Painless Labour

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Painless delivery refers to the use of an epidural injection for pain relief during labor. An anesthesiologist gives an injection in the lower back and places a plastic tube through which drugs are released around your spinal cord

Labor pain has been described by most as the most painful experience a woman can have in her lifetime. Efforts have been taken for centuries to remove this labor pain. But it has never been easy in the past as in the present. Despite of this entire negative attitude by many 85% women prefers some methods like epidural for labor pain management.

Question of painless or painful labor was raised only about one and half century back with the advent of anaesthesia in medical sciences. Only three months after Morton’s historic demonstration of ether as an anaesthetic for the first time in 1846, James Young Simpson anaesthetized a woman with ether for childbirth. Queen Victoria unable to tolerate labor pain wanted anaesthetic. First lady anaesthetised for labor in United States was Fanny Longfellow wife of famous American poet Henry Wadsworth Longfellow. She wrote- “This is certainly the greatest blessing of this age.”

But certainly the acceptance of painless labor starting from its early age to its adulthood in modern times has never been so easy in different social classes. Like the earlier times when British clergymen argued that painless labor is a sin against the will of God who has made the childbirth painful; a few modern experts opine that labor pain makes a good bondage between mother and child.

The reasons of controversies in this issue are several. Those who do not like pain-free childbirth have the following excuses.

Firstly, the childbirth is a natural process, which should not be disturbed. Secondly, the mother should cherish the joy of motherhood at the time of delivery and so no pain should be felt.

Thirdly, pain is a psychologically regulated subjective feeling and proper antenatal education and relaxation may give painless childbirth.

Fourthly, as mentioned earlier, labor pain makes a good bondage between mother and child

Fifthly, every medication has some side effects, which should be avoided.

But certainly these excuses seems to be ridiculous to those who are in favor of painless labor and think non-interference of severe pain of childbirth when one has the safe options is an offence. In the modern age of scientific and technological excellence many natural phenomenon are modified in such a way that it becomes beneficial for human lives. There are so many examples; a dam is build to produce electricity; in agricultural fields, modifications has improved the quality and quantity of crops; similarly, artificial and parenteral foods are often given to the patients to save their lives.

Unfortunately in India incidence of painless labor by epidural anaesthesia is very rare even in these days. Reasons are many.

Lack of proper set up (including training of doctors & para-medical staffs)

  • 1. Ignorance of expected mother and their family members. Most of them do not know that they have safe painless option of childbirth.
  • Doctors and midwifery staffs should be more sympathetic to deal with the intense pain felt by expected mother.
  • Coming to the point of safety, every drugs has some form of side effects, even simple paracetamol may kill a patient. The percentage of serious side effects is more important. Ether, which was used in earlier days for painless labor is now obsolete as better options with fewer side effects are now available.

At present one has the following options for painless labor.

  • Analgesics (pain killer)- Morphine group of drugs are only effective but used mainly in earlier stages when the pain is not so intense. It has serious side effects on baby, so used rarely.
  • Oxygen and nitrous oxide mixture- this mixture is inhaled to get rid of pain. It is very safe to both mother and baby, but not very effective, good amount of pain persists.
  • Other methods (TENS etc.): not so effective.
  • Epidural analgesia and anaesthesia- It is the most effective, most safe for both mother and baby and so, most widely used in western country. More than 85% of expected mother prefers this method at present days in western countries and available since 1960s. A fine catheter (tube) is introduced in the back between two lumber vertebrae in a space called epidural space, which lies immediately outside the outermost layer of the spinal cord (There are three layers or membranes which cover and protect spinal cord.). Whenever there is pain, a liquid (diluted anaesthetic drug mixed with other drugs) is introduced via the indwelling catheter and there is almost instant pain relieve. Some ambulatory pump introduces the drugs contineuously. Here only the pain sensation of abdomen and lower limb goes away. The patient is fully conscious, can move her legs and all other sensations are present.

What is an epidural?

Dura is a thin covering on the human brain which extends from the skull downwards through the spinal column covering the nerves leaving the spinal cord and ends at the sacrum. From the skin if one approaches the spinal cord then there are following layers that will be encountered – skin, subcutaneous tissue, supra spinous ligament, infra spinous ligament, ligamentum flavum, dura and lastly the spinal cord.

Epidural space is the space between the dura and the Ligamentum Flavum. In common language it means the space that lies outside the dura is epidural space. If one enters inside the dura or goes beyond the dura then it is called intradural space.

When anesthetic medications like opioid agents or local anesthetic agents are deposited in the epidural space it can be used either to cause analgesia (relief from pain) or anesthesia (where there is total numbness and an operation can be performed on a patient).

How does it work?

The anesthetic medications which are deposited in the epidural space act by two mechanisms. The nerves that are leaving the spinal column are blocked by these medicines hence the nerve conduction is blocked and hence analgesia or anesthesia is achieved depending upon the dosage of the medicine.

There are opioid receptors in the spinal column that are blocked by these opioid medicines, which then results in pain relief or anaesthesia.

The concentration of the medicine determines whether the medication is an analgesic or anesthetic in nature. When higher concentration of a medicine is used it will block all the sensations carried by that nerve and lead to anesthesia. If the same medicine is used in lower concentration it will block only the pain fibers and will cause analgesia which means only the pain relief without causing muscle weakness.

This mechanism is used in giving labour analgesia or what is commonly called as painless labour. Here the nerves that carry pain sensation — caused by strong uterine contractions — is blocked at the spinal level and not allowed to reach the brain; where normally humans feel pain. Therefore, the pregnant woman can deliver the child with very little or no pain.

How is it administered?

There are two main techniques to administer an epidural, they are:

Single shot epidural: The epidural space is usually injected with opiod medication, by injecting it into the epidural space. This usually involves the doctor administering an injection on the patient’s back (in the cervical, thoracic or lumbar region).

Epidural catheter technique: Alternatively a fine bore tube can be passed into the epidural space and the medication can be deposited into the epidural space continuously or intermittently.

So, if you are really interested for a normal delivery but minus the pain,then we are there to help you at APOLLO.My team is available round the clock to help you in your pursuit for motherhood, and most importantly PAINLESS….