Epidural anesthesia (PDA): birth without pain?

What is a PDA?

Peridural anesthesia, also known as epidural anesthesia or PDA for short, is local anesthesia in the region of the spinal cord. It enables women giving birth to have their child with significantly less pain but with full consciousness. The number of women opting for epidural anesthesia has been steadily increasing for years. According to a MomaSquad survey from 2009, even without a medical reason, 40 percent of all women giving birth now opt for this anaesthetic. In some hospitals, an epidural is now even used in over 70 percent of births.

When is an epidural inserted during childbirth?

The epidural is performed by an anesthetist after consultation with the midwife and possibly the gynecologist. It is usually only inserted when the cervix is ​​four to five centimeters open. So you don’t have to commit yourself from the start. However, if the cervix is ​​already dilated too much, it is too late. The birth is then almost over and the pain-relieving effect would no longer start in time.

The laying of the PDA

In epidural epidurals, a soft catheter is placed on the back between the vertebrae and the spinal canal. You will hardly feel this process. So you don’t feel any pain. In order for the anesthetist to find the right spot, you have to “bend your back” while sitting or lying down. The area is then locally anesthetized with a skin anesthetic. A needle is then inserted into your back and a soft, very fine tube is attached to it, through which the medication enters your body.

Figure: Epidural anesthesia (PDA)

How does the epidural work during childbirth?

The drug, given through the epidural, blocks the nerve impulses that are responsible for the pain of labor. If you feel a pleasant feeling of warmth in your legs after laying, that’s a good sign. The warmth signals that the PDA will soon take effect. After about 15 to 20 minutes, the full effect has finally unfolded and the pain has almost disappeared. You only feel an occasional push and pull in your stomach and how it becomes hard with the contractions . Sometimes it happens that the anesthetic only works on one side of the body – then you should let us know immediately. It is usually sufficient to lie on your side so that the active ingredient can spread. Otherwise the position of the catheter will be corrected by your doctor.

When is a PDA useful?

In most cases, the epidural is placed at the request of the woman giving birth. In special cases, however, it is also recommended by the midwife or doctor. If, for example, the birth process is greatly delayed, the woman giving birth is very tense and there is a risk that the baby will no longer have to be delivered naturally but by caesarean section, then an epidural can help. The anesthetic relaxes your body. This often speeds up the birth process .

The dosage of the epidural

As a rule, you can regulate the dosage of the medication yourself. For this you get a small push button that regulates the dosage of the drug. So you can decide if you can endure the pain or if you want to relieve it to the end. It makes sense to reduce the dosage towards the end of the birth because you will get a better feeling for the birth process in the final phase. Otherwise there is a risk that you will lose the natural body awareness of when you should push and when you need to rest. A longer birth can then be the result and complications can arise. However, your doctor and midwife will be by your side the whole time to advise you and help you with the dosage.

Possible side effects of an epidural

Even though epidural anesthesia relieves the pain of childbirth, you should be aware of the possible side effects. During childbirth, your blood pressure can drop sharply, affecting your general well-being. In addition, your body does not release any endorphins as endogenous pain relievers through the epidural. Since the PDA supplies you with joke drugs, this fact does not change anything for you. However, your baby is exposed to increased stress because it can no longer benefit from this endorphin release and the painkillers of the epidural do not reach your baby. In addition, the PDA can lead to your own contractions being inhibited. As a rule, you also lose a little feeling for your body during the birth due to the anaesthetic. By losing your perception of when you eg If you have to support the birth by pushing, the birth may take longer than without anesthesia. There is also the danger that you will no longer be like thatbreathe deeply into your belly and thus no longer supply you and the baby with oxygen as well. You will often need to be reconnected to a labor drip to induce artificial labor to speed up labor .
The following side effects may also occur after childbirth:

• headache
• back pain
• Bonding problems due to hormonal influence
• Missing birth experience
• Delayed flow of milk

Side effects of epidurals for your child

Epidural anesthesia has no direct effects on your child because only a small part of the active ingredients gets into your circulatory system. However, some midwives criticize that epidurals cause the baby to be exposed to increased stress during birth:

• Normally, your body produces pain-relieving endorphins during childbirth, which are also passed on to your baby and thus help him to cope better with the stress of childbirth. This is no longer the case to the same extent after an epidural. Your baby will then lack your endorphins. This increases his stress.
• In some cases, the insertion of an epidural can also reduce labour. Then labor-inducing drugs must be administered. Midwives criticize that this can disrupt the baby’s natural rhythm and thereby increase the potential for stress.
• The drop in your blood pressure can affect your child’s well-being and can thus further contribute to increased stress.

Although most children born with an epidural are just as fit as babies born without an epidural, one thing should be clear: childbirth is often less complicated and less risky if the use of medication is kept to a minimum. You can read about other measures that can help against pain during childbirth in our special “ Relieve pain during childbirth ”.