Painless Labour - The Need Of The Time!

“Giving birth should be your greatest achievement, not your greatest fear.” Jane Weideman

The main aim is to get a successful vaginal delivery.  The fear complicates all. Most of the young mothers are in constant grip of fear of labour, leading oneself into a high chance of caesarean delivery even after being given a fair trial. The first question my patient asks me is “Mam is there a risk of epidural?” My answer to this question sometimes raises eyebrows, “Don’t you think getting pregnant itself is a risk. But you still do. And it has its own benefits. Same way epidural is a boon for those wanting normal delivery and scared of pain.” Everything in this world has two sides.

Today, epidural analgesia is the most widely used method of pain relief in childbirth. This does not mean that the method is free of complications or contraindications, but these are considered to be of minor importance and is generally an infrequent event. In general, the gains outweigh the losses and epidurals are now regarded as a safe method for both mothers and babies provided there are no specific medical indications that advise against or prevent using this anaesthesia and informed consent has been obtained from the expectant mother. However, each case must be analysed individually by trained and qualified professionals. The pain must be understood as a socially, constructed concept involving psychological, educational, cultural, and sociological factors, which must be examined from the standpoint of subjective perceptions and context. Context influences the perception of pain, and how individuals address their suffering or the decision not to suffer.

Benefits of pain relief: less pain is good; mother is more relaxed and can participate more in exercises and pushing; post-delivery mother is fresh to feed and take care of the baby; caesarean section will not require repeat anaesthesia; labour is faster; lactation sets it early; post-op pain can be taken care.

Points to be taken care when taking epidural: your centre should have the facility; your gynaecologist should be confident and trained for epidural analgesia; there can be a little chance of fetal distress, hence everyone to be vigilant; it can be tackled well if taken care; in second stage there is a chance of a patient getting free of pain and start sleeping and stop pushing hence chance of instrumental delivery high but nothing to worry as it can be dealt easily if the patient knows the steps.

Medically indicated in these patients: marked obesity; high chances of caesarean; severe pre-eclampsia, high risk for general anaesthesia, patients with mitral stenosis

Contraindications for Epidural analgesia: patient’s refusal, raised intracranial pressure, severe hypotension, anticoagulant therapy

To be used precautiously in following cases: previous caesarean planning for a vaginal delivery(VBAC), twins.

Myths: It prolongs labour; it causes permanent backache; it increases the chances of caesarean; it is costly; if we don’t go through the pain we do not become a good mom

In my experience the chances of normal delivery increase drastically with epidurals. The patient is fully dilated within 2-3 hrs. There is an immediate relaxation of pelvic muscles; the mother feels more relaxed as pain goes away, and descent of the baby is fast.

What is new: We have a PCEA(patient-controlled epidural analgesia), the patient can increase the dose of medication depending on the increase in pain; the patient can move around and do exercises as they are just pain-free; combined spinal-epidural can be given for immediate pain relief; post-op pain relief is the best, no pain even after delivery and you can enjoy with your baby.

Just remember- “Your labour will be as singular and unique as you are because it is shaped by your unique physiology, life, financial situation, birth environment, spiritual self, relationships and birth team.”  Hazel Tree

 

 

DR. YASHICA GUDESAR

HOD And Consultant - Obstetrics & Gynaecology

Manipal Hospitals, Dwarka, Delhi

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