Together with our partner, expert in reproductive health, gynecologist-endocrinologist Nataliia Silina, we continue to unravel a myth about women's health.

Today we are talking about childbirth and different ways to make it safe for the mother and baby.

Questions about epidural anesthesia (EA) are heard in my office every day. Many people ask about my personal experience of analgesia during labor (more details are at the very end of the article). In Ukraine, the epidural anesthesia during childbirth is applied in 18 to 23% of cases, in the UK it is 20%, and 60% in the USA. It should also be noted that this figure increases to almost 90% in private clinics. This is due to the fact that practicing obstetricians have appreciated the advantages of this technique, which allows to prevent women’s traumatic experiences.

But more and more often in our society the question arises: “women have given birth before and they have endured it somehow, haven’t they? Women are created to endure “the pain of childbirth and ensure that the baby passes through proper perinatal matrices”.

Yes, they are created for that and yes, they have endured it.

But now let's talk about reality. If a woman has a low pain threshold by nature, if it is difficult for her to endure pain and she has always taken pain killers during menstruation, then, of course, it is an indication for an epidural anesthesia.

The epidural anesthesia does reduce the pain of the mother, but it does not deprive her of her activities: she breathes and works to ensure a successful childbirth. The fetus goes through maternal passages anyway, and therefore undergoes all the "intranatal tests" inherent in nature.

Assessment of the degree of “authenticity” of motherhood according to the criterion of the naturalness of childbirth is a sign of a “mythical” type of thinking. Here are some medical facts about epidural anesthesia that will help you make a decision about a pain relief during birth using the epidural anesthesia, because, as you know, #happy_woman_is_healthy_and_aware.

What are the advantages of epidural anesthesia?​

1. It allows you to have some rest in case of prolonged labor.

2. The absence of pain helps a woman to perceive childbirth more positively.

3. This method of anesthesia allows you to remain conscious and take an active part in the labor and delivery process, even if you are giving birth through a cesarean section.

4. Epidural analgesia will help you to cope with exhaustion, irritability and fatigue; it will allow you to have a rest, concentrate and give you the strength to move forward as an active participant in the labor and delivery process. When I worked in a maternity ward, I had experience working with exhausted women who, instead of pushing, simply asked to help them get their baby out of them faster.
5. EA helps doctors reduce certain complications such as cervical spasm or increase in arterial blood pressure.

But let's remember that epidural anesthesia is still a medical intervention that has not only its advantages but also its contraindications, and a certain percentage of complications, as I will explain below.

Risks associated with the use of epidural anesthesia:​

1. EA can cause a sudden fall in blood pressure. Therefore, you will receive an intravenous medication. Arterial blood pressure will be monitored periodically. Generally, this is normal when you are placed in the delivery room and you have a venous catheter installed in order to have access to the bloodstream at any time. If it is not needed, it will be removed after childbirth.

2. A spinal headache caused by a minor loss of cerebrospinal fluid. Less than 1% of women have this side effect. Several of my patients had this syndrome with varying degrees of intensity. And some of them had to undergo treatment by a neurologist for 3 to 6 months.

3. After placing the epidural catheter, lying in bed, it is necessary to change position and control the baby's heartbeat. A midwife will perform a CTG (cardiotocography), i.e. a procedure for monitoring your baby's heartbeat; most pregnant women pass this procedure after 36 weeks of pregnancy.  If you keep lying in the same position, this can slow down or even stop the contractions.

4. Some women experience the following side effects: shivering, tinnitus, back pain, sensation of pain at the injection site, nausea, difficulty urinating. But it does not affect the fetal condition.

5. A few hours after delivery, you may feel numbness in the lower body and you may need someone else’s help to move.

6. In rare cases, a nerve damage may occur in the area of catheter insertion.

7. There are several studies suggesting that some newborns may have problems with the nipple latch, which causes complications with breastfeeding.

8. Very rarely during EA, a disturbance of the fetal heart rhythm and the development of hypoxia (lack of oxygen) may occur, which in turn requires either a Caesarean section or a perineal incision (episiotomy) or a vacuum extractor application to get the baby faster.

And now, some of the most common questions that our charming Women and their partners put to an obstetrician-gynecologist

I am afraid of pain, can I have an epidural anesthesia during my first contractions?​

This method can be used from the moment of the cervix opening up to 4 cm. The opening of the cervical canal for more than 4 cm indicates a shift towards the active phase of labor and allows the anesthesiologist to start the EA procedure.

Is it true that EA causes a powerless labor?​

Yes, sometimes EA weakens the labor and this is corrected by the administration of oxytocin.

How will this anesthesia affect my baby during labor and the first day after birth? And probably the rest of his or her life?​

A baby's health condition at birth and after birth depends on many factors. They include the time of birth, parturient woman’s high blood pressure and problems with sugar, placenta condition and, in general, the course of pregnancy as a whole and, of course, genetic factor depending on baby's parents.  As I indicated above, EA may cause fetal hypoxia, which may require either Cesarean section or vacuum extraction. But again, it is difficult to identify epidural anesthesia as a major factor in the development of complications in the baby. Many factors affect the birth process and fetal condition. But it is proved that mom's anxiety and constant self-analysis definitely cause an increase in stress hormones, which is rapidly passed to the baby via placenta. It’s important that all your questions and fears be written down and discussed with the doctor who monitors your pregnancy.

My girlfriend requested the EA application, but it was denied. Why did they do so? Wasn't there a doctor trained in the EA technique?​

Like any medical intervention, EA has its contraindications. And I urge you not to transfer another woman’s experience of birthing to you personally. You are not aware of all her diagnoses, course of pregnancy, etc.

Conditions that prevent your doctor from applying epidural anesthesia:

• Low platelet count (cells preventing bleeding work like a welding machine in the puncture area)

• You have an accelerated labor or you have come to a maternity hospital with a cervix dilated to 8 cm or more. The doctor expects the baby to be born in the next 60 to 90 minutes.

• You have an infection or injury at the puncture site for anesthetics injection.

• You are taking anticoagulants, a medicine thinning your blood.

• You are bleeding.

• The uterine cervix is not opened up to 4 cm.

• Allergy to drugs used by the anesthetist.

• The method of using epidural analgesia is constantly being improved and a significant part of its success depends on the skill of the doctor. But this rule applies in every sphere.

If you have doubts about using EA, you must make an appointment with an anesthetist and discuss with him all the issues that concern you.

As promised, about my personal experience.

All three times I gave birth without using EA. Yes, it was painful for me, but I was able to go through and forget it a few days after the childbirth. But I am sure that it does not in any way characterize me as a woman and mother, that is, it does not make me more or less feminine, sexy or better than a woman who gave birth using EA or Cesarean section.

My dear, let's stop the tradition of measuring the number of children, the "naturalness" of births, and the duration of lactation! It is the sense of inner dignity, ability to enjoy life, and respect for another woman that make a woman!

1. American Academy of Family Physicians

2. William’s Obstetrics Twenty-Second Ed. Cunningham, F. Gary, et al, Ch. 19.

3.Mayo Clinic Guide To A Healthy Pregnancy Harms Roger W., M.D., et al, Part 2.