In day to day practise, we see that for many moms-to-be, the joy of giving birth is coupled with many fears about labour pain. Most of them hear not so encouraging stories about labour pain from their friends and relatives, which makes them very apprehensive.
Pain is a part of a natural labour process. Pain tolerance in labour varies from women to women. Some pregnant women have low pain thresholds so they tend to demand caesarean very early in labour. At this point, it is important to stress that there are safe and effective options available for pain relief during labour. Every patient has the right to know about them. Talk to your doctor about your birth plan and pain relief in labour.
Epidural block or analgesia is a commonly used procedure for pain relief in labour. It can be used in patients when injectable painkillers offer little relief. The goal of an epidural block is pain relief with full consciousness and active participation of the patient in the delivery process.
An anaesthetist will explain the procedure to the patient. It is given in lower back in a small area below the spinal cord, called epidural space. The patient is either asked to lie down on one side or sit. The area where the injection is given is cleaned with an antiseptic. A local anaesthetic agent is injected in the skin where a needle is to be passed. Then a needle is put in epidural space through which a very thin tube or catheter is passed. There will be little tingling, numbness or heaviness in the lower body at this stage. The catheter is then fixed. A mixture of painkiller drugs is then injected through the tube at regular intervals to reduce pain. Low doses are used to minimize side effects.
The patient is fully conscious. She can move from side to side but may not be allowed to walk. The pain reduces significantly and the patient becomes more comfortable after a while. She feels less exhausted. She can use that energy later when pushing is required. At the same time contractions are still felt and pushing is fully possible. Little pain will also be felt when a doctor examines for dilatation. The lower part of the birth canal becomes numb and even taking stitches after delivery causes no pain.
Simultaneously, an injection is given to augment contractions under strict fetal heart rate monitoring. Artificial rupture of membranes at good dilatation also hastens the process. It is also good practice to reduce dose in the end when pushing by the patient is required.
The side effects which can occur sometimes are reduced blood pressure in mother which slows baby’s heartbeat, for which a good amount of intravenous fluids are given before the procedure.
It is best to use epidural at 3-4 cm cervical dilatation and start of active phase when chances of normal delivery seem good. If in any case caesarean is required, it can be done through the same anaesthesia.
There are a few myths related to this procedure. Many women think that it causes chronic back pain for years, but that’s not true. Studies show that the incidence of back pain in women is no different with or without an epidural. Rarely there can be a headache due to spinal fluid leakage, which is treatable. Another myth is that patient cannot feel pain so can’t push the baby, which increases the chance of a caesarean section. It again is not true as she is fully aware of contractions and can push.
Epidural can make birthing experience more enjoyable. Most patients who use epidural block in their first delivery ask for the same in the subsequent deliveries. In our country, painless delivery is slowly and steadily gaining popularity. The main hurdles in its use are prevalent myths mainly among elders of the family. But checking with your doctor about this option can help and you can have a painless delivery!
Note: These are the views of a qualified doctor and author. These are general suggestions and do not replace actual checkup by a doctor. Any resemblance to anybody is coincidental.
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