Labour Analgesia
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Introduction
Pregnancy is dreams come true of all couples. The first time mothers are filled with apprehension and innumerable questions. They develop misconceptions and fears regarding pregnancy and labour pains. The delivery of the baby into the arms of a conscious and pain free mother is one of the exciting and rewarding moments in medical field. Expectant mothers are with the feelings of excitement, worry and also fear. One of the greatest fears is the fear of intense pain during labour.
The pain of child birth is the most severe pain most women will feel is their lifetimes.
The perception of pain during labour and delivery varies between individuals. Especially the first time mother need a proper antenatal counseling regarding good nutritious diet, antenatal exercises and physiology of labour pains. Here we shall only be dealing with labour and delivery.
There are many pain relief methods is labour like
- Transcutaneous electrical nerve stimulate
- Parenteral narcotics
- Inhalational Methods
- Regional analgesia – epidural, spinal or combination
Out of which epidural analgesia is the most versatile method and gold standard technique for pain control is labour.
Reason of pain during pregnancy
During the labour or delivery there is stretching of the cervix, uterus, vagina and perineum leading to stretching of nerve fibres supplying them, thus causing pain.Epidural anesthesia is an advance in pain management during labour. It is a regional anesthesia is which an anesthetic drug is injected near the spinal coral.
Areas Affected
It numbs the body below the waist, but the movements are not impaired.
Time of anesthesia
It is administered when the patient is in active labour. It can be given as a single injection or in multiple doses through a special epidural catheter by a skilled anesthetist.
It is administered only is advanced stages of labour when cervix opens to about 3-4 cms.
With a local anesthetic, a needle is passed through the space just outside the dural membrane surrounding the spinal cord, spinal nerve, roots and spinal fluid. The patient feels no pain during the whole process except the needle prick.
- Almost complete relief from pain with the patient being mobile.
- No past partum headache as in spinal anesthesia.
- Mother is conscious and alert throughout the labour.
- An instrumental delivery, if needed, can be performed under same anesthesia.
- If the patient has to be taken for caesarean section, the effect can be topped up through the epidural catheter.
- Dosage can be topped if necessary.
- Good post operative pain relief.
- Sudden drop in the blood pressure
- Because of pelvic floor relaxation baby’s head may not rotate.
- Slight increased rate of instrumental and caesarean deliveries.
- Sometimes the anesthesia may not be complete; as a result the patient may experience more pain. This might require the procedure to be
- repeated.
- Epidurals can lengthen the duration of the labour.
- Around 1% of women experience headache immediately following the procedure.
- Dislodgement of catheters
- Haemadynamic instability – hypotension, bradycardia
- Respiratoy consequences
- Total spinal anesthesia
- Intravascular injection of local anesthetic drug
- Transient parasthesia
- Foetal bradycardia
When not to opt for labour analysis
- Is allergic to certain local anesthetics
- Has a neurological disease
- Has a bleeding tendency
- Regularly taking aspirin
- Has an infection is the lower back area.
- Has had a previous back surgery
- Has a psychological disorder or fear of needles
- Is morbidly obese
- Is unable to co-operate or position herself to allow an epidural
- Is too early in labour
- Has an abnormal labour or fetal monitoring pattern
Effects of epidural on the baby
Normally a small dose of medication is used which does not have any effect on the baby’s behavior. The effects of the medication on the mothers body usually wears off before her breasts starts producing breast milk.