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Painless Delivery: The Perfect Option Under - Explored In India

Pregnancy is all about emotional preparation for the arrival of your child. The nine months of pregnancy are spent in excitement and anticipation, mostly revolving around the safe arrival of your baby or babies.

However, as the delivery time approaches you might fear the intense labor pain. Yes, your worry is very justified as labor pain is the pain of the highest intensity anyone can experience. A human body can bear only up to 45 del (the unit for measuring pain) but at the time of giving birth, women experience up to 57 del of pain, which is equal to twenty bones getting fractured at a time in the body.

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For the purpose of comparison, here is the intensity of pain for each one of the following causes.

  1. Sprain - 14 del
  2. Fracture & Arthritis - 18 del
  3. Toothache - 20 del
  4. Cancer pain - 25 del
  5. Severe back pain - 30 del
  6. Childbirth (with training) - 40 del
  7. Childbirth (with no training) - around 50 del

The thought to overcome labor pains started in 1847 and has evolved to the present advanced techniques to bring painless comfort, joyous experience to the mother while maintaining the safety and well-being of mother and child.

About Birthing

The process of normal delivery is long and tedious. It has 1st, 2nd, and 3rd stages following one another and takes approximately 8 – 20 hours for the first, 2 – 3 hrs for the second stage to enter the next stage. Uterine contractions during the labor process start off slowly with mild discomfort in the tummy. As it progresses, the frequency and pain intensity increase to maximum towards the end of 2nd stage. These are the two stages when pregnant women need support for pain relief.

Options For Pain Relief

Vaginal birth is the most preferred and recommended mode of delivery.

The process of normal delivery can be unpredictable. Everyone experiences pain differently. Every woman is different and every birth experience is unique, so is the pain relief requirement. Pain tolerance of an individual is all in their state of mind.

All the pain-relieving options we talk about are meant for those seeking normal delivery. A very tolerant woman in the initial stages may only require non-pharmacological (without using any medicine) methods for pain relief like massages, warm baths or showers, yoga, walking around, and relaxation techniques (rhythmic breathing, visualization, meditation, and self-hypnosis). Changing position may also help reduce the pain. These are just alternative pain therapies that may be beneficial as no proven scientific data analysis is available on the quality of pain relief.

A pain-sensitive woman requires one of many pharmacological (using medications) methods using intravenous medications for short durations which have their limitations due to temporary undesired side effects during labor affecting both mother and the child.

Inhaling (Entonox) Nitrous oxide and oxygen mixture relieves anxiety, helps to tolerate mild pain in the early 1ststage and during the 2nd stage of labor from second delivery onwards.

Interventional techniques like spinal and epidural would give us maximum safety profile and comfort to the delivering mother. Spinal may be used in urgency when pain relief is needed for a short duration towards the end of 1st stage. Epidural is the gold standard and gives at least 90% pain relief.

When And How Is An Epidural Done?

You may request an epidural at any time during your labor. The ideal time for taking it is when you experience pain that you cannot tolerate. It is not dependent on cervical dilatation, because it is a procedure meant for comfort. Often in some hypersensitive women with zero tolerance to pain, it is placed well in advance of her labor pains, when she is planned for elective induction of labor. As the anesthesiologist takes around 15 minutes to complete the procedure, such patients may not cooperate during their labor, making it impossible to relieve their pain later by other means.

Epidural can be done while you are comfortably sitting or lying to one side (lateral position). A space between the bones of your lower back spine is identified (remember, it is between bones, NOT to the bone). Using the thinnest needle available in the market, a local anesthetic drug is given to numb 0.5 cm area of the skin to enable comfort. After reaching the target area (epidural space) a 1 mm thick epidural catheter is inserted, safety checked, and fixed. The only pain you feel during the entire procedure is the skin prick while starting it. It is no different from the TT injection you take during your pregnancy. You may just feel a little pressure while doing the procedure but not pain.

The intention of doing an epidural technique is to block all those nerves in the epidural space (an area around the spinal cord) carrying the pain sensation of the contracting uterus to the brain which perceives it and reacts. Hence, no pain is felt.

A predetermined dose of anesthetic drugs mixture as decided by your anesthesiologist is given through the Epidural catheter would just make the delivery process painless in 10-15 minutes. It would neither hamper the intensity of contractions nor the process of delivery. These drugs are continuously given through an infusion pump to maintain pain relief till the delivery of the baby and can be continued up to four days using a filter for postoperative pain relief if the normal delivery gets converted into an emergency C-section for other reasons.

Based on your health condition, your anesthesiologist will choose the safe painless delivery option for you. Discuss with them in advance.

Benefits Of An Epidural

In general, epidural analgesia is very safe, but not risk-free. Common side effects like a mild drop in blood pressure, nausea, shivering, soreness in the back, mild numbness in the tummy and legs (but rarely weakness in legs) are temporary, well manageable, and needs no thinking for the laboring woman. Uncommon ones include Dural puncture (1%), headache (<1%), patchy block (3-4%). Rare ones are Failed blocks.

Very rare side effects occur in 1 in 50,000 – 2,50,000 patients while death from motor vehicle collision occurs 1 in 10,000 people.

Who Cannot Get An Epidural?

You may not be given an epidural if you have an allergy to local anesthetic medications, bleeding disorders, active infection in the area of epidural placement, certain brain & spine disorders with or without technical challenges, spine surgery, unable to cooperate, too obese to feel the spine (technical failure)and who are too close to baby delivery, etc.

MYTHS & FACTS About Epidural

  • Epidural slows down the progression of labor – by around 1 hour at the luxury of the pain-free labor process. Pushing the baby by the end of 2nd stage is always possible with the correct mixture of medications. You should expect to feel some pressure as the baby moves through the birth canal, and this helps you know when to “push”.
  • Increase the frequency of C-sections – NO evidence yet.
  • Increase in incidence of forceps and vacuum extraction delivery – YES up to 5 to 10% if dose titration could not be achieved by the time of delivery of the baby.
  • Causes long-term back pain – NO. The most probable reason for post-delivery back pain is the laxity of pelvic bone joints which is caused by hormones of pregnancy to accommodate the growing baby and facilitate the birthing process. Specific exercises in the post-delivery period to regain the strength of those joints to near normal may decrease its incidence.

Remember, 50% of mothers who delivered normally without epidural/spinal injections get back pain while 50% of women who receive injections over the spine do not get any back pain.

  • Timing of epidural – at your request (No relation to cervical dilatation)
  • Poor breastfeeding or lactation failure NO it does not have any effects on lactation
  • Effects on the baby – NIL
  • Paralysis of legs – NO. In fact, you need not lie and rest on the bed till delivery but you can walk in the birthing suite, get engaged in your interests till the time of delivery if titration of the dose is well adjusted (WALKING EPIDURAL). Ask your anesthesiologist.



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