Dr. Sushil Kumar Bangalia (MD, DNB, MNAMS)

Consultant Pain Medicine Consultant Obstetric Anesthesia & Labor AnalgesiaConsultant Intensive Care Unit

(Ex.PGIMER Chandigarh.)

PAINLESS DELIVERY

HISTORY Labor Pain : Worst

imaginable pain No other situation where

severe pain is acceptable

15th Century – Midwives offered pain relief burned (wrong to avoid the pain of divine punishment)

Biologic process subject to study and control by new methods of science.

Queen Elizabeth eighth child

Last 100 years : Most Effective & safe(ACOG recommended)

PAIN OF CHILDBIRTH Uterus contracts & relaxes

to push baby down. These contractions like a vigorous exercise are responsible for pain.

Pain impulses travel from the uterus to the brain via nerves in the backbone.

Initially mild, slowly increases in frequency and severity. More in anxious and in primi.

Each women’s labour is unique.

REGIONAL ANALGESIA (EPIDURAL & SPINAL)

Pain impulses are blocked with in the back bone and they do not reach the brain.

Will the labour progress if there is no pain?

Epidural techniques block the pain produced by uterine contractions. They do not reduce intensity & frequency of contractions. Thus, it does not have bad effect on progress of labour, actually it fasten the progress.

OTHER METHODS OF PAIN RELIEF

Systemic Medication

WHICH IS BETTER ?

Minimize pain but not labour and safe to both baby and mother.

ALTERNATIVE METHODS

AROMATHERAPY HYPNOTHERAPY LAMAZE TECHNIQUE ACUPUNCTURE TENS BATHING TOUCH & MASSAGE

BACKBONE

TYPES OF REGIONAL ANALGESIA

EPIDURAL SPINAL

WALKING EPIDURAL Combined

Spinal Epidural

HOW DO I POSITION MYSELF

ACTUAL PROCEDURE

MONITORING

IDEAL REGIONAL ANALGESIA

WHEN CAN I HAVE AN EPIDURAL

ACOG (American College Of Gynecologists) Recommendations:

Maternal Request is sufficient indication

EFFECT ON BABY

Beneficial : Increases blood flow Newborn outcome better

EFFECT ON PROGRESS OF LABOR

Walking or Sitting more upright

Speeds up the progress of labor

CAN I EAT OR DRINK DURING LABOR

Active Labor :•Avoid Solid food•Clear fluid (Water, Fruit juices without pulp, cold drinks, clear tea, black coffee.)  1glass/hr

SIDE – EFFECTS & COMPLICATIONS

Excellent worldwide safety record. As with any procedure, however, some patients may experience some minor side effects like shivering; decreased blood pressure; mild itching in labor; headache; persistent pain in some areas, etc. Other complications are very rare like local anesthetic reaction(inform if H/O allergy)

Are there any other advantages?

Apart from pain relief, Increases blood supply to baby and improves

its well-being . Especially where blood supply to baby is compromised e.g. High BP, Growth restricted babies etc.

Shorten duration of labour. Studies have also shown that the caesarean

delivery rate is reduced. If a patient requires emergency caesarean

section, anaesthesia given through the same catheter without additional pricks.

COMMON WORRIES Does Epidural increases the chances of Cesarean

Section ? No

Does Epidural affect Breast feeding ? No

Does Epidural cause back pain ? No. The reason for backache after delivery : -laxity of ligaments & abdominal muscles, -change in the curvature of back, -lack of calcium in diet / supplement.

COMMON WORRIES

Scared of needles ? Before epidural needle, numbing medicine

with tiny , thin needle, less painful than labor pain. Then you only feel pressure.

Will I able to push? Yes. It make pushing more comfortable.

Will I be able to urinate Every hour pass urine, without urge.

COMMON WORRIES

Do I have to stay in bed? Not necessarily.

What will I feel? Significant pain relief will occur, may aware of

pressure of contractions. May temporary numbness, heaviness in legs.

How long will block last ? Till delivery with additional doses. After delivery,

catheter will be removed and, within a few hours, sensations will return to normal. 

COMMON WORRIES

What if I plan for delivery without Epidural ? By all means you can go ahead. At any time if

you feel that it is too much to bear the pain and change your mind, we will be happy to help you. Changing your mind should not be considered as failure.

Situations where Epidural have an advantage? High BP, Heart diseases, Lung diseases etc.

INFORMATION

http://www.aoaindia.com/patient Information.html

ENJOY YOUR CHILDBIRTH

SHARINGS