Epidural Pain Relief during Labor
From Encyclopedia of Sex and Sexuality
The labor pains experienced by women during delivery ranks among the most severe forms of pain. Their amelioration should be mandatory to avoid suffering by the mother and to reduce pain-related physiological side-effects on the mother and the newborn. Epidural anesthesia for labor has achieved widespread use due to its effective pain relief and safety when properly administered. Its simplicity makes it the technique of choice for rendering the mother insensitive to pain while keeping her fully conscious during labor.
Epidural pain relief is performed by an anesthetist during active labor. The woman lies on her left side, with the medical staff and husband assisting and facing her. The anesthetist stands at her back, scrubs it, and administers a local anesthetic to minimize the discomfort associated with the epidural injection. To assist the anesthetist in locating the proper spot to insert the injection, the woman is asked to curve her back into the “fetal,” or “angry cat,” position, so as to widen the gap between the vertebrae. The needle is then carefully inserted in the lumbar region. The correct location of the needle tip is confirmed using a minimal dose of local anesthetic. A thin catheter is then inserted through the needle, and secured in the epidural space after removal of the needle. The catheter enables the anesthetist to add an additional drug if labor is prolonged; to use it for full epidural anesthesia if cesarean section is required; and to provide effective analgesia after the operation. The catheter is easily removed after labor. The usual drugs used for epidural labor pain relief are long-acting local anesthetics. The addition of a small amount of narcotics makes possible reduction of the required dose, while achieving better pain relief with fewer side effects. Recently a new group of drugs has been used: these act on the adrenergic part of the spinal cord, taking a role in pain modulation.
During epidural anesthesia the laboring woman often feels temporary weakness in the legs, a decrease in sensation, and occasional bouts of shivering; nausea is rare. Headaches are rare and usually occur if the dura is unintentionally punctured by the needle. Serious nerve damage is extremely rare. However, epidural injection should not be administered in the case of bleeding or severe local or general infection.
When adequately performed, epidural pain relief can make labor a joyful experience for the mother by keeping her awake and alert during delivery. The relaxed mother is able to assist in advancement of the labor process, while the attenuated stress of labor-induced pain can be physiologically beneficial for both mother and newborn.
