Pregnancy is a dream come true of all couples. The first time mothers are filled with apprehension and innumerable questions. They get their queries solved by consulting their elders and peers and now newsgroups. They develop misconceptions and fears regarding pregnancy and labor.
During the labor or delivery there is stretching of the cervix, uterus, vagina and perineum leading to stretching of nerve fibres supplying them, thus causing pain. The soft tissues are squeezed due to fetal skull and add pain. This is the reason why pain subsides and decrease in intensity after the head comes out.
At present one has the following options for painless labor.
- Analgesics (pain killer): Morphine group of drugs are only effective but used mainly in earlier stages when the pain is not so intense. It has serious side effects on baby, so used rarely.
- Oxygen and nitrous oxide mixture: this mixture is inhaled to get rid of pain. It is very safe to both mother and baby, but not very effective, good amount of pain persists. 3)
- Epidural analgesia and anaesthesia: It is the most effective, most safe for both mother and baby and so, most widely used in western country. More than 85% of expected mother prefers this method at present days in western countries and available since 1960s. A fine catheter (tube) is introduced in the back between two lumber vertebrae in a space called epidural space, which lies immediately outside the outermost layer of the spinal cord (There are three layers or membranes which cover and protect spinal cord.). Whenever there is pain, a liquid (diluted anaesthetic drug mixed with other drugs) is introduced via the indwelling catheter and there is almost instant pain relieve. Some ambulatory pump introduces the drugs contineuously. Here only the pain sensation of abdomen and lower limb goes away. The patient is fully conscious, can move her legs and all other sensations are present. Other methods (TENS etc.): not so effective.
- Yoga for pregnancy: There are some yoga and pranayamas and mudras which should be done during pregnancy and these has been proved to be effective for a painless delivery. The two very important pranayama and yoga for painless delivery are Bhramari Pranayama which tunes neuroendocrine system of our body and helps in releiving pain during delivery. Other yogasana is Baddhakonasana which provides strength to reproductive organs and muscles active during delivery and makes them more flexible thus reduces the pain. Though some may be anxious and unable to perform yogasana, for them mudras are easier and equally effective which stimulate the body and positively affect reproductive organs. These yoga and mudras or pranayama should be done during the pregnancy period for a safe, painless and uneventful delivery.
- Hypnosis for painless delivery: Hypnosis, is a mind body techniques, It is a process of allowing the mind and body to relax deeply. In hypnosis, suggestions are given, which helps in interpreting contractions as a sensation that is allowed and not oppose them. A person who feels “this is excruciating and extremely painful” has a very different experience from someone who says “this strong sensation means my cervix is opening and now every force can make me a mother of a cute baby.”
Many believe hypnosis means being controlled by someone else. This isn’t true as the first premise of this art is that all hypnosis is self-hypnosis. No one can force you to do or believe anything that you don’t agree with.
- Water birthing a method for painless delivery: Water birth is a type of hydrotherapy for pain management during delivery. It is very much effective for back pain. In this method the woman is made to sit in a tub of warm water for the delivery. The warmth significantly relieves the pain in the fist stage of delivery while cervix of the uterus opens gradually. The buoyancy of the mother and baby allow for a gravitational pull which not only opens up the pelvis, but also allows the baby to descend more easily. Moreover, due to the documented relaxing effects of water, this method is sometimes associated with a decrease in the intensity of contractions, and is thus thought to slow down labour.
Disadvantage of water birthing is one that there is a chance of infection though water and the other disadvantage is the risk of water inhalation by the baby.
More on Epidural Anaesthesia
Epidural anaesthesia is an advance in pain management during labor, which ensures that a pregnant woman has a comfortable labor. It is a regional anaesthesia in which an anaesthetic drug is injected near the spinal cord in the spinal canal.
Areas affectedIt numbs the body below the waist, but the movements are not impaired.
Time of anaesthesia
- It is administered when the patient is in active labor.
- It can be given as a single injection or in multiple doses through a special epidural catheter by a skilled anaesthetist.
- Almost complete relief from pain with the patient being mobile
- No postpartum headache as in spinal anaesthesia
- Mother is conscious and alert throughout the labor
- An instrumental delivery can be performed under the same anaesthesia, if need arises
- If the patient has to be taken for caesarean section, the effect can be topped up through the epidural catheter.