Public Awareness - PAIN RELIEF IN LABOUR

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Combined Spinal Epidural Block

Here a local anaesthetic drug is placed in the subarachnoid space to get a prompt and instantaneous effect and also an epidural catheter is placed to get a prolonged and continuous pain relief.

What is Walking Epidural?
When local anaesthetics are administered in the epidural space they not only block the pain impulse transmission but also block the motor fibres supplying the muscles in that area. This causes weakness or sometimes total paralysis of the muscles below the umbilicus temporarily, which gets corrected after some time. But, this itself is disadvantageous in some ways: a. The mother cannot sit up or walk to the toilet during labour. b. The mother cannot push the baby voluntarily during the second stage thus increasing the instrumental deliveries. This was the situation a few years ago when the Anaesthesiologists were using high concentration of local anaesthetics (>0.125% Bupivacaine) and narcotics were narcotics were not in use. But nowadays we use a combination of a very weak solution of a local anaesthetic (0.0625-0.1% Bupivacaine) with a powerful narcotic like Fentanyl or Sufentanyl which produces intense pain relief yet maintaining the muscle power so that the mother can be ambulant during early labour and also can push during delivery. This technique is popularly known as Walking Epidural.

SIDE EFFECTS
Most side effects of epidural analgesia are mild and hence are insignificant.
Shivering
Epidural can cause shivering in about 30% of the patients. But this is something that is very simple and can be treated by just warming up the mother by covering using a blanket.
Fever
Mild fever is a rule in all epidurals. But the temperature rarely goes above 38o C. It does not cause any harm normally and can be treated simply by an oral paracetamol.
Itching
Itching of the nose, peri-oral region and flanks is a common problem. In most cases it need not be treated at all, but if becomes troublesome can be treated with a mild anti-histaminic like Inj Chlorpheneramine (a harmless drug).
Hypotension
A fall in blood pressure is also a possibility but rarely is it severe. Rapid intravenous fluids (1-litre of lactated Ringer solution) should be infused before instituting an epidural.

COMPLICATIONS

More serious complications like local anaesthetic toxicity, total spinal anaesthesia, nerve injuries and Neuraxial infections are all a possibility but are extremely rare (less than 1 in 1,00,000). Hence they are all of academic importance only.

Why is epidural not popular?

Lack of awareness this field is relatively new and hence even among the medical professionals the awareness is far from acceptable levels.

Lack of facility Epidural Labour Analgesia requires a dedicated team of Obstetricians and Anaesthesiologists which is not present even in the metropolitans.

The attitude of accepting labour pains as an integral part of child birth People think labour pains are inevitable and hence have to be accepted. The feeling is that labour pains were there during our forefathers time and is going to be there in the future too.

The male dominant society Though labour pains are universal, the affected population is only 50%( only females!!). Even among women those who have passed the reproductive age group do not have to suffer labour pains and hence join their male counterparts asking the parturient to tolerate the labour pains. Ultimately the percentage of vulnerable population is a meager minority (less than 10%).

Labour Pains are inevitable. They cannot be postponed and hence for whatever reason she cannot get pain relief (Lack of facilities, consent etc.,) and thus will have to bear the pain.

Out of all the kind of pains the mankind has to suffer the labour pain is the only one which has a final positive outcome The Child. The smile, the play, the cry and all that a baby has makes the mother forget the pain which she has suffered and stimulates her to get prepared for the next one.

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ISA KANYAKUMARI

Public Awareness

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