Features: Magazine | Literary Review | Life | Metro Plus | Open Page | Education Plus | Book Review | Business | SciTech | Friday Review | Young World | Property Plus | Quest | Folio |

Enjoy the experience

Epidurals have changed the way women deliver babies without pain

BUNDLE OF JOY Arrives without pain

Priya and Sanjana are in the labour room waiting to deliver their bundles of joy. It is a first for both, but they show nothing of the nervousness associated with first-time mothers. Well into labour, they are still beaming. All thanks to an epidural analgesic that prevents them from feeling the pain caused by the contractions. The medication abolishes the pain while allowing uterine contraction to proceed, so that they can push when the doctor tells them to and relax otherwise.

Just a couple of hours ago, both were screaming to be relieved from the pain. This, when their cervix was just beginning to dilate in preparation for the birth. Ten minutes later, the babies have crowned (head becomes visible), but Priya and Sanjana show no sign of distress. Both go on to deliver healthy children. Time was when girls, unable to bear the pain associated with a normal delivery, would opt for a Caesarean. Now increasingly, doctors are counselling patients to opt for epidurals unless there is a medical emergency.

Across the world, women are given epidurals to make childbirth easier and non-traumatic. That trend is slowly catching on in India. Women are also realising the benefits of opting for a vaginal delivery where they can experience the miracle of giving birth, firsthand.

At the E. V. Kalyani Medical Centre, Chennai, pregnant women are being offered epidurals for the past five years. "They are most receptive to it. Epidurals are an excellent form of pain relief, which actually make the entire process of delivery pleasurable," says Dr. Gita Arjun, obstetrician and gynaecologist.

In her hospital, pregnant women are counselled about the use of epidurals during labour preparation classes.

Labour is divided into three stages. The first, where the cervix dilates from 0-10 cm, is most painful. It is in the latter half of stage one and in the early part of stage two (full dilation to delivery) that one requires an epidural. For this, the anaesthetist inserts a catheter (flexible plastic tube measuring 1-2 mm) into the epidural space (which lies before the spinal cord). A syringe pump delivers the medicine. Contrary to fears, an epidural does not increase the chances of a Caesarean or back pain and headache anymore than a normal, unassisted vaginal delivery, says Dr. Sudarshan, anaesthetist.

Counselling is the key. "Overseas, midwives are trained to prepare women for an epidural. Here, awareness is a little less," he says.

Gynaecologist Vani Mohan agrees. She says though most women are willing to opt for an epidural, the increased cost (for the medicine, equipment and anaesthetist charges) and the fear of developing a backache discourage nearly 60 per cent of them who change their minds at the last minute. Gynaecologist Asha Rao also recommends an epidural for a vaginal delivery provided the patient is fit.

"All said and done, a normal delivery is more advantageous to the mother and there are lesser complications. But, sometimes, girls are exhausted midway through labour."

Earlier, only a Caesarean would help in such cases. But now an epidural supports the pregnant girl morally and makes her more comfortable. Most important, it removes the fear factor.

An epidural makes the partner feel comfortable in the labour room.

"The fact that he does not have to see his partner suffer makes a lot of difference," says Dr. Gita.

The real thing

Still there are some who insist on a normal delivery.

Like, Vanitha who bore the pain, without shedding a tear. Ask her why she didn't opt for an epidural and she says: "I wanted to experience the intensity of the pain and the sensation of the baby coming out."

Dr. Gita agrees. "We don't suggest that everyone has an epidural. When someone is having a reasonably comfortable labour, we just give them a pain killer and allow them to deliver normally."

Painless option

One of the reasons why an epidural is not popular here is that an anaesthetist has to be on call throughout. "Though the obstetrician and patient decide on an epidural, the principal person behind the technique is the anaesthetist," says Dr. Sudarshan. In India, where there is still no official system of midwifery, this poses a problem.

Otherwise, a trained midwife can monitor pain relief. It is also vital to take a prior decision on an epidural. A patient can decide on pain relief at the last minute, but it poses a problem of logistics. If the decision is taken earlier, a catheter can be inserted before the onset of labour and the medicine injected later. If you are against being injected in the spine region, you can go in for medical gas. Entonox is an alternative to an epidural. When inhaled during severe pain, it can immediately ease pain by 60-70 per cent.

An epidural is not fool proof. Possible problems include increased incidence of instrumental delivery (forceps, vacuum) (15 per cent), back pain (.5-1 per cent), headache (1 per cent) and a Caesarean (1-15 per cent). The percentages are, however, no different than in normal, unassisted labour. But, with better anaesthetic and patient care, these incidences can be brought down.

SUBHA J RAO

Printer friendly page  
Send this article to Friends by E-Mail