PDA is bad

The PDA from a midwifery perspective: advantages and risks

It has found its way into our delivery rooms since the 1990s: epidural anesthesia, in short PDA called. The PDA is a low-complication option to make labor pain easier or even to switch it off completely. But as with so much in life, there are not only positive aspects - the pain relief definitely has its price.

You will be informed about the actual risk of anesthesia by the anesthetist (anesthetist) who will put the PDA when the time comes. But I can assure you that risks in the sense of permanent damage are really very rare.

Rather, today I want the obstetric "side effects" to dedicate a PDA that the anesthetist does not talk about. His job is to relieve you of the pain and to inform you about the immediate side effects of anesthesia to fear, what effects the epidural has on the course of your labor is irrelevant to him.

What does a PDA "do"?

Put quite simply, it slows down the transmission of pain, i.e. you continue to have contractions, but the information “pain” is no longer passed on to the brain. One is stunned area near the spinal cord.

When does it make sense to use a PDA?

Anesthesiologists usually argue that you can't put an epidural too early. Understandable from her point of view, because the later the PDA is placed and the stronger the contractions, the more restless the woman sits and the more difficult it becomes.

From an obstetrical point of view, however, a PDA only makes sense if the contractions are regular and productive, i.e. when the cervix has already opened and the head is making reference to the pelvis. If you insert a PDA too early, it is not uncommon for the child's head to be incorrectly adjusted. That takes pressure from above to slip into the right position and get through the pelvis.

With a PDA, the contractions usually ease, the pressure on the head is reduced and there is more space to rotate and in some cases to turn incorrectly in the pelvis.

What are the obstetric consequences of a PDA?

The main consequence and what we all wish for when a PDA is placed is usually pain relief or even freedom from pain. However, despite the advertised “walking PDA”, there is still a lot to do with most women Feeling in the legs lost, so that walking or standing is mostly difficult.

Often she has to bladder be emptied with the help of a small tube (catheter), because this control is also lost. That doesn't hurt, but it always carries a certain risk of germs and thus the risk of cystitis in the puerperium.

A maximally relaxed body usually does not have such good contractions at first either, i.e. the majority of women with PDAs get one Contraction drip. In principle, this is not a drama either, because you no longer notice the contractions and you have no pain even with a contraction drip. However, artificially created contractions can never be controlled as perfectly as your own, and due to the lack of a cocktail of hormones in the mother's blood, some children react more stressed to contractions. Because during labor your body produces its own painkillers, which also reach the child. With the PDA, these substances are no longer needed.

Some women react with you Drop in blood pressure on the anesthesia, for this reason an infusion is always attached when the PDA is placed; this continues for almost the entire duration of the birth Initially, the maternal blood pressure and heart rate are also measured using an EKG.

So you can imagine that you are relatively “attached” with EKG, blood pressure monitor, infusion and CTG. That means, you are even with a well-dosed PDA and full feeling in your legs significantly more limited motor skills.

In rare cases, the maternal drop in blood pressure leads to one Drop in heart rate with the child. If this cannot be brought under control with the help of medication, in the worst case scenario, a caesarean section must be performed immediately and as an emergency. In the case of an emergency caesarean section (not the “normal” unplanned caesarean section, but really only in an emergency situation), no matter what time after the PDA has been inserted, general anesthesia is always performed, since the injection (the high dose of the anesthetic) for a caesarean section takes some time Claims that you don't have in an emergency.

Here you can find out which side effects an epidural can have for childbirth, which reasons speak clearly in favor of epidural anesthesia and what I personally think as a midwife about it: The epidural: My opinion as a midwife

Our texts on health topics are in no way a substitute for a doctor's visit.
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