The World Health Organization (WHO) believes that anesthesia helps provide women with a "positive childbirth experience" and ultimately offers many more advantages than disadvantages [1].
What methods of pain control are allowed by WHO?
Both epidural and intravenous administration of opioids, as well as various massage and relaxation techniques, can be used during delivery depending on your preferences. It is necessary, however, to understand that all medical methods of anesthesia have side effects, while non-medical pain relief methods are often less effective.
In many countries, an expectant mother can have an epidural if she wishes [1, 2].
How does an epidural work?
Pain-relieving medications are injected into the epidural space between the dura mater of the spinal cord and the periosteum in the lower back. As a result, the nerve impulses in the lower body are blocked and sensations are lessened. The goal is not to block all feelings in the lower body, but to lessen the intensity of the pain.
However, sometimes depending on the dosage and drug choice, all sensation may cease and the woman laboring may not be able to notice the urge to start pushing. In this case, she will not be able to push in rhythm with her contractions and labor may be delayed for a couple of hours until sensation is regained. Alternatively, the doctor may use forceps to help the baby through the birth canal [3]. This is considered normal and does not threaten the life of the baby.
On the other hand, when a woman is not distracted by pain, she can adequately interact with the doctor, nurses, or midwife, which means that the birth becomes more conscious and controlled [1].
Is spinal and epidural anesthesia the same thing?
It's almost the same for the patient. But not for the doctor. With spinal anesthesia, the drug is injected slightly deeper than with epidural anesthesia — into the space where the cerebrospinal fluid is located. Therefore, the effect occurs faster and fewer drugs are required. But the skill of the anesthesiologist should be higher.
How do intravenous painkillers work?
The introduction of narcotic drugs intravenously blunts the sensitivity to pain in general, throughout the body. This proposes a difficult challenge for the doctor; with a small dose, you can not eliminate the pain, but with a higher dose, drowsiness occurs and the woman has little control over what is happening. The most common side effects are nausea and vomiting, and breathing problems in the newborn. However, it is technically much easier to administer the drug intravenously than to perform manipulations near the spinal cord. Therefore, WHO allows their use [1].
When should you not get an epidural?
If you plan to ask for anesthesia, you should consult with your doctor in advance to take into account all the nuances that may complicate the procedure, including [2], [3]:
pustular diseases on the skin in the lower back;
heart disease;
neurological diseases;
spinal injuries in the past;
very high BMI (> 40).
What side effects and complications are possible with epidural anesthesia? Epidural anesthesia may lead to [3]:
longer duration of labor;
limited mobility in the lower part of the body and, consequently, the inability to choose a more comfortable position for childbirth;
increase in temperature;
decreased blood pressure (hypotension);
spinal cord injury and related neurological complications;
urinary retention after childbirth (this also happens after intravenous anesthesia, but less often);
severe headaches;
back pain (up to three weeks after delivery);
infectious complications, such as meningitis and meningoencephalitis.
The baby is not adversely affected by epidural anesthesia. Children born with pain relief don’t get lower Apgar scores than those born without any medical intervention at all. [4]
Under anesthesia, will I have to give birth lying down?
Not at all. With epidural anesthesia, the woman remains fully conscious and can choose the most comfortable position for childbirth [1].
It is important to consult with your health practitioner to discuss the best pain relief options for you and your baby during pregnancy.
This article was created in association with UNFPA, the United Nations sexual and reproductive health agency.
