Epidural childbirth, also known colloquially as “princess birth,” presents a comfortable opportunity for a smooth birthing process. Epidural anesthesia was first experimented with by Corning in 1885. It began to become more widespread in the 1960s and has been implemented in Turkey since 1990, continuing to gain popularity worldwide. In Turkey, the rate of childbirth with epidural analgesia is around 35% in private hospitals, while it’s approximately 11% in university hospitals. The aim of this procedure is to provide sufficient analgesia during vaginal delivery by allowing the uterus to contract without depriving the mother of her pushing ability, using local anesthesia. The patient does not feel pain, but the uterus continues to contract. Epidural analgesia involves inserting a thin needle into the lower back of the mother, specifically at the L2-3 or L3-4 levels of the spine, and administering a local anesthetic through a catheter attached to the outer layer of the spinal cord, ensuring that the lower body does not feel sensations.
This local anesthesia is divided into three types: 1. Pure epidural anesthesia, 2. Spinal anesthesia, and 3. Epidural-spinal or combined anesthesia. While spinal and combined anesthesia are only administered during cesarean sections, epidural anesthesia can be used in both normal deliveries and cesarean sections. The effect of epidural anesthesia during a cesarean section begins within 15 to 30 minutes, whereas in spinal and combined anesthesia, the effect starts immediately. A study conducted in our country did not find any serious side effects in mothers and newborns who received continuous epidural analgesia during childbirth.
When labor pains begin and the cervical dilation is approximately 4 centimeters, epidural anesthesia becomes appropriate. Firstly, a vein is opened in the mother, and appropriate fluids are administered. The mother’s blood pressure and pulse are measured. The mother’s lower back is sterilized, and the procedure is performed with a special needle. A catheter, or a thin tube, is inserted into the epidural space with a special needle, and drugs are administered through it. In this case, the uterus continues to contract, but the mother does not feel pain. With appropriate doses of epidural analgesia, motor fibers do not become numb, allowing the mother to maintain her mobility. When pain begins, the medication is repeated in suitable doses. Epidural anesthesia provides comfort during normal delivery as the mother does not feel pain. In cesarean sections, the risks of local anesthesia are lower than those of general anesthesia, and the mother will see her baby as soon as it is born and will start breastfeeding earlier after childbirth.
In pregnant women who gain excessive weight, epidural anesthesia may be unsuccessful. Blood pressure may drop and a feeling of nausea may occur after epidural anesthesia, which can be prevented with precautions. Regardless of whether epidural, spinal, or combined anesthesia is performed, the mother may experience headaches afterward, but the use of thin needles in modern procedures has greatly reduced the likelihood of headaches. Even if headaches occur after the procedure, they will improve quickly and heal on their own within a few days. Epidural anesthesia performed by experienced hands has very few side effects, and the rate of drug transfer to the blood is very low. Even if drugs do pass into the blood, they are quickly broken down before passing to the baby through the placenta, so there are no negative effects on the baby. Epidural anesthesia should be administered at the appropriate time once labor has become regular. If true labor has not begun, early placement of the epidural catheter may slow down labor, but when placed at the appropriate time, it does not affect labor. It may only make pushing difficult in the second stage by reducing the sensation of pushing. Therefore, dosage adjustments are made appropriately by the doctor in the second stage. It is not correct to administer epidural anesthesia to pregnant women with excessive bleeding or low blood pressure or those allergic to medications. When administered to suitable cases by experienced anesthesia specialists, epidural anesthesia makes childbirth very comfortable.
