Say No To Pain
Hi! Friends.
What does the title mean to you? You would say it’s so obvious that none of us wants to bear the pain. And would do everything possible to avoid pain. Exactly! That’s what I want to tell you today. Pain during labor is one such situation where the mom-to-be is expected to endure the agony lying down without making any hue or crying about it. She ends up making lots of it is a different story. The intensity is said to be quite severe by those who have experienced the ordeal. I don’t mean to scare you. As I am sure you are educated, well-read individuals who can comprehend rationally.
God has chosen women to bear children, as it requires infinite patience, tolerance, and sacrifice. But why do the mothers have to bear the pain during childbirth? An interesting biblical story says that it is the punishment given to Eve for eating the forbidden apple in the Garden of Eden. Physicians have been trying to relieve labor pains from time immemorial. It was British physician John Snow who had administered chloroform to Queen Victoria. During the birth of her eighth child with the help of a cloth. This was the first ever painless delivery reported. Since the royal family was involved all the opposition died down and religious acceptance followed. However, it took many years to find the right method.
There are various methods of providing pain relief e.g. the Lamaze technique, prepared childbirth, acupuncture, acupressure, TENS, inhalation agents, regional analgesia, etc. The Lamaze technique includes classes for pregnant ladies. Wherein they are told about the anatomy of the uterus and reproductive tract, the physiology of labor, and breathing techniques. And what to expect during labor and how to deal with it. This is helpful as the mother knows what to expect and the fear of the unknown is eliminated. All other methods are tried and tested but the best one to date which has stood the test of time is epidural analgesia.
Let us know what is epidural analgesia.
This technique is the most effective and popular worldwide. The person who is entitled to provide pain relief is the anesthesiologist. When a lady has uterine contractions, she perceives labor pains. The pain during early labor is mild and is restricted to the lower back. But as labor advances, the intensity of pain also increases and pain is felt in the whole of the belly and thighs as well.
Which is the right time to ask for pain relief?
You can ask for pain relief at any time during the process of labor. Pain is a subjective feeling. Some women have a low threshold and hence want pain relief early in labor while some can endure it for a longer time. So it depends upon your pain perception.
What is the procedure?
Your back is cleaned with an antiseptic solution. You may be made to sit or lie down on one side. A local anesthetic is injected with a fine needle, and an epidural needle, which is specially designed, is inserted through your back from a certain area. Through this needle, a thread-like catheter is inserted in the epidural space. You are required to cooperate during the procedure as obtaining the right space is crucial and skillful.
If you don’t give the required position, the procedure may take longer. After the catheter is placed inside, it is taped to the back and the first dose of local anesthetic medicine with a small dose of opioids is injected. The effect is observed within 10-15 minutes and you will feel much better as the intensity of pain reduces considerably. The effect of the first dose may last for 45 min to 1 hour. and the medicine may be given continuously through the catheter or intermittently as and when demand by the mother is made.
Will I have no pain after that?
The severity of pain is measured with a scoring system, a scale of 0-10, e.g. 0 means no pain, and 10 means worst possible pain. When a patient demands pain relief the intensity is usually between 8-10 which is severe or intolerable pain and after giving the anesthetic drug the pain reduces to 1-3 which is very mild and quite bearable, it can be even 0 which means no pain in early stages of labor. But as the labor progresses, the severity of pain is around 2 as the dose of a drug that may be needed to provide complete pain relief will be high and hence not recommended during labor. The bottom line is you will have considerable freedom from agony and would enjoy the birth process better. Sounds interesting, isn’t it?
What are the side effects of the procedure?
As such there are minimum side effects as the dose of the drug is too less so it won’t affect the baby or the mother adversely at all. Certain effects like itching, and retention of urine may occur rarely but can be taken care of with simple measures.
Does it cause backache?
It’s a myth that an injection given in the back causes backache. The backache in the postnatal period is due to the laxity of ligaments and a change of posture during pregnancy. It can be treated with proper post-natal strengthening exercises.
Does it cause headaches?
Generally, epidural catheter placement would not cause headache but if there is an inadvertent dural puncture, headache may ensue. It may be due to the non-cooperation of the patient during the procedure. But you need not worry about it as it can be taken care of by rest and drinking lots of fluids to ensure adequate hydration.
Does it increase the incidence of cesarean section?
No, the incidence of the cesarean section does not increase as this procedure does not interfere with uterine contractions but only reduces the perception of pain. However, if there are other reasons like distress to the fetus or non-progression of labor, a cesarean section may have to be done. And in that case, anesthesia can be extended through the same catheter. Moreover, you can enjoy postoperative pain relief by getting a pain-relieving drug through the indwelling catheter.
“The delivery of a newborn in the arms of a conscious and pain-free mother is one of the most exciting and rewarding moments in medicine” a famous quote by Moir. I would like to reiterate that alleviating the pain of a laboring woman is one of the most satisfying endeavors for me. As an anesthesiologist and I feel blessed to be the chosen one. Thus I am entrusted to carry on the divine task of alleviating the pain and sufferings of the mothers.
I hope I have answered all your queries through this write-up. And hope that you are aware of the options available in today’s era and know what is best for you.
Dr. Manisha Shembekar
MD, DA
Joint Managing Director
Omega Hospital, Nagpur