pain. Added to this is the sedentary lifestyle of most women, overeating and chronic diseases. All these factors together create the preconditions for a painful birth.
Take the first step
make an appointment with a doctor!