Painless Labour

Most of the women who do not receive pain relief during labour, rate the pain as severe. In this era of modern medicine with advanced techniques and availability of skilled practioners, in some countries it is now considered ‘inhuman’ not to relieve the pain of labour. The American College of Obstetricians and Gynaecologists says “Labour results in severe pain for many women. There is no other circumstance where it is considered acceptable for a person to experience untreated severe pain, amenable to safe intervention, while under a physician’s care”.

Just like any major or minor surgery is never done without anaesthesia, it is now ensured, in most parts of the world, that techniques are available for painless delivery. But, it is not a pre-requisite for delivery! It totally depends on your choice and your tolerance level.

What is an Epidural injection?

Epidural is a process where a small injection placed in your lower back, through which a fine, thread sized tube (epidural catheter), is passed into your back bone. Drugs are injected through this tube at regular intervals to relieve your labour pain. These drugs work on the sensory nerves cause numbing of lower body without affecting the motor neurons and hence, ability to move. These drugs are safe for the baby. With an epidural in place, contractions can be felt, but they are painless.

Why have an Epidural for painless labour and delivery?

Till date, among all the options available, epidural is the best method of pain relief in labour. The advantages of epidural are:

• It helps you to actively participate in birthing of your baby by allowing you to rest, relax in between and gives you the strength to bear down. By reducing the discomfort of childbirth, it results in a more positive birth experience.
• If you land up in caesarean section, the same epidural catheter can be used to provide anaesthesia during the procedure.
• An epidural helps you to deal with exhaustion, irritability and fatigue.

Who can have an epidural for painless labour and delivery?

All women in labour who are willing for pain relief, with normal test reports and no contraindication to the procedure, can opt for it. Epidural is not necessary for a normal delivery, but it makes the experience pleasurable.

Who should have an epidural for painless labour and delivery?

Epidural is recommended in some patients to optimize the outcomes.

• If you have a complicated or prolonged labour. Epidural helps your baby and you to have a stress-fee and painless normal delivery.
• If you are trying for vaginal birth after a previous cesarean section
• If you have suffer from medical conditions like heart disease, hypertension & preeclampsia, where bearing the pain may result in adverse outcomes.

Who should not have an epidural for painless labour and delivery?

Epidural is contraindicated if you:

• Have certain bleeding disorders
• Are on blood thinning medications
• Have a history of lower back surgery
• Have certain neurological disorders

Your need to discuss these conditions with your obstetrician and anesthetist.

How is epidural done?

You are asked to curl up on one side or sit bending forwards. Your back is cleaned and sterile draping is done. This is followed by local anaesthetic injection into the skin. A small thread sized tube (epidural catheter) is inserted into your lower back. It is important to stay still while the anesthetist is putting in the epidural catheter, but afterwards you are free to move. Through the catheter a pump gives pain-relieving drugs continuously. The anesthetist keeps checking the proper working of the epidural to ensure a normal painless delivery.

What monitoring will be done for your safety after epidural for painless labour and delivery?

Vital signs like blood pressure and pulse rate are monitored every few minutes for about 15 minutes and then at longer intervals. Your baby’s heart rate is checked intermittently or continuously as in other normal deliveries. Thus ensuring a painless labour and normal delivery

When can I have an epidural for painless labour and delivery?

Whenever your pain is significant and you are in established labour, you can ask for an epidural. It can also be provided before the labour pain is too bad in those anxious patients.

How effective is an Epidural in labour?

Epidural analgesia causes significant relief in labour pain. Epidural analgesia is the most effective method for reduction of pain and discomfort during labour and delivery. You can just feel some pressure symptoms and some tightness with contractions after an epidural. Sometimes, if there is discomfort related to the pressure effect from the baby’s head in the perineal area, it can be relieved from a stronger dose of medicine but there may be a risk of causing muscle block and inability to push to deliver the baby./p>

Can an Epidural Fail?

Occasionally, an epidural might not work as well as we want. In such situations, the anesthetist will give extra dose of medicine or change the catheter’s position. If it still does not work, the procedure is repeated.

What are the side effects and complications of an epidural block?

• Epidural block can cause a fall in your blood pressure. To decrease this risk, intravenous fluids are given.
• Sometimes there may be itching which disappears when the epidural is stopped. Antihistaminic are given to relieve the sensation.
• An epidural may land up in prolonged labour and reduce the urge to bear down. This may lead to an instrumental delivery.
• Rarely, women may develop severe headache after an epidural. It is called post dural puncture headache (PDPH) and can be treated with fluids.
• There may be numbness or heaviness in the legs in a small number of women. It usually weans off once the epidural is discontinued. The risk of any kind of permanent damage is extremely low.

Does epidural cause backache?

Backache, for many reasons, is common during pregnancy and afterwards when you are looking after your newborn. Evidence supports that epidural does not cause long-term backache, though there may be some soreness at the site of the injection for a few days.

Do epidurals increase the chance of a cesarean section?

No. There are numerous studies on this topic and it is now clear that epidural per se does not influence the rate of cesarean section. There are a proportion of women trying for normal delivery who ultimately land up in cesarean section. But this proportion remains unaffected with the presence or absence of epidural