Normally during the process of giving birth to a child(labor) there are intense contractions of the uterus which are very painful
Many urban women want to deliver a child normally but they are afraid to do so because of the pain associated with normal delivery.
A women whose pelvic passage is adequate, and who wishes to opt for a normal delivery but is afraid of the pain that she has to go through can select the option of Painless Delivery, it is possible to have a painless delivery with an epidural anasthesia in medical terms it is called the “Epidural Block.”
The epidural block has been used over the past 50 years. It is seen that more and more women now plan and demand an epidural block in order to avoid labor pain.
In this article we will see what is an epidural block? How it helps in a painless delivery? What are the significant advantages and disadvantages of epidural anesthesia? Are there any better alternatives to epidural?
What Is an Epidural Block ?
Epidural anesthesia or analgesia refers to total or partial loss of sensation in the trunk between the fundus and the pubis or lower.
An anesthetic agent such as Marcaine, Lidocaine or Carbocaine), a narcotic such as Demerol, or Fentanyl, or a combination of the two, is injected in the lower back in the epidural space between lumbar vertebrae two and five (L-2 and L-5).
One must understand the difference between Anesthesia and Analgesia.
Anesthesia, as with a standard epidural, is the total loss of the sensations of labor, while Analgesia, as with a light epidural is the partial loss.
Benefits of Epidural Block
- Epidural anesthesia or analgesia provides relief or reduction of labor pain without affecting the mother's mental state.
- It enables an exhausted mother to relax or sleep during labor and calms the woman who is anxious and tense because of pain.
- Once an epidural catheter is in place, additional medication can easily be administered as needed, providing prolonged and consistent pain relief.
- Some women are very anxious about their labor , Anxiety can cause excessive production of the mother's stress hormones such as epinephrine and norepinephrine, which slow contractions. By allowing the mother to rest without pain, the epidural removes her anxiety and her labor progress may improve.
- Epidurals often lower blood pressure, this may benefit some women with pregnancy induced hypertension.
- Epidurals are also useful for cesarean births, making it possible for the mother to remain alert and involved while free from pain. They enable her to avoid general anesthesia, which is considered to carry greater risks.
- Epidurals reduce pain without reducing other sensations or muscle function, hence the women can change positions more easily than with anesthetics.
- The women remains aware of her contractions and often continues to participate; using breathing patterns and other comfort measures.
Epidural blocks carry some risks to the mother, fetus and newborn.
Undesired effects tend to be greater with larger doses of medication, a longer interval during which the medication is in effect and immaturity or distress in the fetus.
Undesired effects on the mother:
- Inadequate pain relief (up to 10%)
- Drop in the mother's blood pressure treated with position changes, oxygen and possible vasopressors (less likely if a bolus of IV fluids is given before the epidural).
- Short or long-term postpartum backache from bruising caused by the injection or from ligament strain caused by prolonged time spent in a damaging position or inappropriate movement
- Long-term backache is almost twice as likely to occur with an epidural than without.
- Possible unintentional spinal block and resulting spinal headache requiring days of bed rest.
- Mild to severe itching of the skin (with narcotics)
- Retention of urine, requiring a bladder catheter.
- As there is no pain the mother may feel detached from the process and becomes just an observer.
- The attending doctor or nurse can no longer assess labor progress by observing the mother and must rely more on the monitor and vaginal exams.
- Problems caused by human error or maternal structural anomaly, such as inability to place catheter properly; inadvertent injection of anesthetic into a blood vessel; or too much anesthesia, affecting respiration and swallowing (rates vary with skill of the practitioner and anatomy of the mother).
- Rare complications, such as residual numbness or weakness from needle injury to nerves (almost 1 in 10,000)
- Delayed respiratory depression with epidural narcotics (up to 12 hours later)
Undesired effects on the labor:
- Epidurals may slow labor, requiring Pitocin;( a drug used to increase contractions ) and has been found to increase the chances of a cesarean delivery in primigravidas by two or three times.
- An epidural often slows second stage by reducing or eliminating the normal surge of oxytocin; and by reducing pelvic floor muscle tone, which may lead to more deep transverse arrests or persistent occiput posteriors.
- In addition, forceps or vacuum extractor are required more often (20-75%).
- Delaying pushing until the fetal head is on the perineum reduces the need for forceps or vaccum. Even though this approach lengthens the second stage, it does not increase the incidence of fetal distress.
Undesired effects on the fetus:
Abnormal heart rate patterns, requiring oxygen to the mother, position changes and possible cesarean delivery.
If the mother develops post epidural fever, it can affect the baby by passing on the infection thus leading to need of antibiotics etc for the baby.
Undesired effects on the newborn:
Some babies may show subtle neurobehavioral effects, such as irritability and inconsolability and decreased ability to track an object visually or to shut out noise, bright light.
It is reported that there are more difficulties in feeding babies whose mothers had an epidural when compared to unmedicated babies.
Decreased infant responsiveness may lead to long-term consequences for the parent-infant relationship.
Parents need to be counseled to give their babies time to recover from the birth and medication and should avoid a label of "difficult child" or "incompetent mother."
When the mother is managing her pain well and progress is normal, the risks of an epidural outweigh the benefits. If, however, she is exhausted, in extreme pain or requires painful interventions, the benefits may outweigh the risks.
Epidural is a relatively safe alternative available but there are other and much safer alternatives available to epidural anesthesia.
Homoeopathy – Homoeopathic medicines are an much safer alternative to epidural anesthesia, homoeopathic remedies can provide excellent pain relief and a smooth progress in labor with no potential risk to the mother and the fetus.
Irrespective of the phase, pace & complications encountered in pregnancy & childbirth homoeopathic remedies can help to ease the process and help in a smooth delivery.
Some commonly used homoeopathic remedies for pain management are-