FAQ - Delivery Without Pain

Delivery Without Pain

Birth of a baby is one of the most joyous moment in a woman’s life. To have this joy, the labouring woman has to undergo a long journey, which is full of pain. The pain varies in intensity from person to person. Textbooks have described this pain as “worse than pain of a fracture”!

Various methods have been used in the past to alleviate the pain. These range from psychotherapy to massages to various drugs. These have been practiced since ages & various reports have claimed that their method is the best.

Why does labour cause pain ?

Once the process of labour begins, the uterus tries to push the baby downwards to the pelvis and tries to expel the baby out. The uterine muscle contracts & relaxes resulting in pushing the baby down. These contractions like a vigorous exercise are responsible for pain.

How severe is the pain ?

Pain experienced during labour is mild initially. It slowly increases in intensity, frequency and severity as time passes. The intensity of pain is much more in anxious patients and in primi gravidas. (Women delivering for the first time)

Is pain useful ?

The intensity of pain enables to know how the labour process is progressing. However, at a point, the pain becomes a suffering than an indicator of onset and progress of labour. Pain itself has deleterious effects on mother and baby.

Will the labour progress if there is no pain ?

 The common misbelief with labour analgesia is that if the labouring woman doesn’t get pain, how will she progress towards normal delivery. Pain reducing techniques block the pain produced by uterine contractions. They do not reduce intensity & frequency of contractions. Thus, it does not have bad effect on progress of labour.

What can be done to reduce the pain ?

Various methods can be adopted to reduce intensity of pain.

      Education of patient & counseling also plays important role in pain management as the patient understands & expects a certain amount of pain.

      Drugs: drugs like morphine, pentazocine by intravenous route have been & are being used to reduce pain.

      Gentle back massage is also helpful in relieving pain to a certain extent. – Breathing gases like Entonox are quite popular in the western countries & are extensively used. These increase pain tolerance.

      Stimulating certain skin areas with mild electrical current is also useful for pain relief.

      Epidural analgesia is the most commonly administered modality to get relief from pain during labour.

What is epidural analgesia ?

Epidural analgesia is a technique in which local anaesthetic agent is placed around the nerves supplying the uterus & birth canal. It thus stops the pain associated with contractions, dilatation of cervix and distension of birth canal. The patient is still aware of contractions of the uterus. Patient is awake & in control of labour as the drugs used for the technique has no sedating effect on the mother & baby.

Who will do it ?

A qualified anaesthetist specialized n the technique of labour analgesia will do the procedure of insertion of catheter and will be with you in the labour ward till you deliver. Pain relieving injections will be given as per your demand.

Prerequisites for Epidural analgesia

Detail history is taken & examination carried out by anaesthetist to rule out risk factors if any. Anaesthetist may ask for certain blood test if required. Consent is taken. Procedure is explained to the patient.

When can I have Epidural or Spinal Analgesia ?

You should discuss your wishes about labor analgesia with your obstetrician or anaesthetist during your prenatal care. Spinal or Epidural analgesia is easier to start before labor discomfort makes it difficult for you to discuss your situation or cooperate in analgesia administration. However, you may let the labor nurse and your physician know if you are interested in having Epidural or Spinal analgesia at any point in your labor.

When you can actually receive the analgesia depends on circumstances surrounding your labor pattern and assessment by your physician. At the appropriate time, an anesthesiologist will discuss the techniques with you and suggest options in accordance with your wishes and those of your physician. You may have concerns unique to you that your anesthesiologist will need to discuss, and you should have an opportunity to ask questions. If you and your anesthesiologist agree after this discussion, preparations will be made to administer an analgesic. Although it is unlikely, an anesthesiologist may not be immediately available to administer the analgesia because of emergencies; or there might be a reason that makes if inadvisable for you to have Epidural or Spinal analgesia.

How is epidural catheter put in ?

Catheter insertion procedure is done in sitting position or lying down on one side. Patient is asked to remain still during the procedure so as to avoid inadvertent injury. It is easier to put in epidural catheter when the contractions are not too painful but it is never too late to ask for one.

The anaesthetist will clean your back using antiseptic solutions. Small amount of local anaesthetic agent is injected into the area where the catheter will be inserted. A special large needle will be used to determine epidural space. (It is a space above the dura, which covers the spinal cord.) A very fine polythene tube is inserted in this epidural space through the needle. The needle is then removed. The tube is left in place and firmly fixed to the back. Local anesthetic & other pain relieving drugs are given through this tube for analgesia whenever the patient demands. It takes about 15 – 30 minutes for maximum pain relief.

What can I expect from Epidural or Spinal Analgesia?

Pain relief from Epidural or Spinal analgesia is usually more complete and intense as compared to the other forms of labor analgesia. Most women notice a pressure sensation with their contractions; this pressure sensation is an important mechanism that keeps labor progressing. With the concentrations of local anesthetics and adjuvants used for epidural analgesia labouring woman can ambulate. There is no weakness or numbness in legs.

How long will the Analgesia last ?

Continuous Epidural analgesia can usually be made to last as long as your labor lasts. Injections will be effective depending on the characteristics of the drug injected. Without the use of the catheter, they cannot be repeated without replacement of a needle. Toward the end of labor - when the birth of the baby is close at hand and discomfort is more intense - additional medication or techniques may be needed.

What happens if I need a C-Section ?

The type of anesthesia used for a C-Section will depend on the urgency and nature of the reason for the surgery. Continuous Epidural technique can be extended for use during a C-Section.

Are there any other advantages?

Apart from pain relief, epidural analgesia increases blood supply to the baby and improves its well-being. This is very important in cases where the blood supply to the baby is compromised e.g. High blood pressure in mother, Growth restricted babies etc. Epidural analgesia is known to shorten duration of labour. Studies have also shown that the caesarean delivery rate is reduced. If a patient requires emergency caesarean section, anaesthesia can be given through the same catheter without additional pricks. In case of dire emergency, the anaesthetist is always available at the very instant to undertake emergency measures.

Does the medication affect the baby ?

The doses of medication typically used in labor analgesia usually do not cause any noticeable effect in your baby’s Apgar scores or behavior. The Spinal and Epidural techniques use very small doses of medications; the local and IV techniques use larger doses. Your body will have essentially eliminated these medications before your breasts begin producing milk for breast feeding.

Are there any complications ?

Complications with epidural analgesia technique are extremely rare. Occasionally, headache can be complained by the patient, which may require treatment. Reaction to local anaesthetic is extremely rare.

Will this injection cause backache ?

Epidural analgesia is not responsible for backache. The reason for backache in a woman after delivery is laxity of ligaments, change in the curvature of back, laxity of abdominal muscles, lack of calcium in diet / supplement. These are wrongly attributed to the injection in the back. Several studies have shown that epidural analgesia does not cause backache. Epidural anesthesia or analgesia provides relief or reduction of labor pain without affecting the mother’s mental state. It enables an exhausted mother to relax or sleep during labor and calms the woman who is anxious and tense because of pain. Once an epidural catheter is in place, additional medication can easily be administered as needed, providing prolonged and consistent pain relief.

 

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