Painless Normal Delivery
LABOR ANALGESIA
“Delivery of the infant into the arms of a conscious and pain-free mother is one of the most exciting and rewarding moments in medicine.”
Why do we need Obstetric Analgesia?
- All mothers who are on the verge of motherhood have one common fear.
- The fear is of acute labor pain during the time of childbirth.
- The quantum of pain varies from one mother to another mother.
Effect of labour pain on mother and foetus
Labour pain causes:-
- Marked stimulation of respiration and circulation in mother.
- Activation of sympathetic nervous system
- Mental disturbance-
– postpartum depression
– post traumatic stress disorder.
Lumbar epidural analgesia
- Gold standard technique for pain control in obstetrics
- Low doses of local anaesthetic or opioid combinations are administered
Advantages
- Almost complete relief from pain with the patient being mobile
- No postpartum headache as in spinal anaesthesia
- Mother is conscious and alert throughout the labor
- An instrumental delivery can be performed under the same anaesthesia if need arises
- If the patient has to be taken for caesarean section, the effect can be topped up through the epidural catheter.
Disadvantages
- Sudden drop in the blood pressure
- Because of pelvic floor relaxation, baby’s head may not rotate and forceps application may be required.
Who should have an epidural?
In some patients, epidural is recommended to optimize outcome.
- If you have complicated or prolonged labor, in such circumstances it will benefit you and your baby.
- If you are trying for a VBAC (vaginal birth after cesarean section)
- If you have certain medical conditions such as certain heart conditions, hypertension & preeclampsia.
WHO should not have an epidural?
- Those with certain bleeding disorders
- Those taking medications that can affect blood clotting \(clopidogrel, heparin, warfarin, etc)
- If you have had a Lower back surgery (in certain cases)
- If you have certain neurological disorders
Can an Epidural Fail?
Occasionally, epidural may not work as well as we would like it to. If this happens, the anesthesiologist will help by giving extra doses or changing your position or the catheter position. If it still does not work, the procedure has to be repeated (by placing the epidural catheter again)