EPIDURAL ANALGESIA OR PAINLESS DELIVERY

Painless labour or epidural analgesia for delivery is quite popular these days.Having been introduced with the aim of making labour a pleasant process, epidural analgesia for pregnant women in labour has many pros and cons.I hope to brush across the most important aspects related to this topic quickly in this article.

"A strong intention, a relaxed body and an open mind are the main ingredients for an active birth"-Janet Balaskas


What is epidural analgesia? An epidural is a procedure carried out by an anaesthetist wherein a local anaesthetic agent is injected into the space around the spinal nerves in your back.A commonly done procedure for providing post-operative safe analgesia to patients undergoing prolonged surgeries,it hasn't been that long since epidural analgesia has been introduced to make the process of labour less agonizing.This ensures that the pain of contractions are reduced while not affecting the process.


Who administers an epidural analgesia?

It is the anaesthetist who performs an epidural analgesia. How is it administered? It’s administered through a catheter inserted through a needle inserted into the epidural space that surrounds your spinal cord.The catheter remains in place during labor and delivery for continued supply of pain medications. When is epidural given during labour? An epidural is best administered in the first stage of labour (period of cervical dilatation) though it might be given at subsequent stage too. What are the pros and cons of epidural anaesthesia?

PROS

1

Effective relief in labour pains.

2

Provides rest to the expectant mother especially if a prolonged labour is expected or if it is the first pregnancy.

3

Helps to stay alert as most of the patients after continued pain of labour get exhausted otherwise.

4

A few recent studies have also postulated that it decreases the risk for Postpartum depression though further insights are needed.


CONS

1

Though it shortens the first stage of labour,it can prolong the important second stage

2

Not everyone is fit to undergo an epidural such as those with spinal cord issues or scoliosis (bend in the vertebral column).

3

It might lower the blood pressure.

4

Some patients may have no relief and may need to undergo multiple procedures.

5

There is an increased risk for assisted delivery with instrumentation such as forceps or vacuum.

6

Permanent nerve damage which is extremely rare however.

How to decide whether to opt for an epidural during my labour?

Well,only you can determine whether this option is right for you.The most important determinant of this choice would be one's own pain threshold.The other factors include the size of pelvis,the relative size of the baby,the position of the baby and the intensity of contractions.Weigh the pros and cons after a thorough discussion with your doctor and family members and take a decision which you think is appropriate.Your doctor can only guide you-the ultimate decision is yours.It must be remembered however that an epidural might not work every single time.


Epidural and headache

A common doubt regarding the epidural is the post-procedural headaches.This occurs if the needle pierces deep past the dura(protective covering of the spinal cord beyond the space into which drug is injected).With the small sized needles used nowadays,this risk is low now.Even if headache develops,proper hydration is the key.Anaesthetist prescribes specific drugs which are highly effective,in case it happens.


Special situations

Scoliosis : it per se is not an absolute contraindication for epidural analgesia.However the procedure might be a little difficult for the anaesthetist proportionate to the deformity.


Multiple gestation: Though strongly mandated if normal delivery is planned,it is still a personal choice.There are many mothers who have successfully delivered twins without epidural analgesia!


Tattoos: There is contraindication only if the tattooed skin over the back is still inflammed.The anaesthetist takes the final call in this situation.


In a nutshell

Several factors have an implication on a woman's perception of labour and therefore,the experience is subjective and unique.Gone are the days when women were ordained to suffer the pangs of labour.There are multiple options for pain relief during labour including epidural analgesia and pharmacotherapy today.Do consult your doctor to learn more about the multitude of options available and take your time to arrive at an appropriate decision.


Post your doubts if you have any!


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