Safe childbirth,

a fundamental need.

By DOCTOR ALAIN STAGEL
ANESTHESIST RESUSCITATOR

 

With MYBUBELLY, you’ve chosen to have a boy or girl, you are an active and motivated woman, and since you don’t like to leave things to chance and fate, it is very likely that you will prepare your delivery down to the last detail.

Safety during childbirth is fundamental for both baby and mother, and the entire act of giving birth must focus on this absolute necessity.

Current medical techniques make it possible to combine safety and pain-free delivery. Today, you might even say that a painless delivery is an essential element for a safe birth.

Epidural and spinal anaesthesia are local anaesthesia; these words which are part of the common language of motherhood can be seen by some as aggressive or full of potential complications.

You may feel apprehensive about these techniques. Our message is to demystify and destigmatise them in order for you to see them as a benefit and an opportunity for you and your child.

 

THE GOAL OF PERIDURAL OR SPINAL ANESTHESIA:

The lower half of the body, i.e. everything below the navel, is innervated by nerves from the lumbar area of the spine.

These nerves ensure that you’re sensitive to touch and pain, among other things, and they also ensure the transmission of stimuli controlling voluntary or automatic movements.

By injecting products such as local anaesthetics and morphine derivatives into these nerves, the transmission of painful sensations and movements can be blocked. Epidural or spinal anaesthesia allows these products to come into contact with the nerves at their emergence from the spine using special needles.

Depending on the product and the dose administered, the speed and duration of the action, and whether or not movement will be present will differ. The anaesthetist will choose the product specifically adapted to the situation.

The objective of loco-regional anaesthesia is to relieve the pain of childbirth while respecting the mother’s consciousness and the sensation and pleasure of giving birth, unlike general anaesthesia.

EPIDURAL OR SPINAL ANAESTHESIA

The epidural allows the anaesthetic to be injected into the spaces between the vertebrae in a specific area, called the epidural space, and a catheter (a small tube of millimetre size) to allow for repeat injections to prolong the anaesthetic effects.  But it’s a little longer and more complex to implement, and its effectiveness is slower to build than with spinal anaesthesia.

 

Spinal anaesthesia, which is faster to perform, also consists in passing between the vertebrae to inject the products into the space where the cerebrospinal fluid circulates. It takes effect almost immediately, but repeated injections are not possible because a catheter cannot be left in place.

It is possible to combine the two techniques, to have the advantages of both.

Only the anaesthetist will be able make the final decision on the choice of technique according to the specificity of the delivery setting, after informing you.

The injection between the vertebrae is not painful, as it is preceded by a local anaesthetic at the injection site. The injection is generally performed while the mother is lying on her left side, but it can also be performed in a sitting position. In these positions, the mother must round her back as much as possible to open the spaces between the vertebrae to facilitate the anaesthetist’s job. it is sometimes difficult to locate the vertebrae by palpation and to locate the spaces between them for overweight women. In this case, the anaesthetist can use an ultrasound scanner to visualize the injection site. If you are particularly ‘plump’ make sure that this relatively recent technique is available.

As soon as the product starts to take effect, you will feel tingling in your lower limbs and a progressive loss of sensitivity. Finally, depending on the desired effect, you’ll have a more or less significant loss of mobility in your lower limbs. Sometimes tremors appear, but these are absolutely normal evidence of the anaesthesia’s effectiveness.

In case of difficulty with the labour and childbirth that require the use of forceps or an emergency C-section, these procedures can be performed immediately without general anaesthesia, which is a time-saving and effective advantage. In the case of foetal suffering, it is a major increase in safety.

In addition, general anaesthesia during childbirth potentially presents a risk of regurgitation of gastric fluid and its inhalation, called Mendelson’s syndrome, which is a severe complication that can lead to life-threatening complications.

 

INCIDENTS AND COMPLICATIONS

Incidents and complications with these techniques are very rare: headaches are reported, for which effective treatment is available; or paraesthesia-type pain or unpleasant sensations that disappear within a few weeks.

COUNTER-INDICATIONS

• These are rare, and will be evaluated by the anaesthetist you will see in consultation before giving birth
• Blood-clotting disorders.
• Neurological disorders.
• Malformations or vertebral pathologies.
• Infection, especially on the back, hence the importance of the quality of skin hygiene. You’ll need to pay particular attention to this in preparation for an epidural.

ALTERNATIVES
They exist but without the guarantee of safety for mother and child: pain-free childbirth is a psychological preparation; hypnosis is a long and not always effective process.