Labor pain causes unnecessary ache, physiological stress as well as fatigue for the mother. Therefore, pain-free delivery with epidural anesthesia (anesthetic agents administered from low back) has, recently, gained popularity.

When Is Pain-Free Delivery Performed?

It is started after uterus starts contracting at regular intervals and cervix thins or effaces by approximately 60 to 70% and dilates by 4 cm; at this phase of the delivery, labor pain causes significant distress to the mother. On the other hand, earlier administration affects the contractions adversely and delays the delivery. However, the mother suffers from unnecessary pain and cannot stay still while the epidural catheter is inserted in case of late administration.

How Is Pain-Free Delivery Performed?

First, the site of injection on the mother’s back is scrubbed with an anti-septic solution and covered with a sterile drape. This approach aims infection prevention. Then, skin and subcutaneous tissues are numbed with a very thin needle.  A catheter is inserted using a blunt-tip needle into the epidural site and the drug is administered. It is crucial for the mother to remain still for several minutes especially at this point. Catheter is a very thin and small tube that is made of soft materials. It is inserted to administer additional drugs after effect of the first medication wears off. The exposed part of the catheter is adhered on the skin of shoulder with a special nonallergenic plaster. This catheter is easily removed after the pain disappears completely following the delivery.

Since the goal of epidural anesthesia in spontaneous vaginal delivery is only to eliminate pain, potent pain killers are also administered along with smaller doses of local anesthetic agents into the epidural space when compared to the C-section. This allows the mother to have a sense of touch and be able to move legs, since motor function loss does not occur, but no pain is felt at all. Dose of local anesthetic agent is minimized, enabling the mother even walk during spontaneous vaginal delivery.

What Are Advantages Of Pain-Free Delivery?

• You can walk after the drug is administered.

• Epidural analgesia does not cause disorientation or make you feel ill.

• It does not inhibit bowel movements or disrupt gas discharge.

• It increases the odds of spontaneous vaginal delivery by providing psychological relief and relaxing the muscle spasms.

• It eliminates most of the delivery stress and relaxes the muscles. You will feel the pressure and contractions instead of labor pain.

• You can start pushing simultaneously with contractions when giving birth and thus, you can quicken the delivery.

• You can hold your baby sooner and breastfeed immediately since you will not be fatigued after giving birth.

• You will not feel pain, while forceps is used or stitches are placed during the delivery.

• Since the local anesthetic agent is not given into blood stream, its effects on the baby are minimal. The procedure ensures perfect management of pain in the mother without any effect on the baby.

What Are Potential Procedure-Related Problems?

The two most common problems faced after epidural drugs are administered are low blood pressure (hypotension) and nausea, which are easily treated.

Regional or temporary itching disappears spontaneously or it wears off several minutes after a drug is administered.

Headache is more common if the patient moves excessively during the procedure or it is performed by inexperienced staff. Said conditions can be seen only in one out of 100 to 500 patients; may occur within 3 to 5 days after the procedure and will disappear in 1 to 5 days.

When they hear the word “epidural”, every candidate mother is scared of permanent disabilities (paralysis), which is an extremely rare condition when administered by an experienced anesthesiologist.

Neurologic complications (strength loss in legs or urinary incontinence) are very rare.

Epidural anesthesia does not usually cause low back pain unless a problem exists at low back region (the concern for herniated lumbar disk is completely groundless). It is an option and not contraindicated for people with lumbar hernia and low back pain.

Who Are Not Administered Epidural Anesthesia?

This type of anesthesia is contraindicated for patients with active bleeding, low blood pressure due to excessive hemorrhage or other causes, allergic to the anesthetic agents, infection at the injection site or suspicion of neurological disorders. Pain free delivery with epidural anesthesia provides comfort for the mother as well as a positive environment for the baby.

We, experienced anesthesiologists of Beylikdüzü Birinci International Hospital, always offer all types of medical aid with debonair; patients' relatives can leave their patients with us at our operation theatres with mind at ease and no worries. We wish you healthy days.

Mehmet ÖZEL, M.D.