Pain threshold varies from person . Some people can bear extreme pain while some cannot tolerate pain caused even by a pin pick . Labour pain though of short duration can have bad and fearful memories . Nowadays laboure can be made bearable with the use of different drugs like Narcotics, Inhalation agents and Epidural Analgesia. Narcotics and other inhalation drugs only help in relieving pain to a certain extent, they do not ensure painless childbirth nor do they mark extremely painful labour tolerable. Relief from such painful uterine contractions can be accomplished by injecting a suitable local anasethetic agent into an Epidural space in the spinal column. This is Epidural Analgesia populary known as Painless Labour and Childbirth .
Epidural Analgesia has many advantages; it gives continuous pain relief and is relatively safe for both the mother and the child . If prevents exhaustion and preserves the morale of the patient . The patient is awake and can make movements without feeling the painful uterine contractions .
Indications for the use of epidural analgesia are not absolute but may be placed in the order of priority , It is especially helpful in hypertension , slow painful labour , fear of repetition of previous painful labour and expressed wish of the patient to have painless labour .
Prior to epidural analgesia a written consent of the patient is taken and an IV drip of 5% glucose is started . The patient’s back is cleaned with an antiseptic solution and a small injection is given at the back through which a needle is introduced in the epidural space. Then a sterile, than plastic tube /catheter is passed through it into the space. This catheter is then fixed on the back and the patient is made to lie on her back .The analgesic agent is injected through this tube and in about 10 minutes the analgesic effect is felt by the patient .The pain sensations are abolished and slight heaviness of the legs may be felt .Some times nausea, vomitting and slight drop in blood pressure may occur. Since the catheter is retained in the space repeated doses can be given as and when required that is after 2-3 hours till the patient delivers.
Epidural Analgesia is normally given when uterine contractions are well established , that is every 5 to 10 minutes . it may be given early depending upon the severity of the pain experienced by the patient.
Epidural Analgesia is contraindicated in patients of previous caesarean section , abnormal fetal position, local skin infections, previous surgery on the back and bleeding disorders. In a small percentage of patients complete pain relief may not be achieved and indication for obstetric interferences do not change with this procedure.