Labour Analgesia
Pain relief during Childbirth

Dr Sagar Alley
Anesthesiologist
IHR India

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What is Labour Analgesia

Labour Analgesia is providing pain relief during labour thereby facilitating the smooth delivery of the baby. The benefits of Labour Analgesia are manifold.

Harmful effects of Labour Pain

1. Loss of Morale
2. Anxiety
3. Suffering
4. Increased Oxygen Consumption
5. Increased Blood Pressure
6. Increased Catecholamine release
7. Impaired Uterine Contractions
8. Decreased blood flow to the foetus

All the above effects of Labour pain can lead to decreased foetal oxygen and thereby harmful for the baby.

Benefits of Labour Analgesia

1. Relieves pain, anxiety and fatigue
2. Prevents abnormal labour
3. Decrease chemicals like catecholamines and corticosteroid level which thereby leads to improve blood flow to the foetus
4. Reduces maternal oxygen consumption

All this leads to improved oxygenation of the foetus and thereby preventing the harmful effects of labour pain

Methods of Labour Analgesia

1. Non-pharmacological :-
   • Hypnosis
   • Biofeedback back
   • Acupuncture
   • Breathing and relaxation
   • Hydrotherapy & Aromatherapy
   • Touch and Massage
   • Music

2. Pharmacological:-

There are many anaesthetic and analgesic drugs used to relieve labour pain but the most popular being Lumbar Epidural Analgesia

Epidural  Analgesia

After a thorough pre-anaesthetic checkup and consent of the patient has been taken, intravenous access is achieved and monitoring of the patient is done. The patient’s back is sterilised and an epidural needle is inserted through which an epidural catheter is inserted into the Epidural Space. Epidural space is a space around the spinal nerves. A common misconception is that needle is pricked into bones (spines). But it is not so. Medications are given in a space present in front of the spine, not in spines. After a test dose is given a low dose of a local anaesthetic drug is injected through the epidural catheter.

Combined Spinal – Epidural Analgesia

The most important new technique in obstetric analgesia is dubbed “Walking Epidural”

Advantages:-

1. Better analgesia than other methods
2. Reduced motor block so patient can ambulate
3. Lower dose of drug use
4. Continuous pain relief
5. Ability to convert from pain relief to anaesthesia

Myths

1. NICE guidelines indicate that epidural analgesia is not associated with a longer first stage of labour or an increased risk of Caesarean birth.
2. Studies have found that neither epidural analgesia alone or epidural analgesia with opioid drug like fentanyl had any adverse effect on the initiation or duration of breast feeding.

Conclusion

Modern epidural techniques and medications have resulted in more consistent, predictable and effective analgesia during labour. Recent innovations in drug combinations and delivery systems have resulted in a flexible technique that meets the needs of most pregnant women in a safe and effective manner. The use of low concentrations of local anaesthetic, combined with lipid-soluble opioids does not impede the progress of labour or depress the newborn.

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