Painless delivery / Painless labour is a modern day concept that relieves the women of the dreaded fear of pain during delivery. A complete reality for their dreams. There is a lot of anxiety among the first mothers-to-be and have many unsolved questions, which they try to get the answers from their elders or peers and now digital media is providing the solutions for such queries. They develop misconceptions and fears regarding pregnancy and labor.
The feeling of pain during labor and delivery varies between persons. Firstly, first-time mothers need proper antenatal guidance regarding a good nutritious diet, antenatal exercises, and the physiology of labor pains. Here we shall only be dealing with labor & delivery.
Epidural anesthesia is an advance in pain control during labor, which ensures that a pregnant woman has comfortable labor. The physician instills the anesthesia in the spinal canal in the spinal cord providing painless delivery.
It affects the sensation of the body below the waist but does not impair the movements.
Time of anesthesia
The physicians give the pregnant ladies anesthesia who are in active labor. Anesthesia can be given either continuously or discontinuously. Only a certified anesthetist can perform this sort of anesthesia.
How it is done?
There are two main techniques to administer an epidural, they are:
In a single shot or injection, an opioid-based drug is administered into the epidural space. This usually involves the doctor delivering an injection in the cervical, thoracic, or lumbar region of the patient.
Epidural catheter technique:
An epidural catheter is pushed into the epidural space where the anesthetic agent is released. The release can be continuous or intermittent.
While administering an epidural, finding the epidural space is most important. Trickiest part is not to puncture the dura or stay outside the dura.
Can there be any complications?
Any procedure in medical science has complexities and epidural is no exception to that!
The most severe complication encountered is non-achievement of the desired effect, which means an epidural failure, or achieving only a partial effect, known as a patchy epidural.
As discussed previously, the safest part is to stay away from the dura, but some technical glitches, anatomical locations or sudden movement on the part of the patient leads to puncture in the dura and an epidural becomes a spinal. In such instances a patient can have an acute headache, vomiting with vision blurring for 2-3 weeks in erect position or on coughing up.
A failed dural puncture with the delivery of entire anesthesia into space causes a fall in blood pressure and may also lead to cardiac failure.
Epidural administration requires complete asepsis; otherwise, inflammation can occur, which, if spread to the meninges (brain covering), may result in meningitis.
The complications related to the epidural catheter include migration into dura (deeper layer) or into a blood vessel or may form a knot inside or may break during pulling out. Very rarely it can lead to backache of short duration.
What isn’t a candidate for an epidural?
The contraindications for an epidural anesthetic are patients with the following conditions:
- Low blood pressure due to shock,
- Heart diseases,
- Anatomical difficulties in the spinal column,
- Infections of the tissue near the epidural region
- There is a reported allergy to the local anesthetic medication used in epidural anesthetics
- Almost absolute relief from pain with the woman being mobile
- No postpartum headache as in spinal anesthesia
- Mother is awake throughout the labor
- If required, delivery with instruments may be done under the same anesthesia
- If the patient has to be taken for cesarean section, the effect can be topped up through the epidural catheter.
- The sudden drop in the blood pressure
- Due to pelvic floor loosening, the baby’s head may not rotate and forceps utilization may be required.