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As an expectant mother, you have the choice of whether or not to have an epidural. For certain conditions the doctor will advise against it, other situations (twin births, etc.) require appropriate pain relief. If a cesarean section occurs, spinal anesthesia is the preferred procedure; it can also be performed using an epidural. If you are thinking about using this anesthesia procedure, you should not ignore the risks. On the other hand, there are good reasons for using epidural anesthesia. Here you can find out all the important information about PDA!
What Is PDA?
The abbreviation PDA stands for epidural anesthesia, which, like spinal anesthesia, is a regional anesthesia procedure. In contrast to general anesthesia, you remain conscious because the pain is only switched off in certain parts of the body. PDA is the most common form of medication used to relieve pain during childbirth. It is also the method of choice for many operations and provides significantly better pain therapy than other methods. In obstetrics, the PDA (also: epidural anesthesia) has a high value, because the effect sets in quickly and allows women a pain-free birth. If complications arise during a spontaneous birth, a cesarean section can be performed under epidural. In this case, the anesthesia is adjusted by means of the catheter.
How Is PDA Performed?
If PDA is used during childbirth, it is usually applied in a sitting or lateral position. The doctor will ask you to arch your back and relax your shoulders. Then the skin in the corresponding area will be disinfected and you will receive a local anesthetic. In the area of the lumbar spine, the doctor feels the puncture site between two spinous processes and carefully inserts the special hollow syringe needle. The needle passes through the taut ligaments located between the vertebral body processes, and the peridural space can then be easily located.
A total of three protective sheaths surround the brain and spinal cord. The outer sheath is the dura mater (hard skin of the spinal cord), which is divided into two layers in the area of the spinal cord, between which the peridural space is located. This area contains blood vessels and connective tissue, and spinal nerves also enter the spinal cord here. These nerves conduct pain signals to the brain. The drug blocks this transmission because it numbs the spinal nerves. A thin tube called a peridural catheter (PDK) is inserted through the hollow needle and remains there for a longer period of time to ensure the supply of medication. Afterwards, the needle is removed and you are given a bandage to fix the catheter. The whole procedure usually takes no more than 10 minutes and is not considered painful by most women.
Proven: PDA During Childbirth
The dose of anesthetic is usually increased gradually, and after about 10 to 20 minutes, the pain-relieving effect sets in. Since a birth usually takes a little longer, the doctor can add doses of the drug if necessary. Another option is to use a syringe pump (perfusor), which ensures a continuous supply. Often, the expectant mother can additionally administer herself another dose (bolus) by means of a hand trigger when pain peaks occur. Around 50 percent of all women giving birth in Germany now receive an epidural via catheter. This is particularly relevant for first-time mothers, who often describe the labor pain as difficult to bear and are also unsure whether the epidural should really be used during birth. If the expectant mother is ill, the administration of the epidural may be medically necessary. For example, in the case of heart or lung disease, it may be necessary to prevent pain-related stress reactions such as high heart rates (tachycardia) or increases in blood pressure (hypertension). In the case of delivery from a breech presentation or the birth of twins, doctors usually consider it an obstetric indication.
PDA – What Are The Side Effects, Risks & Late Effects?
The procedure has been extensively tested and is comparatively low-risk. As with most drug administration, side effects cannot be completely ruled out here. Different agents can be used for epidural or peridural anesthesia, which differ in terms of possible side effects:
In many cases, switching to a different medication helps here.
Low Blood Pressure
Initially, blood pressure may drop (hypotension) and the pulse may slow down (bradycardia). Dizziness and nausea are the result. You will be closely monitored by the anesthesiologist, so he can quickly take countermeasures if necessary. Most often, this occurs in 14 out of 100 women.
Infections And/Or Fever
In about 23 out of 100 women, fever sets in as a result of the epidural.
Severe Headaches And/Or Back Pain
These effects do not present themselves in some women until after the epidural. In one in 100 women, the doctor may stitch too deeply and injure the inner protective covering of the spinal cord. This causes cerebrospinal fluid (CSF) to leak out. As a result, some women suffer from severe headaches for several days.
Problems With Bladder Emptying
Temporarily, the epidural may make it difficult to urinate, and these women receive a catheter in most cases. This may be the case in about 15 out of 100 women.
Sporadically, a slight numbness or tingling in the legs may occur after an epidural.
PDA – Other Risks And Late Effects
Colloquially, PDA is referred to by many people as a spinal cord injection. For many women, this term has negative associations, as they fear an injury to the spinal cord. However, serious complications such as bruising, abscesses, paralysis or direct nerve injury are extremely rare. The needle remains outside the hard meninges during prenatal epidural anesthesia, so injury to the spinal cord is largely ruled out. In people with impaired blood clotting systems (due to disease or anticoagulant medication), there is a major risk factor for peridural bruising. Spinal anesthesia procedures should only be performed in patients at increased risk for infection or bleeding after careful consideration of the risks and benefits.
No PDA For Back Tattoo?
You have an extensive tattoo on your back and are concerned that peridual anesthesia is not possible? It must be ensured that no ink particles enter the sensitive peridural space. For this reason, the anesthesiologist will only make the puncture in an un-tattooed spot to reliably avoid this. In most cases, a site one vertebral body higher or lower can be selected without any problems. If there is no un-tattooed spot, the anesthesiologist will actually refuse the PDA as a rule.
PDA – How Does The Birth Proceed?
The birth is divided into four phases:
- Opening phase
- Transition phase
- Expulsion phase
- Postpartum phase
You can recognize the opening phase by the onset of contractions, which occur less than seven minutes apart. The cervix slowly opens more and more and in the transition phase the contractions become stronger. In this phase, the exercise contractions begin. Once the baby’s head has reached the pelvic floor area, the expulsion phase begins. The contractions become stronger again and come at shorter intervals. Now the descending contractions begin. The contractions of the uterus move the baby out through the birth canal. In the postpartum phase, the afterbirth contractions expel the placenta. The epidural can be administered during the opening phase or the expulsion phase.
Does Epidural Change The Course Of Labor?
Under epidural or peridural anesthesia, the duration of a birth may be somewhat prolonged. It is believed that some infants turn more slowly into the optimal birth position and this leads to a prolongation of the expulsion phase.
With epidural, the risk increases that the birth will have to be assisted by suction cup or forceps:
- Without PDA = out of 100 women, a suction cup or forceps is used in 10 parturients
- With PDA = used by 14 out of 100 women
It is not uncommon for women in the expulsion phase to have a diminished sense of when to push. This is not a problem, as you will usually receive appropriate advice from your doctor or midwife. You do not have to worry about your child with regard to the epidural, as only a small part of the active substances reaches the unborn child via the umbilical cord. Children born under epidural are therefore just as fit as babies whose mothers did not receive epidural medication.
Special Form Of PDA: Walking Epidural – What Is It?
In the USA, walking epidural is the first choice for many women giving birth. This is a low-dose epidural where you still retain feeling in your legs and can walk around the room. A portable pump is used here that delivers a medication at regular intervals. In addition, with walking epidurals, you can usually top up the dosage within the specified range by pressing a button. In most cases, the anesthetic is administered during the opening phase. Walking epidurals are now also increasingly being offered to women in labor in Germany.
PDA Or Spinal Anesthesia?
In most cases, spinal anesthesia is used for a cesarean section. In addition, other operations on the lower abdomen and procedures on the perineum, groin or legs are performed using spinal anesthesia. This procedure, like PDA, must also be performed under aseptic conditions to minimize the risk of infection. In most cases, the puncture for spinal anesthesia is made between the third and fourth lumbar vertebrae. Injury to the spinal cord is largely unlikely with spinal anesthesia, since it has already divided into individual spinal nerves in the area of the puncture site.
Initially, a sensation of warmth develops and increasing numbness usually spreads upward from the feet. The duration of the blockade depends on the dosage of the active substances used and is usually 1.5 to 6 hours. The main differences between PDA and spinal anesthesia lie in the procedure regarding the insertion as well as the dosage of the active ingredients. With spinal anesthesia, the physician manages with a comparatively low dosage and can thus anesthetize the entire lower half of the body. If epidural anesthesia is performed, larger amounts of the anesthetic are used for targeted pain therapy. If the applicable guidelines and instructions regarding use are observed, epidural and spinal anesthesia are safe and offer patients many advantages.