Methods of pain relief during surgical childbirth. Anesthesia for caesarean section - general, spinal, epidural Spinal anesthesia for caesarean section consequences
Caesarean section is a fairly common delivery operation. Every year the frequency of its holding increases. Knowledge of the features of selection and application spinal anesthesia will help a woman prepare for the birth of a child and protect herself as much as possible from unpleasant consequences.
Indications for caesarean section and types of anesthesia
Spinal anesthesia for caesarean section most often used in the presence of the following factors: a scar on the uterus after a previous operation, breech presentation or oxygen deficiency of the fetus, anatomically narrow pelvis, complications during natural childbirth. In some cases, doctors take into account non-medical indicators, such as the age of the primigravida over 30 years, the risk of damage pelvic floor, the desire of a pregnant woman. Contraindications include unfavorable fetal condition (prematurity, death, deformities, prolonged oxygen starvation), clinically significant infection, prolonged labor for more than 24 hours.
Pregnancy causes serious changes in the body of the expectant mother, including hormonal ones. They are of great importance for the anesthesiologist, because only with their consideration can the woman be provided with qualified assistance. As a rule, her blood pressure decreases due to a decrease in vascular resistance, the respiratory rate and tidal volume and oxygen consumption increase, and the motor activity of the stomach decreases. These changes in the functioning of the body directly affect the characteristics of anesthesia. The most commonly used methods of reducing pain during childbirth are psychoprophylaxis, systemic and regional anesthesia.
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Attention! The information on the site is presented by specialists, but is for informational purposes only and cannot be used for self-treatment. Be sure to consult your doctor!
Approximately 20% of babies are born in a non-standard way - through a surgical incision in the anterior wall of the abdomen and uterus. This operation is called a caesarean section and has been practiced for decades. For what indications and for what period is a caesarean section performed, how is the procedure carried out, under what anesthesia - these and many other questions prevent expectant mothers from sleeping peacefully. All the most interesting and important information we will try to present it here.
All sorts of things surgical intervention, even the most insignificant, to a certain extent carries potential danger for the health (and sometimes for the life) of the patient. This is why a pregnant woman cannot “order” a caesarean section from her attending physician just like that, for no apparent reason. And although in society you can find an opinion about attractiveness artificial birth due to their efficiency and painlessness, with medical point From our point of view, natural delivery will always be a priority.
There are absolute and relative reasons for surgery.
Absolute readings:
- The first child was born by cesarean section and independent childbirth can lead to complications.
- The baby is positioned across the uterus or “sat” on the butt.
- The expectant mother has been diagnosed with any disease or condition that could cause the death of the baby during childbirth.
- The baby's head is too large to fit through the pelvic bones.
- Severe late toxicosis.
- Multiple pregnancy.
Relative readings:
- Anatomically non-standard development of the mother's skeleton (for example, a narrow pelvis not intended for natural childbirth).
- Big baby with breech presentation.
- Pregnancy beyond the expected due date.
- Varicose veins of the genital tract in a pregnant woman.
- Pathologies of uterine development.
- Questionable condition of scars from previous operations on the uterus.
- Spicy and chronic diseases mothers who may have a negative impact on the course of labor or harm the mother in labor ( high degree myopia, arterial hypertension).
- Late birth.
- Previous history of artificial insemination, spontaneous abortion or stillbirth.
- Severe swelling.
A planned caesarean section is usually prescribed in the following cases:
- Heavy infectious diseases from the expectant mother.
- The pregnant woman is HIV-infected.
- During prenatal diagnostics, symphysitis was discovered (excessive enlargement of cartilage in the area of the pubic symphysis).
- Shortly before birth, intrauterine fetal hypoxia was established.
Caesarean section: contraindications to surgery
Artificial birth is not performed if:
- the child died in the womb;
- the baby was diagnosed birth defects developments incompatible with life;
- the mother's skin and genitals became infected.
In all of the above situations, during a cesarean section, the risk of developing sepsis and peritonitis due to infection in the blood increases sharply.
How many weeks is a caesarean section performed?
A planned caesarean section is prescribed during pregnancy, and only a doctor can determine the final date of the operation. The optimal time to start the procedure is the first contractions. In order not to miss an important moment, the expectant mother goes to the maternity hospital 1 - 2 weeks before the birth date.
A planned caesarean section is prescribed no earlier than 37 weeks of pregnancy. In what week a cesarean section is performed depends on the decision of the specialists. When choosing a day for surgery, the doctor always focuses on the expected date of birth of the baby. To prevent the development of intrauterine hypoxia, cesarean section is performed at 38–39 weeks.
If the first pregnancy ended in surgical delivery, the second child will also be born via cesarean section. A repeat operation, as with the first birth, is prescribed for a period of 38 to 39 weeks, however, if the doctor is confused by the condition of the suture from the first cesarean section, the woman in labor will be operated on ahead of schedule PDR.
How to do a caesarean section: the preparatory stage
The doctor will definitely inform the woman in labor about necessary measures preparation for surgery. 12 hours before the procedure you need to refrain from eating and 5 hours from drinking. An enema is given immediately before a cesarean section. There is little pleasant, but the risk of contracting an infection during childbirth is practically absent, and rehabilitation process will go faster.
During the operation, the integrity of the abdominal muscles is disrupted by a large incision. At first after artificial childbirth, even the slightest tension in the abdomen will cause noticeable discomfort, despite drug pain relief. And an enema done before the operation will relieve the young mother from the agony of trying to go to the toilet “in a big way” in the first days after a cesarean section, since the intestines will be relatively empty.
If it matters expectant mother will warn you about the need to epilate your pubis.
How to do a caesarean section: procedure sequence
The operation is carried out in several stages and is certainly accompanied by anesthesia. The woman in labor will be offered three options for pain relief: epidural, spinal anesthesia or general anesthesia. We'll talk more about them a little later.
Once the painkillers have taken effect, the doctor will make an incision in the pregnant woman's abdomen. Most often, this manipulation is carried out using the Pfannestiel method - the incision runs along the pubic hair growth line. In emergency cases, when every second counts, an infero-median incision is performed - from the navel along the midline down to the pubis. During elective surgery The uterus is cut, like the abdomen, horizontally. A vertical incision is performed in case of multiple pregnancy or pathological attachment of the placenta.
Through an incision, the doctor removes the baby from the uterus, separating the placenta. Afterwards, the newborn is placed on the happy mother’s chest or handed over to the father’s hands. Then the baby is sent to the ward of the children's department.
After the baby is removed, oxytocin and methylergometrine are injected into the uterus, which help the hollow muscular organ to contract faster. The operation is completed by suturing the cut tissues with self-absorbing suture material. First, the uterus is sutured, then the peritoneum, muscles, ligaments and skin. The skin is fastened with a regular or intradermal (more accurate and aesthetic) suture.
How long does a caesarean section take? The operation takes approximately 30 – 40 minutes. After its completion, the new mother is sent to the intensive care unit to recover from anesthesia, and then to the postpartum ward. To avoid the development of vein thrombosis, the woman is raised from bed immediately a few hours after the anesthesia has stopped working. Walking – best prevention blockage of blood vessels. It is strictly forbidden to lift anything heavy.
Who performs a caesarean section in the maternity hospital depends on the policy medical institution and on the health status of the mother and her baby. Usually these are 2 obstetricians-gynecologists, 1 anesthesiologist, 1 midwife who receives the child and 1 neonatologist.
Anesthesia for caesarean section
Artificial childbirth is a serious abdominal operation and is performed only with preliminary anesthesia. There are several types of anesthesia that are used to make a woman feel comfortable during surgery.
Epidural anesthesia for caesarean section
To deprive the mother of sensitivity using this method, an injection is made under the spine in the area lumbar region– where the spinal nerves are located. A catheter is left at the puncture site, through which an anesthetic is periodically injected during the operation.
The main advantage of epidural anesthesia is that the woman in labor does not fall asleep and is perfectly aware of everything that is happening to her, but does not feel the lower part of her body. The woman is immobilized below the waist and will not suffer from severe pain when doctors make cuts to remove the baby.
Among other “advantages” of this type of anesthesia, we note:
- ideal for women who suffer from bronchial asthma;
- does not distort the work of cardio-vascular system, since the painkiller is supplied to the body in doses;
- Thanks to this injection, the administration of opioid anesthetics after surgery is allowed.
Despite the obvious advantages of the procedure, epidural anesthesia for caesarean section has certain disadvantages and consequences.
This type of anesthesia is not suitable for:
- blood clotting disorders;
- infections;
- allergies to painkillers;
- transverse presentation of the child;
- uterine scar;
- the presence of inflamed or purulent areas in the puncture area;
- curvature of the spine.
We also list the disadvantages of the method. There are women for whom they are of decisive importance:
- the likelihood of the anesthetic drug getting into the choroid or arachnoid membrane of the spinal cord, as a result of which the woman in labor develops convulsions and the pressure drops sharply;
- high degree of complexity of the procedure;
- anesthesia gains strength only 15 - 20 minutes after the injection;
- sometimes anesthesia is only partially effective, so the woman in labor is forced to experience obvious discomfort during the operation;
- the likelihood of pain medication getting into the placenta, which causes a violation heart rate and baby's breathing.
If anesthesia in the form of epidural anesthesia is performed during a caesarean section, the pregnant woman must be warned about the consequences of such a step: back pain and headaches, tremors lower limbs, problems with urination.
Spinal anesthesia for caesarean section
This type of anesthesia is in many ways similar to the previous technique. The injection is carried out in the back, but in this case a very thin needle is inserted even deeper, directly into the spinal lining. The injection is made strictly in a certain place (between 2 and 3 or 3 or 4 vertebrae) so as not to damage spinal cord. For spinal anesthesia during cesarean section, a smaller volume of anesthetic is required than in the previous version.
Advantages of spinal anesthesia:
- complete loss of sensitivity;
- rapid onset of effect – a few minutes after the anesthetic enters the body;
- low likelihood of complications due to the precise location of drug administration;
- absence of unexpected reactions in case of incorrect injection.
Disadvantages of spinal anesthesia:
- short duration - the injection lasts no more than 2 hours;
- probability of reduction blood pressure if the anesthetic is administered too quickly;
- the risk of developing headaches, which persist on average up to 3 days after surgery.
Doctors are forced to refuse to perform surgery under spinal anesthesia if a pregnant woman has contraindications to such anesthesia:
- rash or pustular formations at the site of the intended injection;
- circulatory and blood clotting disorders;
- blood poisoning;
- neurological diseases;
- pathologies of spinal development.
General anesthesia for caesarean section
Today, general anesthesia for artificial childbirth is used less and less often, since of all types of anesthesia it has the most negative effect on the mother and child. The procedure involves intravenous administration an anesthetic that makes the pregnant woman fall asleep within a few seconds. A tube is then inserted into the woman's trachea to artificially supply oxygen.
General anesthesia for caesarean section is performed in the following cases:
- obesity, previous spinal surgery, blood clotting pathologies - other types of anesthesia are not suitable for these diseases;
- fetal presentation, prolapse of the umbilical cord;
- the need for an emergency caesarean section.
Advantages of general anesthesia:
- almost instant loss of sensitivity.
- no interruptions in the functioning of the cardiovascular system;
- no difficulties in administering anesthesia.
Disadvantages of general anesthesia:
- probability of penetration gastric juice into the lungs with subsequent development of pneumonia;
- the likelihood of a harmful effect of the anesthetic on the central nervous system of the newborn;
- the risk of developing hypoxia in a woman in labor.
The best anesthesia for caesarean section is the one chosen by an experienced specialist. Only a doctor can take into account the advantages and disadvantages of each type of anesthesia and correlate them with the well-being and condition of a particular woman in labor. In this matter you need to trust exclusively professionals.
Possible complications after cesarean section
During the birth of a child, a woman experiences an enormous burden and is subjected to extreme stress, regardless of whether the birth is natural or artificial. The surgical intervention is not very long, but may result in some complications for the woman in labor, including:
- bleeding;
- inflammation of the uterus;
- thromboembolism;
- adhesions;
- hernia in the scar area;
- damage to certain organs during cesarean section (for example, the bladder).
Not only the woman, but also the newborn child may face unpleasant complications due to the operation:
- the risk of being born prematurely if a planned caesarean section is scheduled for an earlier date than the PDR. In this regard, it will be difficult for the baby to adapt to the outside world. In addition, practice shows that “Caesarean babies” get sick more often than children born independently;
- anesthesia, even the weakest, also affects the baby. In the first hours of life, the newborn is sleepy and inactive. There is a risk of developing pneumonia due to anesthesia;
- After a caesarean section, mother and child are not together for some time. This may subsequently affect breastfeeding not in the best way.
Rehabilitation period after cesarean section
It will take several months after the operation before the woman fully recovers and feels well. During this period, it is important to treat your health with great attention.
- On the first day after cesarean section, you are only allowed to drink. The choice is limited to still water at room temperature. The next day you can eat yogurt, porridge, sweet tea and lean meat. Light diet should be observed for about a week after surgery.
- After surgery, the stitch hurts a lot for some time, so the woman is prescribed painkillers. As you recover discomfort weakening every day.
- For 2 - 3 weeks after Caesarean woman will have to be strictly observed intimate hygiene, because at this time she will still be disturbed bloody issues. Then they will completely disappear.
- About 2 weeks after the birth of the baby, you need to regularly treat the suture on the abdomen to prevent it from becoming infected and rotting. At the same time, the state of health is overshadowed by strong cutting pains in the area of the incision. The tissue at the site of stitching first turns red, and later, when the scarring process begins, turns purple. In the future, the color of the scar will almost merge in color with the skin. The incision on the uterus will heal within six months.
- 2 months after the operation, the woman is recommended to gradually get involved in sports. Intensive training is allowed only after 6 months. Sex life It is best to resume 1 month after birth.
IN Lately More and more expectant mothers are thinking about the possibility of giving birth to a baby through a caesarean section. Perhaps women are afraid of the pain during natural childbirth. However, the risk of complications is present both during independent and operative childbirth. Before you finally decide on how to little man comes into this world, you need to carefully listen to the arguments of your attending physician about the “pros” and “cons” of a cesarean section.
How to do a caesarean section. Video
Caesarean section is considered a surgical intervention with low development potential postoperative consequences. As a rule, the trigger for complications after a cesarean section is the reason that forced one to resort to this type of delivery. For example, premature placental abruption prompts the doctor to perform emergency surgery. At the same time, the problems arising in postoperative period, primarily arise due to early placental abruption. Most often, the urgency of the situation does not allow for spinal anesthesia (the complexity of the procedures), so general anesthesia is usually performed, during which the incidence of complications is much higher.
Read in this article
Risk factors
If a cesarean section is performed, complications after the operation can be caused by a number of factors:
- obesity;
- large fruit size;
- complications that led to the need for surgery;
- prolonged labor or surgery;
- history of several births;
- allergies to latex, anesthetics and other drugs;
- limited physical activity mothers during pregnancy;
- low blood cell count in a woman;
- use of epidural anesthesia;
- premature birth.
What complications are most common?
The following complications may occur during surgery or in the postoperative period:
- infectious;
- excessive blood loss;
- damage to internal organs;
- the need for a hysterectomy (removal of the uterus);
- blood clot formation;
- reaction to drugs;
- neurological problems (consequences of anesthesia during caesarean section);
- tissue scarring and possible problem with subsequent births;
- death of mother;
- traumatization of the child.
Fortunately, serious complications from a caesarean section are rare. Although maternal mortality with this operation is higher than in women with natural birth. Since the reasons for which this surgical intervention is performed are quite often potentially life-threatening to the mother.
Infectious complications
The operation itself, as a result of which the abdominal wall and membranes of the uterus are dissected, causes bacteria (usually non-pathogenic from the vagina) to enter the wound surface. This can lead to the development of various infectious complications in the postoperative period.
Postoperative wound suppuration
Sometimes bacteria multiply not in the uterus, but in the abdominal wall. Infectious inflammation of the skin and underlying tissues to which it is applied can lead to the formation of abscesses and purulent leaks, which will require reoperation. But, as a rule, these complications are recognized on initial stages when treatment with antibiotics is possible.
Fever, pain and redness in the area of the postoperative wound are the symptoms that most often occur with this problem.
Puerperal fever and sepsis
According to some reports, 8% of women in the postoperative period may develop so-called childbed fever or postpartum fever. Usually the complication begins with inflammation of the uterus or vagina, then bacterial infection spreads throughout the body, affecting the lungs (occurs after cesarean section) and other organs.
When microbes are detected in the blood, the process is called sepsis. This is a pathology that requires long-term antibacterial treatment, and is considered the most dangerous complication, sometimes leading to fatal outcome. Fever during the first 10 days after is a sign of childbed fever. Timely initiation of treatment can prevent further development this serious complication.
Bleeding
During natural delivery, the average blood loss does not exceed 500 milliliters; during a cesarean section, it can reach 1 liter. In most cases, such blood loss is tolerated by women who do not have concomitant pathologies without any difficulties. However, serious bleeding can sometimes occur and may occur during or after surgery.
Postoperative bleeding
Blood loss of up to 1 liter during a cesarean section can be considered normal. Bleeding may also occur after surgery and is usually due to clotting problems. This is an urgent situation, so if a woman notices leakage from the wound, she should immediately contact her doctor.
After stopping the bleeding, it is usually necessary recovery period within a few weeks. Sometimes blood and blood substitutes are given intravenously, iron supplements and vitamins are prescribed.
Atony
After the baby and placenta are delivered, the uterus usually contracts, causing gaping blood vessels to close. When this does not happen (a condition called uterine atony), prolonged bleeding is possible. Fortunately, doctors have very effective drugs that help combat this problem. Most of them contain prostaglandins. Today, delayed complications associated with uterine atony are extremely rare.
Ruptures, damage to internal organs
There are times when the incision is not large enough to remove the baby without tearing the uterine tissue. To the right and left of it are major arteries and veins, which in this situation can become damaged and bleed. As a rule, the operating surgeon notices this in time, preventing the woman from losing a lot of blood. Sometimes he can damage nearby organs with a scalpel. Injury Bladder leads to serious bleeding and, as a rule, requires stitches to be placed on its wall.
Dense attachment and placenta accreta
When a tiny embryo moves into the uterus, cells called trophoblasts accumulate on its wall (these form the placental villi). They penetrate the wall of the uterus in search of blood vessels. These cells are playing important role in the movement of oxygen and nutrients from mother to fetus. The fibrous layer of the uterus prevents the deep penetration of placental villi into its wall. If this layer has previously been damaged (for example, any operation on the uterus), then a condition called placenta accreta may develop, and sometimes even penetration of trophoblasts into the bladder occurs.
The danger with this problem is that serious bleeding may occur. The good news: doctors today have learned to promptly recognize this formidable complication and quickly take appropriate measures. The bad news is that the problem almost always requires a hysterectomy.
Hysterectomy
Removal of the uterus is sometimes performed immediately after a cesarean section. Some complications (usually related to bleeding) force the surgeon to perform this operation to save the mother's life. Women who have had a hysterectomy can no longer have children. Apart from this terrible situation, as a rule, this operation does not have any additional problems.
Blood clots or vascular thrombosis
One of the most dangerous complications after a caesarean section - the formation of blood clots in the vessels of the legs or pelvic area. Thrombosis of the veins can lead to a blood clot breaking off and moving to the lungs, the appearance of a so-called embolism pulmonary artery. A complication that is the leading cause of death in the postoperative period. Fortunately, the appearance of blood clots in the legs is also accompanied by pain in them, which forces a woman to consult a doctor with these symptoms. Timely administration of appropriate treatment (eg, Coumadin or warfarin) is effective in preventing the development of pulmonary embolism.
Reactions to drugs, latex, anesthesia
In addition to the risks associated directly with the operation itself, there are complications that a woman may experience when using drugs, latex or anesthesia. Adverse drug reactions can range from mild symptoms (eg, headache or dry mouth) to very serious (such as death from anaphylactic shock). The high incidence of these problems during cesarean section is explained by the urgency of the situation: there is not enough time to conduct allergy tests and evaluate possible reaction during drug interactions.
In the case of planned surgery, they also occur, but much less frequently, and practically no serious reactions are observed. Sometimes the mother does not know that she has an allergy to medications, adverse reactions related to anesthesia. These include:
- severe headache;
- visual impairment;
- vomiting or nausea;
- pain in the stomach or legs;
- fever;
- swelling of the throat;
- severe weakness;
- pale skin;
- the appearance of a rash or swelling on the skin;
- or fainting;
- labored breathing;
- weak and rapid pulse.
Most side effects disappear after discontinuation of the drug. Possible serious allergic reactions, but, as a rule, they are effectively dealt with using drug therapy. Women who have serious adverse drug reactions need immediate medical attention.
Complications and long-term consequences of anesthesia
General anesthesia for elective surgery is rarely used; as a rule, it is used for emergency situation. Regional anesthesia is divided into spinal and epidural, which numb the lower half of the body. The main difference between these types of anesthesia is where the anesthetic is injected: into the epidural or subdural space.
Complications after spinal anesthesia for caesarean section:
Complications in subsequent pregnancies
After a cesarean section, a woman may have problems with subsequent pregnancy due to the formation of scar tissue along the excision. Sometimes situations arise where the wall of the uterus and the bladder become fused, which leads to its damage during subsequent operations on the uterus. Also, women after cesarean section are more likely to experience labor weakness during natural delivery.
Risks from the child
Not only women can experience complications after a cesarean section. There are some risks associated with the fetus with this surgery. The following problems may be identified in a child:
| Problem | Why does it occur |
| Premature birth | If the gestational age was calculated incorrectly, then the baby born may be premature. |
| Breathing problems | Some studies suggest that these children have an increased risk of developing asthma in adulthood. |
| Low Apgar scores | This is the result of anesthesia, fetal distress before birth, or lack of stimulation during labor that is present as the fetus passes through the vaginal birth canal. |
| Traumatization with a surgical instrument | Very rarely skin the child is damaged during surgical intervention(on average, 1 case per 100 operations). |
Caesarean operation like any other major surgery, has complications, sometimes quite severe, life threatening both mother and child. Recovery after surgery takes longer than if delivery had occurred naturally. However, in order to save the life of the mother or child, one has to resort to this operation. The emergence of new drugs and methods for determining the risks associated with this operation has made it possible to maximize the safety of this type of surgical delivery; today it is actively used in obstetric practice.
A cesarean section operation is performed exclusively under anesthesia, since it is an abdominal operation. Pain management for surgery is discussed in advance if the operation is planned. And a woman can choose one or another type of anesthesia, but not always. Sometimes this should only be done by a doctor. In this article we will talk about what choice options exist, how they differ, what are their advantages and disadvantages, and also describe situations in which a woman cannot make an independent choice.
What is taken into account when choosing?
The operation includes dissection of the anterior abdominal wall, uterus, removal of the child and manual release placenta, after which they first place internal sutures on the uterus, and then external ones on the incision in the peritoneum. The surgical intervention lasts from 20 minutes to an hour (in particularly severe and difficult cases), and therefore Such an operation cannot be performed under local superficial anesthesia.
Today, when performing a caesarean section, two types of anesthesia are used - epidural (and as a variation - spinal or spinal) and general anesthesia. During an emergency caesarean section, which is performed to save the life of the child and mother, if natural childbirth something went wrong, general anesthesia is usually the default. The question of choosing a method of pain relief for caesarean section is usually decided in advance only when the operation is planned in advance.
In this case, doctors evaluate a lot of factors. First of all, the condition of the pregnant woman and the fetus, possible impact medications used for pain relief on the child and mother. It is necessary to take into account certain contraindications and indications for different types anesthesia. Regional (epidural) anesthesia has contraindications, while there are no contraindications for general anesthesia.
Epidural anesthesia
In this way, up to 95% of all caesarean sections in Russia are anesthetized today. maternity hospitals. The essence of the method is that the introduction medicinal product, which leads to loss of pain sensitivity in the lower part of the body, is done through a thin catheter inserted into the epidural space of the spine.
As a result of this introduction, transmission is blocked nerve impulses into the brain through the spinal canal. When such a “gap” appears in the central nervous system chain, the brain simply does not perceive and associate the ongoing violation of tissue integrity during surgery as a reason for activating the pain center.
The scope of application of such anesthesia is quite wide, but during natural childbirth to relieve pain and during caesarean section, such anesthesia is considered less dangerous than with anesthesia cervical spine spine or arms for operations on the upper body.
As a rule, anesthesiologists administer special, carefully purified solutions that are initially intended exclusively for this use. To relieve pain during natural childbirth, lidocaine and ropivacaine can be administered. But such anesthesia will not be enough to perform a caesarean section. A certain amount of opiates, such as promedol, morphine or buprenorphine, may be administered simultaneously with lidocaine. Ketamine is often used.
The dosage of substances is determined by the anesthesiologist taking into account the health status, weight and age of the woman, but spinal anesthesia of opiates always requires less than with intravenous anesthesia, and the effect can be achieved longer.
How do they do it?
The woman lies on her side with her back bare, her legs slightly tucked and her shoulders brought forward. Anesthesiologist one of existing methods determines where exactly the catheter needs to be inserted. To do this, they usually use a syringe filled with air that is connected to a catheter. If the piston encounters significant resistance, then the catheter is in the ligamentous space. If resistance is unexpectedly lost, we can talk about the correct detection of the epidural space, where the drugs will be slowly injected.
The introduction is gradual. This means that the doctor administers a test dose first. After three minutes, the condition is assessed, and if the first signs of anesthesia and loss of sensitivity appear, the remaining parts of the dosage prescribed for a particular woman are administered in several stages.
A woman can first ask the anesthesiologist, who will definitely meet with her a day before the operation, about the name of the drugs that are planned to be administered. But it is better not to ask about the dosage, since its calculation is extremely complex and is based on numerous factors.
The operation begins after it occurs complete blockade lower body. A screen is placed in front of the woman’s face so that she does not see the surgeons’ manipulations. Throughout the operation, the mother in labor can communicate with doctors, see main point- the first breath and the first cry of your baby.
After this, the doctors will begin to apply stitches, and the baby may well be left next to the mother for a few minutes so that she can admire the long-awaited baby to her heart's content.
Advantages and disadvantages
Complications after such anesthesia are possible, but in practice they occur only in 1 case out of 50 thousand births. What unexpected and negative manifestations? It happens that the blockade of nerve endings does not occur, sensitivity is preserved, and this, according to statistics, happens in one woman out of 50 operations. In this case, the anesthesiologist urgently makes a decision on general anesthesia.
If a woman has problems with blood clotting, a hematoma may develop at the site of insertion of the catheter. When inserting a needle, the anesthesiologist may accidentally puncture the dura mater of the spinal cord, which can lead to leakage of cerebrospinal fluid and subsequent problems with severe headaches.
Inaccurate movements of an inexperienced doctor can lead to injury to the subarachnoid space, as well as to the development of paralysis. Opponents of general anesthesia say that with epidural anesthesia, the injected drugs do not have any effect on the child, in contrast to the total drug-induced sleep into which a woman in labor is immersed under general anesthesia. This is wrong. Medicines that are administered to block pain can cause a decrease in the baby’s heart rate, as well as a state of hypoxia or breathing problems in him after birth.
Many women in labor complain of back pain and numbness in their legs for quite a long time after surgery. It is officially believed that the recovery time from spinal anesthesia is about 2 hours. In practice, the output takes longer.
The advantages of epidural pain relief include the stability of the woman’s heart and blood vessels throughout the operation. A significant disadvantage is that not all nerve receptors are blocked. The woman will not feel pain directly, but she will still have to endure unpleasant sensations from time to time.
Many women are wary of such anesthesia, since it is not even the complications that scare them, but the very need to be present at their own operation - psychologically this is quite difficult.
Often women consider epidural anesthesia and spinal anesthesia to be the same type. In fact, there is no difference for the patient; in both cases, the drug is injected into the back. But with the spinal injection, the injection is deeper, and therefore the sensitivity is reduced more effectively.
If the question is fundamental, specify where the doctor plans to administer anesthesia - in the epidural space of the spine or in the subarachnoid space. Otherwise, everything will proceed exactly the same.
General anesthesia
Previously it was the only kind pain relief for caesarean section. Nowadays, general anesthesia is used less and less often. This is officially explained by the fact that general anesthesia harms the child and the woman. It is unofficially known that the cost of drugs for spinal or epidural anesthesia is lower, and therefore the Ministry of Health in Russia strongly recommends that anesthesiologists do their best to convince women to choose regional anesthesia. This question is complex and ambiguous.
General anesthesia for CS surgery is usually endotracheal. With it, the woman does not feel, hear or see anything; she sleeps peacefully throughout the entire surgical intervention, without worrying herself, and without bothering the doctors who are helping her baby to be born with questions.
How do they do it?
Preparation for such anesthesia begins in advance. In the evening, on the eve of the day for which the operation is scheduled, premedication measures are taken - the woman needs to relax, get a good night's sleep, and therefore she is prescribed a dose of barbiturates or other serious sedatives before going to bed.
The next day, in the operating room, the woman is given a dose of atropine to prevent cardiac arrest while in medicated sleep. Analgesics are administered intravenously. At this stage, the woman, not having time to be frightened by what is happening, falls asleep.
When she is already asleep, a special tube will be inserted into her trachea. Intubation is necessary to ensure pulmonary respiration. The tube will supply oxygen mixed with nitrogen and sometimes narcotic vapors into the lungs throughout the entire operation.
The sleep will be deep, the anesthesiologist will monitor the condition of the woman in labor throughout the entire intervention, measure blood pressure, pulse, and other indicators. If necessary, the doses of administered support drugs will be increased or decreased.
Shortly before the end of the operation, at the surgeon’s command, the anesthesiologist begins to reduce the doses of muscle relaxants, anesthetics, and narcotic substances. When the doses are “reset”, the process of smooth awakening begins. At this stage, the tube is removed from the trachea, since it is possible to breathe independently, without a device artificial ventilation lungs, is one of the first to return.
Advantages and disadvantages
Psychologically, general anesthesia is much more comfortable than regional anesthesia. The woman does not see what is happening and does not hear the doctors’ conversations, which can sometimes plunge anyone into shock, and even more so about a patient lying on the operating table. The woman recovers from the state of relaxation and lethargy quite easily, but finally recovers from anesthesia only 3-4 days later. The final solution is considered to be the complete cessation of the effect of anesthesia at all levels of physiological and biochemical processes in the body.
Great advantage - complete absence contraindications, that is, this method is used for everyone who requires surgical intervention, without regard to possible negatively influencing factors. The quality of pain relief is excellent.
The woman will not feel any sensations - neither pleasant nor painful. TO possible complications Endotracheal anesthesia may include possible injuries to the larynx, tongue, teeth (at the time of insertion and removal of the tube), laryngospasm, and the development of an individual allergic reaction. Quite often, after such anesthesia, women have a sore throat for several days and a dry cough (which is especially painful with fresh stitches on the stomach!).
If a woman decides to choose general anesthesia, she should understand that she will not meet the child right away. She will be able to see the baby only in a few hours, when she is out of the ward intensive care, where all operated women in labor are placed, will be transferred to the postpartum room.
However, in some situations this issue is resolved on the spot - the woman can ask the operating team to show her the baby immediately after she comes to her senses. True, no one can guarantee whether the new mother herself will remember this moment or not.
When is the issue decided only by the doctor?
If a woman undergoing a planned caesarean section is determined to certain type anesthesia, she can report this to her attending physician, who will certainly pass on the information to the anesthesiologist. The woman signs an informed consent stating that she agrees to epidural anesthesia or writes a refusal of regional anesthesia.
A pregnant woman should not indicate the reasons why a decision was made in favor of general anesthesia. She may not justify her decision at all, even in a conversation with a doctor.
According to the law, if a woman in labor refuses epidural or spinal anesthesia in writing, she will automatically be treated with general anesthesia. There can be no second solution here. But the opposite situation, when a woman would like to be conscious during the operation, can turn out differently.
Epidural anesthesia has its contraindications. And no matter how a woman begs the doctor to make an angle in her back before surgery, the request will be denied if:
- there have been previous injuries or deformities of the spine;
- there are signs of inflammation in the area where the needle is supposed to be inserted;
- the woman in labor has low and low blood pressure;
- the woman has started bleeding or is suspected of starting bleeding;
- there is a state of fetal hypoxia.
For women with such features, general anesthesia is considered the best.
They will not ask the patient’s opinion about the preferred type of anesthesia even if there is prolapse of the umbilical cord loops, if the woman has a systemic infection, if it is necessary to remove the uterus after removing the baby (according to indications). Such women in labor also undergo only general anesthesia. Other options are not even considered.
Anesthesia for caesarean section is carried out in several ways, the choice of which depends on the decision of the doctors. The method of such delivery itself exists long time. Its implementation is not complete without pain relief. Let's consider everything possible methods, we list their features, contraindications and complications.
What anesthesia is best for caesarean section?
Doctors do not give a clear answer. The choice of method is entirely determined by the woman’s condition, time, and the presence of aggravating factors. When deciding which anesthesia to choose for a caesarean section, doctors tend to use regional anesthesia. With this manipulation, the process of impulse transmission along the nerve fibers slightly above the place where the substance is injected. The patient remains conscious, which facilitates the process of manipulation, eliminates the need for recovery from anesthesia, and reduces complications. This is also a plus for the mother herself, who almost immediately establishes contact with the baby and hears his cry.
Types of anesthesia for caesarean section
When answering women’s questions about what kind of anesthesia is given during a caesarean section, doctors name the following possible types:
- general, known as “anesthesia”;
- regional - spinal and
First anesthesia for caesarean section is used in exceptional situations when there are contraindications to regional anesthesia. It is used in the presence of specific obstetric cases, including transverse position of the fetus and prolapse of the umbilical cord. In addition, pregnancy itself is often associated with conditions when the process of tracheal intubation and insertion of a tube for anesthesia is difficult. With this manipulation, there is a possibility of gastric contents entering the bronchi, which causes respiratory failure, pneumonia.
How is a caesarean section performed with epidural anesthesia?
This technique is common and effective. Lies in the introduction medicine to the region of the spinal cord. The manipulation begins half an hour before the scheduled time of delivery itself. This immediate interval is necessary for the medicine to work. The injection area is treated generously antiseptic solution, the injection site is marked.
With this type of anesthesia for caesarean section at the lumbar level, the doctor pierces the skin with a special, sterile needle. Then, gradually going deeper, they reach the space above the spine, in which they are located nerve roots. After this, a special tube is inserted into the needle - a catheter, which will serve as a pipeline for medications. The needle is removed, leaving a tube, which is extended, attached to a larger length, brought to the shoulder girdle, where it is secured. The drug is administered gradually, the dosage is increased if necessary. Provides easy access to the catheter.
The procedure for using the medication itself is performed in a standing or lateral position. The manipulation is practically painless. Some women may experience slight discomfort, which is characterized as a feeling of pressure in the lumbar region. When the medicine is administered directly, the patient does not feel anything. The procedure is highly effective.
As a result, sensitivity is completely turned off, but the consciousness of the woman in labor is not turned off - she hears her newborn, his first cry. Talking about how long a caesarean section lasts with epidural anesthesia, doctors note that, depending on the dosage, the removal of sensitivity is recorded within 80-120 minutes. This time is quite enough for the operation.
Contraindications to epidural anesthesia for caesarean section
This method has positive traits, but there are also contraindications. It is prohibited when:
- inflammation of the area where it is necessary to puncture - pustules, papules;
- blood clotting disorders;
- individual intolerance to drugs;
- diseases of the spine, osteochondrosis;
- transverse or oblique position of the fetus.
Talking about the dangers of epidural anesthesia during a caesarean section, doctors note that such manipulation requires experience and clarity. Damage to blood vessels and nerve endings causes irreversible consequences. Considering these facts, the manipulation is carried out exclusively in large clinics where qualified personnel, specialists, are present. equipment.
Consequences of epidural anesthesia for caesarean section
Since surgery with this type of anesthesia requires large dosages of medication, side effects are noted frequently. Among these it is worth noting:
- pain in the back area;
- headache;
- tremors in the legs.
These phenomena disappear on their own after 3-5 hours. They are associated with the effects on the body of the medications used for the procedure. Complications after epidural anesthesia for caesarean section are rarely recorded. These include:
- disturbance of the urination process;
- injury to the membranes of the spinal cord and a nearby nerve;
- allergic reactions to active ingredient medicines.
How is spinal anesthesia given for caesarean section?
With this type of nerve blockade, medication is injected directly into the fluid that surrounds the spinal cord. After the injection, the needle is removed. The woman is asked to sit on the couch or operating table in such a way that her hands rest on her knees and her back is arched as much as possible. The insertion site is treated with an antiseptic, an injection is given after which the subcutaneous tissue loses sensitivity and the procedure becomes less painful. A long and thin needle is used to puncture. It is entered directly into cerebrospinal fluid. After removing the needle, apply a sterile dressing.
Women who are about to undergo surgery are often interested in the question of how long a caesarean section lasts under spinal anesthesia. The duration of the process of such delivery is due to the professionalism of the doctors and the absence of complications during the procedure. On average, this manipulation requires 2 hours from the moment of application of the product and injection into the lumbar region. This is how much the anesthetic dosage is calculated.
Contraindications to spinal anesthesia for caesarean section
Caesarean section with spinal anesthesia is not performed if:
- lack of qualified medical personnel;
- large blood loss;
- severe dehydration of the body;
- disorders of the blood coagulation system;
- infections, inflammation at the injection site;
- allergies;
- high intracranial pressure;
- dysfunction of the central nervous system;
- when using anticoagulants before surgery.
Consequences of spinal anesthesia for caesarean section
This type of desensitization has some consequences. The following complications often develop after spinal anesthesia during cesarean section:
- a sharp drop in pressure;
- headache;
- disruption nervous system;
- pain in the lumbar region;
- damage to the spinal nerves;
- violation of the integrity of blood vessels.
General anesthesia for caesarean section
This type of anesthesia for caesarean section is the oldest type. It is rarely used in modern obstetrics. Conditioned this fact lack of ability to control the state of the woman in labor, as she falls into deep sleep and does not feel anything. in the absence of the necessary equipment and specialists. It is carried out by intravenous infusion of the drug. The duration of its action depends on the type of medication and its dosage and ranges from 10-70 minutes.
When asking a doctor what kind of anesthesia is best for a caesarean section, a pregnant woman often hears about positive features regional. At the same time, the doctors themselves point out that not all maternity hospitals practice it. Large, modern, private clinics always use this technique. This way, it is possible to reduce the risks and consequences of general anesthesia and eliminate the effect of drugs on the fetus.
Local anesthesia for caesarean section
When talking about what kind of anesthesia is used for caesarean section, it is worth noting local anesthesia. They resort to it when it is necessary to reduce sensitivity, relieve pain during puncture and injection of medication into the spinal region. In this case, a small dosage of the drug is used. An intradermal injection is given. After this, the woman practically does not feel the needle entering.