PDA (peridural, epidural) – treatment, effects & risks

PDA (peridural, epidural)

PDA is a method that supports women in the birth of a child by relieving them of some of the pain in childbirth. It is carried out only in hospitals under the supervision of doctors. First used around 1880, today almost half of all women are assisted with a PDA during a vaginal birth. Despite this frequency, PDA is still controversial among professionals.

What is a PDA (peridural anesthesia)?

The word is derived from Latin (durus – area of hard skins around the soft marrow) and ancient Greek (peri – alongside, anaisthesis – no longer perceptible) and therefore means an anesthesia of nerves without affecting the central nervous system, i.e. the brain. The pain-conducting sensory nerves in the spinal cord area are anesthetized or desensitized for the purpose of pain relief. As with any type of anesthesia, the PDA must be performed by a specialist and, despite its many advantages for the woman giving birth, is not without risks. In particular, the possible effects on the health of the expectant child must be taken into account.

When is the PDA applied?

Through an access placed into the spinal cord in the form of a tube, the woman is administered an anesthetic, the dosage of which depends on the degree of pain and the desired duration of anesthesia. These are drugs that reduce the sensation of pain, but it is important that they are a well-considered combination of substances for numbing motor (responsible for movement) and sensory (sensational) nerve pathways. In addition to an anesthetic, the expectant mother is also given circulatory strengthening drugs.

The woman should experience strong pain relief within a short time, which, in addition to the desired effect, also manifests itself in numbness in the legs and other areas of the abdomen. This sometimes results, depending on the combination of painkillers, a possible motor inability that no longer allows the woman to move. For this reason, opiate painkillers have recently been increasingly used, which are less of a hindrance to motor skills and more aimed at relaxation and a sense of indifference.

Discuss PDA before birth

The woman giving birth must be aware that she must make the decision for or against PDA in advance, i.e. before the pain of labor gets out of hand. This is difficult because it has to happen at a time when the pain of birth has not yet reached its maximum. As an approximate rule of thumb, the PDA can only be used if the cervix must not be open more than 6 cm. If it is already further open, the contractions are already too strong for an effective PDA.

It is absolutely necessary to discuss the possibility of a PDA as part of the birth preparation with a midwife or a gynecologist of trust and to clarify all necessary steps. As with any type of anesthesia, whether local or cerebral, there are risks and side effects that the pregnant woman needs to be educated about. With her signature, the pregnant woman then gives her consent to the use of the PDA.

Furthermore, the expectant mother should be aware that she can no longer fully contribute to the birth under PDA. Their circulation can be destabilized, which may lead to a lack of oxygen supply to the child. In addition, a PDA can lead to a loss of bladder control (catheter placement is often necessary to empty the bladder) and sensation in the legs and lower body.

How does a PDA birth work?

During the birth process, the opening of the cervix of the uterus is continuously checked. During a normal birth, this must open so that the baby’s head fits through – only then do the contractions begin and the child is pressed outside.

The PDA is inserted when the opening of the cervix is a few centimeters. The specialist for anaesthesia (anaesthetist) performs this by first anesthetizing the lower back of the woman in the spine area. As a result, the woman giving birth does not or hardly feels the subsequent placement of an access in the lower lumbar region. Through a thin tube into the spinal cord, the woman is now administered an anesthetic, the dosage of which depends on the degree of pain and the desired duration of the anesthesia.

If the desired effect is not noticeable or not strong enough, the doctor decides whether further or stronger administration of active ingredients is necessary.

Coverage of costs by health insurance

The epidural is one of the normal anesthetic procedures, which is why the health insurance covers the entire cost of an epidural, which is around 400 euros.

Risks and complications

Unfortunately, the risks for the child to be born are not insignificant. Due to the limitation of the mother in terms of her participation in the birth, more children are born as so-called stargazers (face up) with epidurals, which statistically means that instruments such as forceps or suction cups are needed more often. As a result, the child can be injured in a variety of ways by these instruments.

The frequency of caesarean sections is also increasing, since the mother is often no longer able to actively help with the birth. The woman’s entire hormonal balance, which normally consists of a combination of birth hormones to prepare the body for the birth and stress hormones at birth, is affected or even disturbed during epidurals, which can lead to a longer and more difficult birth overall.

A further negative effect on the child’s health can result if parts of the painkillers, which often contain opiates, enter the child’s circulatory system, since the child has not yet developed the appropriate organ functions to break them down. The supply of oxygen can also be disrupted.

Dorothy Farrar

Hello and welcome to my Health Guide & Encyclopedia! My name is Dorothy Farrar, and I'm the founder and main author of this platform.
My passion for health and wellness started at a young age when I became interested in the connection between the food we eat and the way we feel. This fascination led me to study nutrition and dietetics in college, where I learned about the importance of a balanced diet and the impact of various nutrients on the body.

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