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What types of anesthesia are possible in obstetrics?

Several anesthesia techniques are possible during obstetric labor. The epidural is the first, more frequent and not compulsory (except medical indication), it is possible that you'll have a spinal anesthesia or a general anesthesia depending on the situation, or an analgesia by infusion if you cannot have an epidural. The anesthesiologist in consultation will check that you can have access to the different anesthesia techniques

Epidural anesthesia

It is the most common anesthesia. This technique relieves pain associated with uterine contractions by injecting drugs (local anesthetics) into a space close to the spinal cord called: epidural space.
These drugs will temporarily block the transmission of painful information from the lower body to your brain.
 

To do this, you need to put a flexible plastic device in place at the bottom of your back. 

The position to take is this (see below):

Sitting on the edge of the bed, relax your shoulders, bringing out the lower back towards the rear. 

Otherwise, the installation can be done in a lying position on the side, raising the knees as far as possible against the chest.

The position can be uncomfortable during placement, but it is essential to maintain this position in order to properly position the catheter and to avoid unwanted effects during placement.
The drugs will work in 10-15 minutes, gradually to give you relief.

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What are the effects of the epidural?

The sensations in the lower body will change, this is normal. You may have difficulty moving your legs if the epidural is strong. In most cases, the anesthetist will suggest that you adapt the medications yourself throughout labor, in order to adapt to the sensations and pains.
We are implementing strategies that allow you to roam around as much as possible.

Benefits of ambulatory epidural anesthesia

If conditions allow, the anesthetist may offer you an ambulatory epidural anesthesia. The installation technique is the same as before, but the local anesthetics are weakly dosed in order to allow you to walk, accompanied, after the healthcare team has verified the absence of a fall. Current scientific data does not show adverse events related to ambulation, but an improvement in patient satisfaction and a decrease in  the risk of urinary retention.

After the  epidural

Recovery is gradual,  the catheter is removed after childbirth. It is important that you are accompanied when you get up for the first time after having recovered  muscular strength and an adapted feeling.  

Spinal anesthesia, general anesthesia, continuous infusion

You can have spinal anesthesia as part of a cesarean section (scheduled or during labor if you did not have an epidural). 

General anesthesia is reserved for maternal or fetal emergency situations (time before your baby comes out too short to use another anesthesia technique)
If your state of health does not allow you to have an epidural for obstetrical work, in most cases we can offer you an infusion of powerful painkillers (with less effectiveness than the epidural).

Are there any risks for my baby?

Some medicines can pass the placenta and go to your baby. Medicines used with the epidural have little or no effect on your baby. General anesthesia is more risky for your baby.

Are there alternatives to the epidural?

Childbirth is a natural process that causes discomfort and pain. Every woman is different and your needs may change during labor. We adapt as much as possible to those there.

Nevertheless, it is possible to avoid certain drugs thanks to breathing exercises, acupuncture, baths, hypnosis, sophrology, and other medicinal techniques: nitrous oxide (via a mask ). The midwife who will follow you will assess your desires and needs with you.

Who performs the epidural?

Epidural anesthesia, spinal anesthesia and general anesthesia in the obstetrical setting are carried out exclusively by an anesthetist-resuscitator. this may be different from that encountered during the anesthesia consultation. 

During this gesture, an infusion and monitoring devices will be installed. Your file and your balance sheet will be re-examined.

Adverse effects of anesthesia in obstetrics

Frequent : 
- Low blood pressure
- Nausea / Vomiting / Itching / Tremor

- Pain or bruising at the injection site 
- Partial effectiveness of anesthesia

- Acute urine retention
 

Rare: 
- Fever
- Nerve damage: loss of sensitivity, stinging sensation, burning, muscle weakness with recovery in a few days to weeks

- Severe or positional headaches: possible dura-meric breach

need to consult if this persists

- Drug overdose

- Failure of the installation: another anesthesia technique  necessary

- allergic reaction

 

Exceptional:

- Nerve damage with permanent paralysis

- Serious infection (abscess, meningitis) linked to the catheter

- Too much anesthesia with inability to breathe alone

- Hematoma with compression of the spinal cord

- Vision / hearing problems 

- Problem with the material used

- Anaphylactic shock

- Convulsions 

- Cardiac arrest-death  

 

Link to the Materniteam site of the Clinique du Parc