painless labour 2

Pregnancy

A dream come true for all couples. The first time mothers are filled with apprehension and innumerable questions. They get their queries solved by consulting their elders and peers and now newsgroups. They develop misconceptions and fears regarding pregnancy and labor.

The perception of pain during labor and delivery varies between individuals. Especially, first-time mothers need proper antenatal counseling regarding a good nutritious diet, antenatal exercises, and physiology of labor pains. Here we shall only be dealing with labor & delivery

Epidural anesthesia is an advance in pain management during labor, which ensures that a pregnant woman has comfortable labor. It is a regional anesthesia in which an anesthetic drug is injected near the spinal cord in the spinal canal.

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 labor. It can be given as a single injection or in multiple doses through a special epidural catheter by a skilled anesthetist.

How is it administered?

There are two main techniques to administer an epidural, they are:

Single-shot epidural: The epidural space is usually injected with opioid medication, by injecting it into the epidural space. This usually involves the doctor administering an injection on the patient’s back (in the cervical, thoracic, or lumbar region).

Epidural catheter technique: Alternatively a fine bore tube can be passed into the epidural space and the medication can be deposited into the epidural space continuously or intermittently.

While administering an epidural, finding the epidural space is most important. The trick here is not to puncture the dura or stay outside the dura.

Can there be any complications? 

Any procedure in medicine has complications and epidural is no exception to that!

The most serious complication that can occur is that the desired effect is not achieved which means a failed epidural, or it can act partly which is called a patchy epidural.

As explained earlier the trick is to stay outside the dura but sometimes due to technical difficulty, anatomical problems or if the patient moves suddenly during the procedure one can puncture the dura and an epidural becomes spinal. In such instances a patient can have a severe headache, vomiting with blurred vision for 2-3 weeks on assuming an erect position or on coughing.

If this puncture is not noticed and the whole dose of the medicine is injected in a patient then a patient can suffer from a fall in blood pressure, difficulty in talking as well as breathing leading very rarely to even a cardiac arrest.

Sterile aseptic precautions are a must while doing an epidural otherwise infection is a possibility which if spread to meninges (covering of the brain) can lead to meningitis.

If a catheter is used then it can migrate to deeper layers like the dura or a blood vessel, may get knotted inside the space or can break while being removed. These are called catheter-related complications of the epidural. Very rarely it can lead to backache of short duration.

Who should not be administered 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,
  • Skin infections at the site where epidural is given,
  • Known allergy to the local anesthetic drug that is injected in epidural anesthetic.

Advantages

  • Almost complete relief from pain with the patient being mobile
  • No postpartum headache as in spinal anesthesia
  • Mother is conscious and alert throughout the labor
  • An instrumental delivery can be performed under the same anesthesia if the need arises
  • If the patient has to be taken for cesarean section, the effect can be topped up through the epidural catheter.

Disadvantages

  • The sudden drop in the blood pressure
  • Because of pelvic floor relaxation, the baby’s head may not rotate and forceps application may be required.

Slightly increased rate of instrumental and cesarean deliveries.

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