On the
morning on April 7, 1853, a little known innovative physician, Dr. John Snow,
was called to Buckingham Palace to administer Chloroform anesthesia to Queen
Victoria for the birth of her fourth child, Prince Leopold. The Prince was
healthy, and the Queen did not feel the pain of childbirth. That was the
beginning of the end for “natural” childbirth, and the dawn of modern anesthesia
for labor and delivery.
 |
| Buckingham Palace |
Now, 25%
of mothers give birth by Caesarian section, and 75% of the remaining vaginal
births receive either a spinal or epidural anesthetic, so that leaves less than
20% to experience “natural” childbirth. We know now that the designation “natural”
does not mean medically superior. The pain and stress of labor and delivery
raises maternal blood pressure, increases circulating adrenaline, impairs
breathing, and interferes with muscle control and fetal descent, all to the
detriment of both mom and her unborn baby. Pain also leads to expulsive
deliveries that increase the occurrence and severity of pelvic lacerations.
We’ve now
progressed from Chloroform to the use of epidural anesthesia. Small amounts of
local anesthetic placed in the lower back near the spinal nerves set up a
regional block of the bottom half of the body. It’s like two cops stopping all
the highway traffic with a roadblock. Modern epidural anesthesia reduces stress
for mom and baby, which is especially helpful if the baby is medically
compromised. Epidurals are used not just for pain control, but also as an
active tool to manage labor and delivery, and to provide flexible options,
safety, and control that is not possible during “natural” childbirth. Unlike
the early days of epidural anesthesia, modern epidural methods do not slow
labor, have minimal effects on the unborn child, and often help to speed labor
and fetal descent.
But in
medicine, there is always a down side. Epidurals are wonderful, when they work.
Even in the most skilled of hands, epidurals are highly technical, difficult to
place and maintain, sometimes marginally effective, and frequently fail. They
are best placed after the labor is well established, usually at 3 to 5 cm of cervical
dilation. If labor is rapid, there may not be adequate time to place an
epidural. Minor complications include a 1% chance of a migraine-like headache
that may require treatment, and the rare possibility of nerve damage, seizures,
infection, or other life threatening problems. Techniques, drugs, equipment,
and monitoring used during an epidural anesthetic are all geared toward
preventing complications.
Epidurals
are usually an elective choice, but not always. There are labor situations in
which epidurals may be mandatory for the safety of both mom and baby.
Anesthesia for childbirth is unique because the anesthesiologist must treat two
patients at once, each one with very special needs. Epidurals are used by
default, because other methods of pain control have unacceptable effects on mom
or her unborn child. The delicate balance between pain control and safety
during labor and delivery is like a tightrope walk. I wonder if Dr. John Snow
realized what he started on that foggy April morning in London.
Secret Thoughts Book Trailer:
****************************************************************************
H.S.
Clark is a mystery writer, physician, anesthesiologist, and the author of
Secret Thoughts: a Medical Thriller, set in Seattle. His thrillers are
ultimately about the interface of ethics and medicine, and the human struggle
for health and wellness. The technology he writes about is 99% cutting edge
fact mixed with a 1% glimpse into the future. He showcases the abuses of
medicine in order to focus attention on the wonders of medical achievement.
Mostly, he wants the reader to enjoy the journey. You can connect with H.S. at his website at:
www.hsclarkmystery.com
www.hsclarkmystery.com
Secret Thoughts:
a Medical Thriller is available for immediate download from Kindle, and in
paperback from Amazon http://goo.gl/UWLVR
