Different methods of anaesthesia are used for different types of childbirth in Nadezhda. In normal physiological labour, epidural (with insertion of an epidural catheter) or intravenous anaesthesia is used.
Spinal, epidural, combined spinal and epidural anaesthesia, and general intubation anaesthesia may be administered at caesarean section.
Epidural analgesia is considered the “gold standard” for analgesia in normal physiologic labour. The epidural catheter is inserted into the epidural space of the spine (outside the dura mater). This allows for repeated administration of local anaesthetic (anaesthetic) and thus provides analgesia both during labour and in the postnatal period.
Epidural analgesia is preferred and has several advantages because it provides a sufficient level of analgesia without motor blockade – the patient can move normally and participate actively in the birthing process.
The other type of anaesthesia that can be administered in normal physiological labour is intravenous anaesthesia – this is an intravenous infusion of painkillers.
It has several limitations and is used in cases where there are contraindications to the administration of epidural anaesthesia or when the patient refuses it.
For caesarean section, the preferred method of analgesia is spinal anaesthesia. Here, the local anaesthetic is administered in the spinal space – puncturing the dura mater at a specific point on the spine.
In addition to spinal anaesthesia, epidural anaesthesia may be used at Caesarean section, the technique of which does not differ from epidural analgesia in normal labour.
There is another type of analgesia, general intubation anaesthesia. It consists of reversibly suppressing the patient’s consciousness and spontaneous breathing by using intravenous and inhalational anaesthetics and relaxants.
Advantages and disadvantages of different types of anaesthesia
Each of the anaesthetic methods described has its advantages and disadvantages. The advantages of epidural analgesia in normal physiological labour are undeniable. Analgesia is very good and without a motor block – the patient can move and actively participate in the process of childbirth. Epidural analgesia allows repeated administration of local anaesthetic during labour. It is important to note that it marginally affects the duration of labour and the strength of contractions. The patient is conscious, enabling her to be an active participant in the birth process throughout and to make full early contact with the new-born. The action of the anaesthetics is local (no systemic absorption) and poses no risk both to mother and baby.
The main disadvantages of epidural analgesia are related to its more difficult technical performance, which requires it to be administered by a well-trained and experienced anaesthetist. In addition, epidural analgesia poses a minimal risk of uneven distribution of the anaesthetized areas, as well as a minimal risk of infectious complications.
In contrast, intravenous anaesthesia is a non-invasive method, which is its main advantage over all others. However, it has several risks and disadvantages, such as an inadequate level of pain relief, changes in the patient’s consciousness, risk to the baby due to the systemic effect of the administered anaesthetics, with possible crossing of the placental barrier.
Spinal anaesthesia is the best choice for elective Caesarean section. Its advantages are the rapid effect of local anaesthetics (as compared with epidural anaesthesia) and the ease of technique when performed in good operative conditions. It has antithrombotic effect and reduces the risk of pulmonary thromboembolism. An important advantage of spinal anaesthesia is that the patient remains conscious throughout.
The most common complication that may occur with this type of anaesthesia is arterial hypotension – a rapid transient fall in blood pressure. But by following standard recommendations for preoperative preparation and, if necessary, medical stimulation, the incidence of this condition is significantly reduced.
Headache is also a common side effect. It is due to a decrease in intracranial pressure following puncture of the dura mater. If the recommended technique is followed, the incidence of this complication is minimized.
General intubation anaesthesia is used in cases of contraindications to spinal and/or epidural anaesthesia, as well as in the event of extreme emergency. In this type of anaesthesia, the patient is unconscious, and this is an advantage for some women who feel tense and do not want to ‘attend’ the operation. In emergency situations involving risk to the mother or baby, general anaesthesia provides safe control of basic vital functions as well as the possibility of a rapid delivery.
The disadvantages here are related to the risks of intubation as well as the slower recovery of the patient. The intravenous anaesthetics administered in this type of anaesthesia may cross the placental barrier and reach the foetal circulation, posing a risk to the baby. A significant disadvantage of this type of anaesthesia is the inability to have the first contact between the mother and the baby, which is precious for the new-born baby.