Thursday, January 25, 2007

Pain relief in labour : Epidural Anasthesia

Here's a great article in this week's Hindu on Pain relief in Labour. Unlike Supriya, I never worried about the pain during labour as every day during those 9 months in the pre natal period itself was a struggle. I never fathomed how painful the delivery process was going to be and always imagined it would be a breeze and the kid would be out in no time. My husband Vivek mentioned about Epidural Anasthesia to me earlier and how it made labor less painful. I wish I had done some more research to find out which hospitals did that or spoke to my gynaec about that much before. Believe me, delivery through normal process is very painful and the pain just goes exponentially as the hours tick by. The pain is something that I cannot equate to anything else, something that you would have never experienced before. One thing that helped a bit during the labour pain was deep breathing.

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Here is the full article:

Supriya has been talking to her friends. She is apprehensive about going through labour. As her due date approaches, her anxiety and fear increase exponentially. Some of her friends and relatives have used some ill-chosen words to describe the travails of labour. She is really frightened about going through labour. Will she be able to tolerate it? Her husband has promised to be with her through the labour but she still needs reassurance that there will be pain relief offered to her during labour and delivery. Supriya need not worry. Modern obstetrics offers her many choices.

In every language in the world, the words for childbirth and labour are synonymous with pain. The joy of giving birth is always coloured with the fear of pain during labour. Some women dread childbirth to the extent of demanding a caesarean section instead of going through natural childbirth.

There are many ways to lessen pain during labour and the birth of a baby. Being prepared with knowledge of the birth process is the first step towards being able to handle labour pains. Labour preparation classes for the couple are important. There are also safe pain-relieving drugs that can be given as an injection. Newer methods include epidural analgesia, which cuts off the pain of labour without interfering with the action of labour contractions.

The type of pain relief that is right for you depends on your pain threshold. Some women can tolerate pain to a greater extent than others. Some women have a low threshold for pain and this, combined with the fear of labour pains, can make them intolerant of the slightest pain. A woman's physical fitness, having taken labour preparation classes, the length of labour, the intensity of labour pains, and the size of the baby play a role in the ability to handle the pain of labour.

What types of drugs are used for pain relief?

Pain relief offered during labour is safe for both the mother and the baby.

Narcotics (such as Pethidine) may be used during the first stage of labour to help you relax. Narcotics are usually injected into a muscle (IM) or into a vein (IV). They affect the entire body. Narcotics lessen the pain and can help you feel less tense or anxious.

Regional anaesthesia lessens or completely blocks the pain in a specific part of the body. The epidural block is a commonly used type of regional anaesthesia during labour. Spinal anaesthesia is also a regional block but is used only for a caesarean and not for pain relief during labour.

With either narcotic pain relief or epidural anaesthesia, there is no loss of consciousness, so the mother can actively participate in the process of delivery.

What is an epidural block?

For an epidural block, pain-relieving medicine is injected into the lower part of the back. Usually a small tube (catheter) is inserted into this area of the back. The medicine can be repeated through the catheter when the effect of the medicine wears off.

In low doses, an epidural block eases the pain of contractions and numbs the birth canal during labour and delivery. The pressure of the contractions is still felt with an epidural block but the pain component will be minimised. In higher doses, an epidural may be used for caesarean sections.

Are there any risks?

Because a narcotic like pethidine affects the entire body, both the mother and the baby may have mild side effects from this drug. Drowsiness and feeling dizzy are the commonest side effects. They are usually not used when the baby is just about to be delivered so that the baby does not have any difficulty.

The medicines used in epidural analgesia are less likely to pass to the baby and affect the baby because the medicine does not enter the bloodstream. An epidural may cause the blood pressure to drop. This may slow the baby's heartbeat. To help stop this from happening, fluids are given through a drip before the block is given.

How can pain during labour be relieved without drugs?

Each woman has a different threshold for pain. How a person deals with the pain depends on her attitude to labour. Attending labour preparation classes help relieve the anxiety about labour. Breathing exercises are an important part of pain relief during labour.

Your husband's presence in the labour room is also important. Your husband can encourage you as you go through labour and it is a strong bonding experience.

You and your husband can take classes to learn about childbirth, body conditioning exercises, and methods of relaxation. All of these techniques can be used with other treatments for labour pain.