Stating that “Epidural” birth is a very successful and safe method today, Özel İmperial Hospital Gynecology and Obstetrics Specialist Opr. Dr. Filiz Tanrıkulu said that “Epidural” birth is accepted as the gold standard all over the world.
Providing advice to expectant mothers, Dr. Tanrıkulu warned about the methods to be used to reduce labor pains and said, “Although becoming a mother is one of the most special and beautiful experiences in a woman’s life, many women preparing to become mothers may feel quite nervous and anxious due to the fears caused by labor pains. Efforts to reduce labor pains first came to the fore in 1853 with the application of chloroform during the birth of Queen Victoria. For this reason, painless birth is also commonly called princess birth. After this date, searches for reducing labor pains increased and many methods were tried so that expectant mothers could go through this process more comfortably. Today, epidural birth is accepted as the gold standard for painless normal birth all over the world because it is a very successful and safe method.”
What other methods can be used to reduce labor pain?
Noting that many methods are used to reduce pain during labor, Dr. Tanrıkulu said, “Methods such as hypnosis, acupuncture, aromatherapy, various exercises, breathing exercises, having anesthetics smelled, applying some painkillers, numbing some nerves that cause pain with local anesthetics and TENS application are used to reduce pain felt during labor. However, these methods are generally insufficient to reduce labor pain. The most effective method known to reduce labor pain is epidural analgesia.”
Side effects are quite low
“When epidural analgesia is applied by experienced physicians, its side effects are quite low,” said Dr. Tanrıkulu, “When epidural analgesia is applied by experienced anesthesiologists, its success rate is extremely high and its side effects are extremely low. When we look at the statistics, it is observed that while the desired effect is achieved in 85 percent of pregnant women with epidural birth, partial effect is seen in 12 percent and no effect is seen in 3 percent of pregnant women,” he said.
What is the difference between epidural analgesia and epidural anesthesia?
Explaining the difference between epidural analgesia and epidural anesthesia, Dr. Tanrıkulu said, “epidural analgesia and epidural anesthesia are not the same. These two applications should not be confused. While epidural analgesia is applied in epidural birth, epidural anesthesia is called epidural anesthesia for epidural birth. Analgesia means painlessness. Anesthesia means insensitivity. With epidural analgesia, pain is not felt, while the sense of touch and movement are not hindered. In this way, it is possible for patients to get up from bed and walk after birth. In epidural anesthesia, the dose of medication given is increased and the sensations are completely eliminated. In case the normal birth follow-up that starts with epidural analgesia cannot be continued as normal birth for various reasons, the dose of medication given through the epidural catheter can be increased and a cesarean section can be performed.”
Can the mother decide on epidural birth alone?
Dr. Tanrıkulu, who emphasized that epidural birth should be decided together, said, “The gynecologist and obstetrician, the expectant mother and the anesthesiologist should decide on epidural birth together.
Can the epidural method be used in all normal births?
For epidural normal birth, the mother must first consciously accept to actively participate in the birth process. In addition; if the pregnancy period has been problem-free, there are regular labor pains, the cervix is 4-7 cm dilated, there is a single baby at head presentation and the pregnancy is 38-42 weeks, the epidural method can be preferred for birth.”
What is the epidural birth process like?
Providing information about the epidural birth process, Dr. Tanrıkulu said, “The administration of medication via the catheter begins when the active labor process begins, that is, when the uterine contractions become regular and start to be felt by the mother and the cervix opens at least 4 cm. The timing of the medication is important. If the medication is given too early, labor will start late and the labor period will be prolonged. If the medication is given later, the pains will become more frequent, the mother will remain still and the medication will be difficult to administer. At this stage, the expectant mother is given a serum. The expectant mother's blood pressure, pulse and oxygen level in the blood are monitored throughout the labor. Since sudden drops in blood pressure may occur as a side effect of epidural analgesia, the mother is given fluid supplements with approximately 2-3 liters of serum during the labor process. The expectant mother starts to see the effect and stop feeling pain 15 minutes after the medication is administered via the catheter. The catheter remains attached during labor and if pain begins to be felt, an appropriate amount of additional anesthetic medication is continued to be administered with the help of the catheter throughout the labor. The purpose here is; The mother does not feel pain but feels contractions and thus actively contributes to the birth process by pushing when necessary. If the mother feels that the contractions are insufficient, the healthcare professionals assisting the birth can follow the contractions by connecting the patient to the device or by manual examination and tell the mother the right time to push. When the birth is completed with epidural analgesia, the catheter is removed. This is not a painful procedure. In the case of a cesarean section with epidural anesthesia, the catheter is not removed during the painful 48-hour period after the cesarean section. During this period, low-dose medications that will relax the mother continue to be administered via the catheter. During this process, patient-controlled painkillers (PCA) can be applied. The mother can press the button of the device and receive the specified dose of painkillers when needed through the attached catheter.
What are the advantages of epidural birth?
Dr. Tanrıkulu said, “Mothers who had an epidural normal birth both experienced the pleasure of a normal birth and stated that they had no pain after birth and had high energy, and recommended an epidural birth. After birth, mothers can easily get out of bed and walk. Since they do not experience the fatigue and exhaustion caused by the pain during the birth process, the postpartum recovery process is quite fast. They can take their babies in their arms and start feeding them immediately after birth. Since it will not stop bowel movements, gas is not prevented. Therefore, mothers do not experience gas bloating after birth. When epidural analgesia is applied at the right time and in the appropriate dose by experienced anesthesiologists, it facilitates the opening of the cervix and accelerates the birth process. If it is not possible for the process to proceed as a normal birth after the application of epidural analgesia, the given medication dose can be increased and the birth can be continued as a cesarean section with epidural anesthesia.” Are there any risks, disadvantages and side effects of epidural birth?
“Epidural birth is a safe and effective method that works quite smoothly, especially when applied by experienced anesthesiologists,” said Dr. Tanrıkulu, “The most common side effect of epidural birth is low blood pressure. To prevent this, regular blood pressure monitoring and fluid supplementation are performed during the birth process. The risk of headache in epidural analgesia is between 0.5 and 1 percent. If the wall of the membrane (dura) in which the spinal cord is located is punctured during the procedure, it can cause the fluid surrounding the spinal cord to leak out. Therefore, headaches may occur. Headaches decrease when mothers lie down. However, headaches increase when they stand up and cough. In this case, fluid supplements are given to the mother; consumption of beverages and foods containing caffeine, bed rest are recommended and medical treatments are applied. When the response to these is insufficient, a procedure called ‘blood patch’ is performed in which the mother’s own blood is taken and again catheterized into the epidural space. Since the amount of medication administered is low, it has very little negative impact on the mother and baby. However, in rare cases, it can cause a slowdown in the baby's heart rate and prolong the labor process. Mild dizziness, lightheadedness, inability to urinate and nausea may occur. There may be an infection in the back area where the catheter is applied. Back pain, numbness and weakness in the legs may be felt in the first few hours after birth. This feeling will pass within a few hours. The possibility of nerve damage and paralysis is extremely rare, but it is a complication that can occur in uninformed and inexperienced hands.
