By Dr Amit Verma, MD (Consultant Anaesthesiologist)
One of the most thrilling and satisfying experiences in a women’s life is the birth of her child. Pain associated with child birth or the labour pain is the most worrisome part of pregnancy for every woman. There have been a lot of misconceptions especially religious and a few medical about the labour pain and its relief. A few believe that labour pain should be borne to enjoy the outcome, while a lot of people still believe that it increases the bonding between mother and the child. Although pain during labour could be a sentimental issue with mothers, it definitely might have some harmful effects on both mother and child, and some sort of pain relief should be offered to all.
Acceptance of labour analgesia (analgesia means pain relief) increased in the western world after Queen Victoria received the first obstetric analgesia in the Royal family on April 17, 1853. She commented “Dr Snow gave that blessed chloroform and the effect was smoothening, quieting and delightful beyond measure.” In 1857 Princess Beatrice was born again without the accompanying agony. Labour analgesia has come a long way since then and has passed through different strictly controlled clinical studies.
Techniques ofpainless labour
Most primitive methods of making childbirth painless included relaxation techniques, hypnosis, acupuncture, etc. The recent ones include trans-cutaneous electrical nerve stimulation (TENS), inhalational and intravenous analgesia and anaesthesia, local anaesthesia, and regional blockade. Every technique is associated with some advantages and disadvantages, and the choice of technique has to be individualised for every patient after a discussion between the obstetrician and anaesthesiologist, depending on the requirements of the mother in labour.
Each woman’s labour is unique to her, and the amount of labour pain she perceives depends on a lot of factors. On request for labour analgesia, the anaesthesiologist and obstetrician will evaluate the mother and the baby and decide the most suitable technique, which in most of the cases is epidural analgesia. Epidural analgesia is a relatively safe, common and the most reliable technique used now by anaesthesiologists for pain relief during labour.
Epidural analgesia
Epidural analgesia is a form of regional anaesthesia involving the injection of drugs through a catheter placed into the epidural space (fig 1).The epidural space is a part of the human spine. It is the space inside the bony spinal canal.
How and when is epidural analgesia performed?
The timing of the injection is usually when the mother starts experiencing labour pain and the cervical dilation is 3 cm or more. In the sitting or lying on one side (fig 2) position the back is cleaned with the antiseptic solution and local anaesthesia is used to numb an area of the lower back. A special needle is placed in the epidural space just outside the spinal sac. A tiny flexible tube called an epidural catheter (fig 3) is inserted through this needle and then fixed on the back (fig 4). The needle is then removed and the drugs are given at timely intervals or continuously through the catheter, avoiding further punctures. Sometimes your anaesthesiologist might puncture your back with another needle to give you spinal analgesia for the immediate relief of pain, because the drugs given in the epidural space take around 15-20 min for pain relief.
How long will the pain relief last?
With the epidural catheter in place, additional drugs can be administered and the pain relief will last as long as the drugs are timely or continuously given till the baby is born.
How does the procedure affect mother and the baby?
Enough medical evidence is available to say that epidural analgesia is safe for both the mother and the baby as long as it is performed by an experienced anaesthesiologist and the mother and the baby are vigilantly monitored thoughout labour.
Does it prolong the duration of labour?
Drugs given in epidural analgesia don’t have any effect on the uterine contractions and the mother rests during the first stage of labour when her cooperation is not required, thereby conserving energy for the next stage. Epidural analgesia makes mothers pain free while allowing them to push when required in second stage.
Does it increase the chances of a caesarean section?
Epidural analgesia does not increase the chances of a caesarean section. In fact, if your obstetrician decides to do caesarean section as an emergency, the same epidural catheter can be used to give drugs so that no time is wasted in giving anaesthesia
Our experience
Since the inception of our hospital we have been encouraging and administering labour analgesia and we also counsel every mother during pregnancy about it. Mothers who received labour analgesia in their first pregnancy promptly insisted on it in the subsequent one as well.
To conclude
Labour pain has been described as the worst pain experienced by a woman in her lifetime, which is highly unacceptable in the present medical era of pain relief. Acceptance of painless labour increases with awareness. Encouragement from family members plays a part in motivating the pregnant mothers to opt for painless labour.
“Divinumest opus sedare dolorum” (To relieve pain is divine)
For queries – amit.dr.verma@gmail.com
