Painless childbirth – Epidural analgesia during childbirth
Childbirth is a milestone in every woman’s life and is generally a pleasant experience. However, bringing a new life into the world is a difficult and painful ordeal for the woman which is why women have historically used various techniques to relieve the pains of childbirth. Among these techniques, only epidural analgesia, also known as “painless childbirth”, offers real relief from the pain during labour.
What is an epidural analgesia?
It is a technique in anaesthesiology that achieves loss of the sensation of pain on an area of the body, in this case the abdomen, genitals and perineum.
How it happens
When labour has started, and if there are no contractions, an anaesthetist can perform an epidural, i.e. insert a thin plastic tube (catheter) through a special needle into the epidural space (a space in the spine that surrounds the spinal cord). The needle is inserted into the lower back with a little local anaesthetic, and the needle comes out once the catheter is inserted. Through this catheter the anaesthetist will administer drugs (mainly local anaesthetics) until the woman is “numb” and no longer in any pain during labour. The catheter will remain in place for the duration of the labour and the anaesthesiologist will be able to repeat the doses of local anaesthetic every so often and thus maintain the desired level of “numbness” and analgesia for many hours.
Frequently asked questions
No. The anaesthesiologist uses a local anaesthetic to insert the needle into the back. The woman will feel a pinch, some pressure on her back and maybe a strange feeling like a small electric shock when the catheter is inserted. None of this is particularly painful.
No. The biggest myth surrounding epidural is paralysis and it is completely unsubstantiated, as the chance of such a complication is zero.
- The epidural can fail partially or completely.
- Nausea and vomiting due to a transient drop in blood pressure.
- The “epidural headache”. Perhaps the most serious of the possible complications, it occurs in about one per one hundred, to one per two hundred epidurals. The headache is usually severe and can last for many days but is curable in the vast majority of cases.
- “Numb feet”. Return of body sensation and movement is certain and occurs between three and ten hours after the last dose is administered, depending on the dosage used.
- Inability to urinate. There is a need to insert a urinary catheter into the bladder for a few hours.
- Itching in the body and chills.
- A slight increase in the likelihood of using an embryo or suction cup.
- Back pain. Very often pre-existing, caused by or aggravated by pregnancy and childbirth, rarely caused by epidural.
- Nerve injury. This is a rare complication. Even if it does occur, the damage to the nerve is usually transient and reversible.
- Total spinal nerve block. A rare complication that may require general anaesthesia to treat.
- Allergic reaction/anaphylaxis to local anaesthetic drugs. A rare complication.
Many women simply want to avoid the pain and the difficulty of childbirth, since science gives them this option with negligible risk. In other cases, an epidural is recommended for purely medical reasons, such as high-risk pregnancies, toxaemia of pregnancy (pre-eclampsia) and births that have an increased likelihood of ending in a caesarean section for whatever reason. In such a case the epidural can serve as the anaesthetic to immediately and safely proceed to a caesarean section without the need for general anaesthesia.
- Refusal by the woman for any personal reason.
- Blood clotting disorders or taking anticoagulant drugs for therapeutic reasons.
- Local infection of the skin of the back or severe generalized infection.
- Some peripheral neuropathies.
- Some heart conditions (e.g., severe Aortic Stenosis).
- Women with multiple sclerosis (MS) sometimes refuse to have an epidural.
- Women with a known allergy to local anaesthetic drugs.
Yes, you can have an unlimited number.
Painless childbirth through epidural analgesia is still a taboo subject, despite its widespread daily use in developed countries and its proven safety and superiority over other methods of analgesia in childbirth. Its correct use and application is transforming childbirth from a difficult and painful ordeal, into a pleasant and painless experience for thousands of women around the world. The decision to use it should be made by the woman herself after careful thought, and of course after discussing it with her anaesthesiologist and obstetrician, so that the benefits of the epidural are properly weighed against the small risks. If there is a serious contraindication to the use of an epidural, the Anaesthetist can offer intravenous drugs indicated for analgesia in labour.