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Painless Childbirth

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20 Aug, 2018

Fear of childbirth

 

The arrival of a newborn is a joyous moment for the entire family as it is for the mother. With all the joy and excitement of holding her baby for the first time comes the fear of the process of childbirth, especially for first time mothers. Most women anticipate and dread the severe pain and discomfort experienced during childbirth. According to experts, if pain associated with childbirth was to be rated on the scale of 10 it would be more than 8. Such pain can be very stressful for the mother and can result in neuroendocrinal responses such as high blood pressure, increased oxygen consumption, impaired uterine contractility and higher maternal-fetal mortality and morbidity.

Due to the fear of such severe pain, many females opt for elective cesarean delivery. This trend is mostly seen in urban areas where advanced healthcare facilities are easily available. Although safe, c-section delivery is not advisable in case of women who can otherwise give birth to their child normally. Of late, different pain management strategies are being used to assist smooth childbirth. Painless childbirth is one such technique, widely used in recent times, which includes the following methods:

  • Non-pharmacological methods include psychoprophylactic method, hypnosis, and acupuncture
  • Pharmacological methods involve paracervical block, regional anesthesia, systemic analgesia, and pudendal block

 

Epidural anesthesia

It is one of the most commonly used techniques for effective pain relief during childbirth. In this method, a small dose of anesthetic agent is injected in the epidural space of the lower part of the spine. The spinal nerves originating from the spinal cord send the pain signals from the body to the brain. As a result of epidural anesthesia, these nerves become numb. This, in turn, blocks the pain signals from reaching the brain.

A catheter is used to deliver the epidural anesthesia through a special needle. The dose of the anesthetic drug can be gradually increased if required. The anesthetic effect can be seen in about 10-20 minutes after the injection.

 

Pros and Cons of Epidurals

Although it is termed as epidural anesthesia the primary aim of the procedure is to provide analgesia during childbirth. Its benefits are enlisted below:

  • It effectively reduces pain and discomfort
  • The mother is alert and can feel uterine contractions and is aware of childbirth
  • Useful in case the labor lasts for a longer duration of time
  • In case any complication arises during delivery, the patient can be taken up for a c-section with some additional dose of anesthetic
  • It helps the would-be-mother to rest, relax and have a positive childbirth experience

 

Risks involved

Some risk factors or common side effects associated with epidural anesthesia are as follows:

  • It can cause drops in maternal blood pressure (BP)-
    • Needs continuous BP monitoring
    • Intravenous fluid administration, if required.
  • It can cause fever in some women
  • About 1% of women may experience a headache due to the leaking of spinal fluid
  • Difficulty in urination
    • A urinary catheter can help
  • Back pain or soreness is reported by a few patients
  • In some cases, vaginal delivery can take a long time with epidurals

 

Neonatal effects

Epidural anesthesia is safe and does not have any long-term effects on the neonates. It may also depend on factors such as the type of medications and dose used, duration of labor, etc. The following effects have been reported in a prospective cohort study conducted to evaluate the immediate effects of maternal epidural anesthesia on neonates:

  • Initiation of breastfeeding was not affected by epidural anesthesia
  • Asphyxia at birth was not found to be associated with maternal epidural anesthesia
  • Time of passage of urine- Delay in the passage of urine has been reported in some case, but it is still within the physiological limit of 48 hours.
  • Instrumental intervention in delivery, such as forceps or vacuum, was found to be greater in case of epidural anesthesia.

 

The other pharmacological pain management methods mentioned earlier include:

  • Paracervical block-
    • Local anesthetic agent is injected directly around the cervix
    • Helps to reduce the pain caused by dilation of the cervix 

 

  • Pedundal block-
    • Local anesthetic, like lidocaine, is injected into the pedundal canal
    • Usually given in the second phase of labor
    • Provides pain relief around vagina and rectum

 

It is of utmost importance that the childbirth is uneventful and safe for both the mother and the child. Use of epidural anesthesia can turn a challenging task of the mother-to-be into a more positive and even enjoyable experience. As the process of childbirth is complicated, a number of factors need to be considered while deciding on the right method of delivery (size of the baby, maternal pain tolerance levels, etc.). Increased awareness about painless delivery methods can alleviate the fear of delivery in women and make them more comfortable in the later stages of pregnancy. This will also help to cut down on the number of unwarranted elective c-section deliveries and their possible complications.