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Birth with epidural anesthesia is a preferred method of delivery in recent years. Many questions about the mothers' minds about this method. Art Health Women's Health and Diseases Specialist Dr. Center. Contact Alper directly Uzman Expert of the Month ”gives answers to the questions in the corner.
What is pain?
In the Stedman Medical Dictionary, pain is defined as hoş unpleasant or sensory experience with real or possible tissue damage ”. Indeed, the pain is an uncomfortable sensation to indicate that something is wrong with the organism, a warning the body sends to the brain.
In every tissue in our body where there are nerve cells, there are sensor cells called receptors. These receptors produce a kind of electric current against the stimuli such as temperature, cold, touch, pressure, stress. From these receptors, nerves reach the spinal cord, and from there to the upper centers in the brain. The brain evaluates and interprets this warning, allowing the organism to take the necessary precautions.
Pain is an abstract concept that can only be felt and defined by the living individual. It is not a concrete finding that can be felt and measured by anyone other than the person experiencing pain. For this reason, the definition of pain and the feeling of pain are different for each individual. The same warning may be the cause of severe pain for one individual and may remain very mild for another. This is roughly referred to as the pain threshold.
When you sprain your wrist while walking, you will experience severe and sudden pain. This pain disappears within a short time. This type of pain is called body protection pain. Such protective pains arise as a result of mechanical, chemical or thermal factors that threaten tissue integrity and the organism takes measures to protect itself. An example of this kind of pain is that you feel pain and pull your hand as soon as you touch a very hot or very cold substance… If the pain is getting more severe after spraining your wrist instead of gradually easing, spreading to the feet and legs, preventing you from walking and functioning normally this time there is something abnormal and perhaps you need treatment. This type of pain is the pain that occurs in pathological conditions where integrity is disrupted.
As can be seen, there are many different types of pain. There is a second definition of pain in the Stedman medical dictionary: her each of the uterine contractions at birth ”. The pains or pains that have been with man since the paradise gardens of Adam and Eve are examples of physiological pain. According to the differences in pain threshold between people, the degree of pain experienced by everyone during birth is also different from each other. But the phrase gibi labor pains gibi used by the ancients to describe severe pain, or çekmek labor pains için to describe a difficult event, is quite sufficient to think that it is one of the most severe pains that people know and know.
There are two basic types of pain during childbirth: emotional and functional.
The cause of emotional pain is fear, obscurity and ignorance. These three factors affect the severity of labor pains positively or negatively. Education about childbirth can teach you how to deal with pain, even if it doesn't eliminate it. A conscious mother who knows what awaits her can resist pain more easily.
Functional pain is the main component of birth pain. Opening of the cervix, uterine contractions, infant descent and medical interventions during birth cause functional pain.
Today's mothers are much more fortunate than their mothers. Because now epidural anesthesia, or halk painless birth bilinen, commonly known as doğum painless delivery or, is used more safely and widely.
What is epidural anesthesia?
Epidural anesthesia is a type of regional or local anesthesia that stops the transmission of pain in a particular area of the body. Anesthesiologist is administered by a doctor. Although it is the most effective method of controlling birth pain, it is not used only for this purpose. Many major surgical procedures performed below the waist level, especially cesarean section, can be performed under epidural anesthesia.
A local anesthetic is given around the membrane surrounding the spinal cord, called the dura, to prevent pain stimuli from reaching the brain. If the nerves that provide motor function in this region are also affected, full anesthesia occurs and the sensation and movement ability in the area below the treated area is lost. In this case, one can neither feel nor move his legs. This is epidural anesthesia applied in cesarean section operations. However, since the aim is only to relieve the pain at birth, the epidural space is given with less painful local anesthetics and strong painkillers. In this way, the motor will not be lost, the mother can feel the touch and move her legs even though she does not feel pain. By keeping the amount of local anesthetic very low, the mother can even walk during labor.
What is Sipinal anesthesia?
It is the administration of anesthetic and analgesic agents not in the vicinity of the dura membrane but in the cipinal fluid surrounding the spinal cord after passing through the membrane.
The effect of epidural anesthesia starts in about 15-20 minutes and may persist for a long time. However, sipinal anesthesia acts immediately, but its effect is shorter. Therefore, both epidural and cipinal anesthesia are performed together before caesarean section operations, this is called combi or combined anesthesia.
When and how is epidural anesthesia performed?
In vaginal delivery, epidural anesthesia can be performed after uterine contractions become regular or when the uterine opening reaches 4 centimeters. If contractions are irregular or inserted at an early stage, this should be taken into consideration as they may cause contractions to stop.
The area where the catheter will be inserted while the mother is lying in a lying or sitting position is cleaned with antiseptic solutions and covered with sterile drapes. The catheter is inserted through the spine in the lumbar region. First, local anesthesia is applied to numb the skin in this area. Then the epidural membrane is reached by passing between the two spines with a thin needle. If sipinal anesthesia is to be applied, a very fine needle is passed through this membrane to enter the subarachnoid space and the drug is given after the observation of cerebrospinal fluid. In the epidural, a very thin catheter (tube, tube) is inserted from the back of the needle and pushed to the appropriate distance and this catheter is placed into the epidural space around the dura membrane. The needle is then removed and the outer end of the catheter secured with patches along the patient's back. Medication can be delivered from the external end with an injector or automatic devices that continuously pump a certain dose of medication can be used. After insertion of the catheter, a small amount of drug is first given as a test dose. The aim is to observe whether there is a possible allergic or overreaction. After observing the absence of such a reaction, the treatment dose is given. In vaginal deliveries, sipinal anesthesia is generally not applied. Therefore, even though the mother feels contractions 15-20 minutes after the catheter is placed and the treatment dose is given, she does not feel pain. Additional doses are given when delivery is prolonged and the effect of the drug is reduced and the patient begins to feel pain. After delivery, episiotomy can be easily sutured without additional anesthesia.
The catheter is removed immediately after vaginal delivery and 24 hours after cesarean section. The patient has no discomfort during removal of the catheter.
Epidural catheter insertion is easy to tolerate, painless and comfortable for the patient. As soon as the catheter enters the epidural cavity, it does not cause any discomfort to the patient, except that an electric shock sensation occurs in the leg. The most important point in the application of epidural anesthesia is the experience of the anesthesiologist.
What are the advantages of epidural anesthesia?
• The most effective way to relieve birth pain
• It should be preferred because of the lower risk of complications compared to general anesthesia.
• Since the mother is conscious, she can participate in labor during cesarean section and can hold the baby in her arms while the surgery is continuing.
• When worn at the appropriate time, it accelerates the progression of normal birth
What are the complications and side effects of epidural anesthesia?
In epidural anesthesia, the risk is extremely low when performed by experienced specialists, contrary to what is supposed. • The most common side effect is sudden blood pressure drop. In addition to the nerves that provide pain and motor conduction in the spinal cord, there are also nerve fibers that control the function of involuntary muscles. If these fibers are affected, loosening and dilatation of the blood vessels may occur and low blood pressure may occur. In order to prevent this sudden drop in blood pressure, there is no problem if the vascular access is filled by rapidly delivering approximately 1 liter of liquid from the vascular route just before the procedure.
• Inadequate or unilateral anesthesia. In such cases, the catheter may need to be removed and reinserted.
• Headache due to rupture of the dura membrane and fluid escaping. In rare cases, severe headaches may occur within 1-3 days after the procedure. If the pain becomes unbearable, clot patch may be applied to the area where the epidural catheter is placed.
• Depending on the medications used, a mild allergic reaction may occur and the patient may develop extensive itching.
• If the expectant mother is not effectively pushed, the second stage of labor may be prolonged and vacuum or forceps may be required.
• Rarely, transient difficulty in urination may occur after the procedure.
• Very rarely infection can develop.
• Stroke is a very, very rare complication.
Who does not have epidural anesthesia?
• Having bleeding disorder
• Anticoagulant treatment
• Presence of infection in the application site
• Detection of platelet deficiency
• Epidural anesthesia is not applied in cases where the mother refuses to apply.
Epidural anesthesia is a modern medical approach that has been widely practiced safely for 25 years, providing both vaginal and cesarean deliveries to be extremely comfortable and enjoyable. Each expectant mother should be encouraged to benefit from this practice.