Epidural or natural childbirth? There must be freedom of choice

Giving birth without pain is possible, provided that no contraindications are found

The perception of pain is very subjective: there are those who endure it easily, and those who are unable to manage it because of anxiety and fear.

This often happens during labor, an experience that inevitably leads to dealing with the pain that accompanies the birth of a child.

However, there are several methods that can relieve it, from relaxation and breathing techniques, to the administration of epidural drugs.

What is epidural

The so-called epidural (or peridural) is a loco-regional anesthesia technique that involves the insertion of a catheter into the epidural space, or in the area between the lining tissue of the vertebrae and the membrane that surrounds the spinal cord, called dura mater.

This type of anesthesia is mainly known for its use during labor, but in reality it is also practiced in other clinical situations, for example for better control of post-operative pain or in combination with other anesthesiological methods in patients at risk (such as the elderly or diabetics).

In the particular case of pregnant women, it is performed at the lumbar level with the aim not to completely anesthetize the pelvis area, but only to reduce the perception of pain caused by uterine contractions.

Once inserted, the catheter can be maintained for some time, thus giving the possibility to dose the drugs depending on the stage of labor and the intensity of pain.

When you can do it

In recent years, even in Italy the current of thought is affirming according to which it must be a right of all pregnant women to be able to choose, with the consent of the doctor and in the absence of contraindications, to alleviate the suffering of childbirth with epidural analgesia.

In this regard, two important US scientific societies, the American Society of Anesthesiologists (ASA) and the American College of Obstetricians and Gynecologists (ACOG), have been arguing for years that “there are no other cases in which it is considered acceptable that an individual should endure severe pain, without treatment, when it is possible to intervene safely under medical supervision. In the absence of a medical contraindication, the mother’s request is therefore in itself a sufficient indication to relieve pain during labor.’

The pain caused by contractions can in fact be very difficult to manage and endure, not allowing the future mother to live this moment with serenity and to actively participate in labor.

At the request of the pregnant woman, obstetrician and gynecologist will then evaluate whether or not it is appropriate to administer analgesics based on the stage of delivery in which you are: usually the epidural is in fact practiced in labor already well underway, or when the contractions are regular, frequent and painful and the dilation of the cervix exceeds 2-3 cm.

However, there are also clinical conditions in the presence of which the gynecologist himself will request this analgesia technique to reduce stress in the pregnant woman: this happens for example in the case of diabetes, hypertension, cardiovascular diseases, severe myopia or long-lasting labors, as in the case of twin births.

When it is contraindicated

To assess whether there are actually contraindications to epidural, in Italy it is required to undergo, possibly in the last month of pregnancy, some blood tests (to evaluate mainly coagulation) and a visit with an anesthesiologist.

The main absolute contraindications, that is, which do not allow in any case to practice this analgesia technique, are an infection in the area where the insertion of the catheter is practiced, the use of anticoagulant drugs or the finding of alterations in coagulation times or platelet count.

In the first case the risk is to spread the infection, while in the second to undergo bleeding.

During the visit, the anesthesiologist may also evaluate on a case-by-case basis other clinical conditions that may influence the choice of whether or not to practice the epidural, such as previous spinal surgery or the presence of scoliosis.