The feeling of motherhood starts in the first months of pregnancy and reaches its highest level at the time of birth. Birth, which is a process that every expectant mother wants to live to the fullest, is an extraordinary feeling defined by mothers. The mother-to-be who wants to experience this process fully carries the fear of the birth pains she will suffer. “Birth pain” is a very severe pain that occurs as a result of the contraction of the uterine muscles, which is indispensable for childbirth, and is defined by many women as the most severe pain in their lives. The severity of pain or pain that may be felt depends on a variety of factors, such as the baby’s height, baby’s position, pelvis (roof) width, strength of contractions, past experiences and expectations, pain threshold, and many more unresolved causes. It is difficult to predict how much pain you will experience before giving birth
Many researches have been done and many methods have been tried in order to prevent these pains, which can turn the birth process, which is perhaps the most beautiful experience in the mother’s life, into an unpleasant experience without adversely affecting the course of birth.
Medications given intravenously to alleviate or relieve labor pains may have some disadvantages and side effects. The most important of these side effects is drowsiness and drowsiness. In addition, side effects such as nausea, vomiting, difficulty in breathing, itching, constipation and urine accumulation in the bladder can be seen. The arrival of breast milk and the start of breastfeeding may be delayed. For this reason, alternative searches have been made.
Regional anesthesia for painless delivery was first used in 1900. As in every new practice, some negative effects were seen at the beginning, but as a result of clinical studies over time, painless birth has become widespread as a safe option thanks to new drugs, methods and techniques and anesthesiologists specialized in painless birth.
The epidural space is the millimetric space between the membrane around the spinal cord and the connective tissue between the vertebrae. It is possible to perform many operations, relieve post-operative pain, and treat chronic unrelieved pain by applying drugs from various levels of the spinal cord in accordance with the purpose in this range.
Here, it is necessary to distinguish the concepts of analgesia and anesthesia from each other. Analgesia means painlessness and anesthesia means insensitivity. During normal delivery, epidural analgesia from the lumbar region, that is, pain relief, is sufficient, while epidural anesthesia is required during cesarean delivery. In terms of procedure, both applications are the same, the difference is only in the drug doses given.
Delivery with epidural analgesia, popularly known as “painless birth”, is becoming quite common nowadays. With a medicine applied through a catheter, which is a millimetric tube placed at waist level, the transmission of pain signals coming from the lower half of the body is temporarily stopped and pain is not felt in the area where the painful stimulus originates. is set. In this method, only pain transmission is blocked, the sense of touch and movement are not restricted. After the application, the expectant mother can get up and walk around the room during the birth process and see all her needs. The contraction of the uterine muscles and the active participation of the mother in labor are not affected, the mother regains her baby physiologically, free from pain at the time of birth.
In general, expectant mothers want to deliver their baby normally, but cesarean section may be required in some cases. In this case, Epidural Anesthesia is applied. Technically, the procedure is the same, the same catheter is placed in the epidural space, but the dose of medication given is different. What is done when normal birth returns to cesarean section is to create epidural anesthesia by administering additional medication through the same catheter. The mother lies on the operating table with her lower back completely numb, but she can move her feet where she lies, that is, there is no complete loss of movement in the legs after epidural anesthesia. Loss of movement, called motor block, is seen in spinal anesthesia by injecting local anesthetic into the spinal fluid. Spinal anesthesia is also a commonly used method of anesthesia today. Sometimes, epidural anesthesia and spinal anesthesia are combined and applied together. Although the advantages of spinal anesthesia are that it is technically easier to apply than epidural anesthesia, and the onset of action is much shorter, it has some undesirable effects such as inactivity in the legs for 4-5 hours, headache, nausea and decrease in blood pressure sometimes seen after the application. Here, the anesthesiologist will determine the most suitable method for the patient in line with his/her experience and skills and recommend it to the patient.
What will you experience during normal birth with an epidural?
When the labor pains begin to disturb, that is, when the birth canal opening is 4 cm, the mother is taken to the procedure room. Serum is placed in the arm, blood pressure, pulse and oxygen status are monitored from the fingertip.
For a successful epidural application, it is essential for the mother to be in good harmony with her physician and to take the appropriate position. In general, the application is done in a sitting position, and while the body is leaning back slightly when the body is in an upright position, the body is bent forward from the waist to separate the vertebral prominences from each other, the chin is leaning towards the chest and both shoulders are left down. After the position is created in this way, an antiseptic drug is applied to the back and waist area, the area is made germ-free and the area is covered with sterile covers. At the level of application, the skin and subcutaneous tissues are anesthetized with a thin needle. Only the entry of this thin needle is felt during the procedure. Then, with another special needle, the epidural space is entered, a thin tube called a catheter is placed here and fixed to the body with the help of plasters. Shortly after the administration of the drugs through the catheter, the pains end, but the uterine contractions are not prevented, they continue in the same way. Painlessness is maintained by using a patient-controlled analgesia method with a pain pump connected to the catheter. From this moment until the birth, everything is the same, but the pain will not be felt.
Impressions of a mother who gave birth naturally without pain with epidural:
“…I wanted to have a normal birth (with epidural) during my pregnancy and I read a lot about it. Although the epidural option relieved me, what you read made me suspicious. However, when my anesthesiologist came to meet us in the morning and told us, I trusted him without questioning what he would do. When my pain started, he came to the room with his team and equipment. Frankly, the preparation took so long that I can not say that I was not afraid. I already shared this feeling with him right away. He told me that our preparation takes a long time, because of our detail. All for your comfort. Since a needle was going to be injected into my waist, I could only hear everything that happened with my back turned, I could not watch anything. The procedure took such a short time that I could not even understand what happened, when the epidural was inserted. Thanks to the medicine, I had a more comfortable and easy delivery process without experiencing the pain and the stress of birth. I would never have been able to have a normal birth without this method. It is a great blessing for the baby and mother to be able to have a stress-free birth…”
