FAQ - Epidural Analgesia For Labour

Epidural Analgesia For Labour

The fear of pain of childbirth haunts every expectant mother almost from the time she gets pregnant. For years women have been tolerating this suffering; mainly because it being a natural process, it is thought better, not to interfere with it. Also it is felt that birth of the baby, being a pleasant ending will make her forget the suffering. A prolonged and painful process of childbirth can have adverse effects on the mother and the unborn baby, hence attempts to reduce this pain date back centuries. Since no safe and completely acceptable method was available, pain relief in labour remained a myth; till recent years when epidural analgesia emerged as the most widely accepted safe choice.

Why does labour cause pain ?

Once the process of delivery sets in the uterus (the bag which holds the baby) starts contracting so as to expel the baby out. These contractions like an extremely vigorous muscular exercise cause pain.

Is the pain really severe ?

Most of the times the pain is very severe and can be compared to the pain of fracture of a bone. Tolerance to pain is subjective and hence some women may be able to bear the pain while others may not. The pain and associated anxiety is more at the time of the first delivery.

Is the pain useful ?

Labour pain gives an indication to the expectant mother that the delivery process has begun. However after that it loses its usefulness and becomes a suffering.

If the pain is gone, how will the labour progress ?

With pain reducing techniques, only the pain conducting nerves are blocked, however the process of uterine contractions continues.

What are the harmful effects of pain ?

Pain leads to increase in anxiety. This leads to excessive sweating, increased heart rate, increased rate of breathing, increase in blood pressure, flushing, muscle cramps, nausea and vomiting in the mother which in turn may lead to distress of the baby within the uterus. An anxious mother or a prolonged labour thus has adverse effects.

What can be done to reduce the pain ?

Various methods have been used to - date like injecting morphine and morphine like drugs through the veins, breathing gases like Nitrous oxide, stimulating certain areas of the skin with mild electric current, meditation, acupressure, psychological natural childbirth techniques and others. The ideal method of pain relief should be one which is 1) Universally acceptable and available 2) It should give adequate pain relief throughout labour 3) It should have no side effects on the mother and the baby. It should not have any effect on the progress of labour 5) There should not be a need for special equipment and it should be affordable. All over the world the method which has proved clearly superior over the others is Epidural Analgesia.

What is Epidural Analgesia ?

In this technique a local anaesthetic is placed around the nerves that supply the uterus and the birth canal and this stops the pain associated with contractions. The woman remains aware of the contraction. She is awake and is able to experience the process of labour as a pleasurable situation.

How is it given ?

The procedure is done by an anaesthetist in either a sitting or lying on one side position.The anaesthetist cleans the back using antiseptic solutions. Local anaesthesia is given at the site of the epidural injection and the epidural space is located by means of a special needle. A very thin polythene tube (catheter) is inserted through the needle into the epidural space. The needle is then removed and the tube is left in place, by fixing it firmly onto the back using adhesive tape. Anaesthetic doses are given through the tube to relieve pain, as and when necessary. It takes about thirty minutes for maximum pain relief. It is easier to put in an epidural catheter before the contractions become too painful, but it is never too late to ask for it.

 Does it have any other advantages ?

Apart from relief of pain, it increase the blood supply to the baby and improves its well being. Epidural Analgesia is also known to shorten the duration of labour. In case some emergency arises in relation to the mother or baby, the anaesthetist is available at the very instant, and the same anaesthesia can be used for caesarean section, if required.

What are the disadvantages ? Occasionally the injection can cause headache which may need treatment. Complications like reaction to the anaesthetic drug and dose related complications are rare. It has been felt over the years that since the pain sensations are blocked, delivery needs to be conducted by instrumental methods like forceps or vacuum forceps. Use of newer drugs and the right timing of the doses have shown that there is no increase in the instrumental delivery rate or caesarean section rate

Does this injection cause backache ?

No. It is statistically proved that an injection in the back is not a cause of backache. On the contrary, epidural injections are often used in the treatment of back problems. After delivery, there are many other causes of back pain like laxity of ligaments, calcium deficiency, which are wrongly attributed to the injection in the back.

What about the cost ?

Every good thing has a price. There are no fixed charges for the procedure, as it would depend upon the place where you deliver (city, district etc), the difficulty and the duration of labour and the prevalent charges of the anaesthetist.

 

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