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Painless Delivery

    If you are a new mom-to-be, you would certainly be experiencing mixed feelings of both excitement and fear. When you conceive, you think about eating right and opt for a healthy lifestyle to help your growing baby with the right nutrition. But as you reach close to your due date, you would probably feel tensed thinking how you are going to give birth to your baby. And the options are either a vaginal birth or having a c-section.

    Almost everyone knows the severity of the pain a woman during natural birth. The pain a woman experiences during the process of childbirth is considered to be the most severe form of pain. And the survival after delivery is considered as the rebirth of the woman. This concept of ‘chance survival’ has changed with the advent of C-Section. C-section has become a boon to many women who couldn′t deliver their baby naturally and for those who have high-risk pregnancies. But, many women started choosing c-section just because they are afraid of the normal delivery pain.

    If you are one among those women, who plan to have a c-section only because of the fear of labor pains or if you have a question “how to get normal delivery without pain?”; you have another option to bring your baby into this world without pain, known as “Painless delivery” or “Epidural delivery”.

    What is Painless Delivery?

    Painless delivery is the natural way of childbirth almost without experiencing any pain during the labor. In short, painless delivery is nothing but the normal delivery without pain. The epidural anesthesia used in this procedure, helps mothers relieve the normal delivery pain and is the most popular method for pain relief during labor. 

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    How does an Epidural work?

    During labor, the uterus contracts powerfully to squeeze the baby out. These contractions are the main cause for the labor pain. The labor commences, when the uterus begins to contract and the cervix starts to open to make way for the baby to come out. During labor, the pain from uterus contractions travels from the uterus to the brain through the nerves of the backbone or spine.  

    An epidural works as a regional anesthesia. When an epidural is injected near the spinal cord in the spinal canal, the anesthetic drug causes a feeling of numbness in the abdominal, genital and pelvic areas. The loss of sensation in these parts blocks those intensifying sensations and prevents the transmission of pain sensations to the brain. Thus, an epidural during the labor ensures the process of childbirth is successful with no pain. 

    Painless Delivery Procedure:

    The procedure of a painless delivery is similar to that of a normal delivery procedure except receiving the epidural to ease labor pains. But, as every woman wants to be sure about each and everything when she is planning for her baby’s birth; here is the complete procedure of painless delivery.

    Before the active labor begins and prior to the procedure of placing the epidural, the woman will be given intravenous (IV) fluids. In general, a woman may receive around 1 – 2 liters of IV fluids throughout her labor and delivery. 

    To start the epidural procedure, your anesthetist may ask you to arch your back and remain still either by bending over a pillow, or lying on your side or sitting up. This position makes it easier to insert the needle into the right place and increases the effectiveness of the epidural. 

    Your lower back will be wiped with an antiseptic solution in order to minimize the chances of infection. Then, a small amount of a local anesthetic will be injected on your lower back to numb the area. A small tube, called a catheter is then threaded through the needle into the epidural space. An epidural space is an area between the bones of the spine and around the spinal nerves. 

    The needle is then removed carefully while leaving the catheter in place to provide the anesthetic either through injections at regular intervals or by continuous infusion. The catheter will be taped to prevent it from slipping out. After giving the epidural, it takes between 5 and 30 minutes to be relieved from the labor pain.

    Painless Delivery Side Effects:

    Painless delivery is generally considered to be safe and reliable, but sometimes the epidural anesthesia used during the labor to relieve the pain may exhibit some side effects which one should look out for. The side effects of an epidural delivery can be classified into temporary and rare; as some symptoms are relieved as the anesthetic wears off or by getting some medications, while some are seen in very rare cases. Here are some potential side effects of epidural anesthesia which are common among many women.

    Temporary Side Effects:

    Itching: Some of the medications used in the epidural anesthesia can make your skin itch. You can relieve the itch with the change in the medication. 

    Nausea and vomiting: Some pain relievers can make you feel sick which may cause nausea and vomiting in rare cases. These symptoms can be treated with anti-sickness medicines.

    Fever: Some women may experience a spike in their body temperature after receiving epidural anesthesia. Fever is more common in women who are having their first babies and especially in those who have prolonged exposure to the epidurals.

    Low blood pressure:Though it is not harmful, many women experience a drop in blood pressure when they get an epidural. This is because the nerve fibers which control the contractions inside the blood vessels are affected when an epidural is given. As a result, the blood vessels are relaxed which lowers the blood pressure.

    Since the blood flow to the baby is affected if the blood pressure drops too low, the woman will be given intravenous fluids before receiving the epidural. Also, to reduce the risk of low blood pressure, a woman’s blood pressure is monitored during labor and given medication to make it normal, if needed.

    Loss of bladder control: After receiving an epidural, the woman loses her bladder control as the anesthetic affects the surrounding nerves which help her know when the bladder is full. So, a catheter will be inserted in order to empty the bladder. The bladder control will be regained once the epidural wears off.

    Backache: After delivery, women may experience soreness at the sight of epidural for few days. Also, during pregnancy, the weight of the belly puts an extra strain on the back which causes back pain. So, it is hard to tell whether the back pain is due to the epidural or from the extra weight of pregnancy.

    In addition to the above-mentioned side effects, there are some rare complications of epidural. These include:

    Severe headache: Women may suffer from severe headache if the epidural needle accidentally punctures the membrane that surrounds the spine and the fluid leaks out. This condition is very rare in the case of epidurals. The headache can be treated with oral pain relievers and plenty of fluids.

    If the pain relievers do not help, a procedure known as ”blood patch” is required. In this procedure, a sample of the women’s blood is injected into the hole, which seals it once the blood clots. This can stop the headache. However, not all headaches after receiving an epidural require a blood patch.

    Rare Side Effects:

    Infection: As an opening in the skin is created while inserting a catheter, there may be a chance for bacteria to get inside and cause an infection. But,  since the needle will be sterile and the skin is wiped off with an antiseptic solution prior to catheter insertion, the chances of infection from an epidural is rare. However, the infection can be treated with antibiotics and rarely needs an emergency surgery if the infection spreads to other parts of the body. 

    Slow breathing: Sometimes, the medications used in the epidural can affect the chest muscles that control breathing. This may cause slowed breathing or other breathing difficulties.

    Seizure / fits: If the anesthetic accidentally gets into the vein while giving an epidural, it can trigger a seizure. 

    Nerve damage: In very rare cases, an epidural can lead to temporary or permanent nerve damage. This can be caused by,

    •  A damage to the nerves from the epidural needle or catheter
    • An infection in the area where the catheter is inserted or near the spinal cord
    • Bleeding in the area of epidural which causes pressure on the spine
    • Accidental injection of wrong medications through the epidural catheter

    Advantages of Painless Delivery:

    Women can have a normal delivery almost without any pain and will be conscious which enables them to see the process of delivery.

    • Pain during labour induces the secretion of stress hormones in the mother that distresses the baby and mother as well. This doesn’t happen in painless deliveries.
    • The duration of the delivery can be significantly decreased.
    • Keeps blood pressure, pulse rate and heartbeat under control.
    • It is easy to perform a c-section if needed in an emergency.
    • Prevents damage of pelvic muscles that may occur during a normal delivery.

    Disadvantages of Painless Delivery:

    • In rare cases, there may be a sudden drop in blood pressure.
    • Since the pelvic floor muscles are relaxed, the baby’s head might not rotate and there may be a need to use forceps.
    • Epidurals can cause a backache, dizziness or shivering.
    • Mothers may experience post-procedure headaches.
    • Difficulty during urination.
    • Due to the numbness, the normal pushing effect by the woman during labour is reduced. Therefore, vacuum may be used or delivery may have to be converted to c-section.
    • Pain at the site of injection.

    FAQs about Painless Delivery

    Painless delivery is a choice for most of the women who think “how to make normal delivery less painful?”. No matter how much women are aware of the procedure of painless delivery, they still have a lot of questions in their minds. So here are some common questions about painless delivery to clear their suspicions and ease their stress. 

    When is the right time to get an Epidural?

    The right time to get an epidural is during the active phase of the labor, i.e., when the cervix is dilated to at least 4 – 5 cms. Most of the women think to wait until they reach a stage when the pain is unbearable to receive an epidural. But, it is always better to get an epidural before reaching the pain point, because a woman must be able to sit still in order to receive an epidural. Otherwise, it makes it difficult for an anesthesiologist to place the catheter safely as it might not be possible for a woman to sit still while she is experiencing the labor pains.

    Are epidurals used for delivery safe?

    Epidurals are safe and do not have any negative effects on the baby or on the labor process when administered carefully by experienced anesthesiologists. Though there are some side effects of epidurals, they are temporary and can be treated with proper medications. While severe complications exist in rare conditions, they are caused as a result of improper placement of the epidural catheter or lack of expertise.

    How long does an epidural last?

    An epidural can last for quite a long time, as long as the catheter is in place and the woman receives the medication through it. But, a woman stops receiving the medication once her baby is delivered and the catheter is pulled out. In general, it takes around two to four hours for the numbness to wear off based on the dosage.

    Does it hurt when the catheter for an epidural is being placed?

    Placing a catheter is not painful. A woman receives a local anesthesia on her back prior to catheter insertion which makes the skin numb. Women may feel some pressure and push in their lower back but nothing like a sharp pain while the catheter is being placed. If they feel any sharp pain, they can let their anesthesiologist know and can get more anesthesia to ease the pain.

    What should I do while planning for a painless delivery?

    When a woman is planning to have a painless delivery, she should

    • Choose a hospital or birth center where epidural is available
    • Know the available epidural procedures
    • Aware of the type of pain relief that suits her the best
    • Inform her doctor about allergic reactions, if any

    When can an epidural would not be a right option?

    Every woman cannot get an epidural to relieve the labor pains. An epidural may not be used to relieve the pain during labor, in any of the following cases :

    • Use of blood thinners
    • Have a low platelet count
    • Have a blood infection
    • The epidural space cannot be located by the anesthesiologist
    • When the woman’s cervix is not dilated at least by 4 cm
    • If the woman has an infection on or in her back
    • If the labor is happening too fast and there is not enough time to administer the anesthesia

    Will I be able to push after receiving an epidural?

     As the epidural anesthesia causes a loss of sensation in the abdominal, genital and pelvic areas, you might not be able to tell whether you are having a contraction or not. When the contractions cannot be felt, it might be difficult to control the push. So, the baby needs additional help to come out from the birth canal, which is usually done by using the forceps.

    What happens after the epidural is administered?

    After an epidural is administered, within a few minutes the nerves of the uterus begin to numb. It takes around 10 to 20 minutes to feel the entire numbing effect after receiving the anesthesia.

    Depending on the type of epidural and dosage, you will be confined to the bed and not allowed to get up and move around. Also, you need a urinary catheterization as you lose your bladder control due to anesthesia.

    As the effect of anesthesia begins to wear off, you will receive more doses for every one or two hours till the baby’s birth. You will stop receiving the epidural doses once the baby is born and the urinary catheterization is removed once the anesthetic wears off and your bladder control is regained.

    What can I do to minimize the risks of an epidural?

    Even if you are not planning to have a painless delivery, considering the possibility can help you avoid any surprises in the labor room. In order to minimize the chances of epidural risks and avoid negative experiences, you should be clear about your medical history with your doctor while planning for the delivery. This helps to determine whether you can get an epidural to relieve labor pain or not. Also, practicing the breathing exercises helps you to manage your stress during the labor process and while the epidural is being administered.