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Pregnant WomenPregnant Women
Our masala movies often have scenes of an anxious father pacing up and down the corridor just outside the delivery room, with wailing sounds of the mother–to–be emanating from the background. The scene sometimes shifts abruptly to the grimacing woman in sheer agony. Fact is not much different from fiction in most cases. However, now, there is a change in the whole approach to the experience of labor, the excruciating process of literally bringing a baby into this world. The question that is being asked today is, does it have to be such a traumatic experience after all, when advances in medical science provide safer and less painful choices?

The maxim, “No pains no gains” does not hold water anymore because there are painless options one could exercise for the same gains. But, before that, it is important to understand the whole process of labor itself, and the pain is necessary. Dr. Belsare, an anesthetist, explained, “Labor is termed as the process of delivering the baby. Pain is experienced when the uterus (the sac containing the baby), tries to push the baby out by contracting. It is just like the pain felt during muscle spasms in any other part of the body. This is because there is reduced blood supply (which also means less oxygen) to that part of the body because of the contractions. The decreased blood supply does not harm the baby as the spasms take place intermittently. The pain signals the onset of labor. Once that is accomplished, the function of pain is complete. Any further continuation of pain only causes discomfort to the mother”.

Says Dr. Gandhi Kota, gynecologist, “The ability to bear pain varies from individual to individual, and the time of delivery also varies in each case. When the labor is prolonged, many often ask for some kind of pain relief”. Although the choice of going in for pain relief has been prevalent for many years, it has mainly been narcotics administered intravenously. Drugs like Trandol and Fortwin have been administered. But, this has its inherent disadvantages cautions Dr. Belsare, “One cannot really determine how the drugs might and could affect the baby and as a result of their use the baby is in a sedated state when born. If the dose is diluted to avoid this, then the pain reliever is not that effective”.

Now it is possible to be relieved of pain during one’s labor without any of these side–effects through a technique known as “Epidural analgesia”. This technique has been in practice abroad for the last 15 years and in India for the last five to 10 years in big hospitals. Now, better, safer drugs like Fentanyl are used which were not available in India even five years ago. Awareness about the technique is low since it is not resorted to often thanks mainly to the time factor. The drug is administered in the epidural space via a catheter (very thin plastic tube) introduced in the vertebral column with the aid of a special needle. It is not a one–time administration of the pain killer. The anesthetist needs to be present throughout labor monitoring the levels of anesthesia administering what is known as “Epidural top–ups”, depending on the stage of labor and the pain bearing ability of the patient, till the episiotomy is complete after delivery. The whole process involves a considerable amount of time (usually four to five hours) due to which pain relief in labor was administered only if anesthetists were not busy with other cases.

Epidural analgesic blocks the pain carrying nerve impulses to the brain. As the concentration of the analgesic is controlled, contractions can be felt but pain not experienced. Dr. Belsare points out, When there is severe pain, adrenalin is released into the blood stream as a protective mechanism. This results in vasoconstriction (the constriction of blood vessels by which the diameter of the vessels decreases) in turn reduces blood supply in the body. To counteract this the heart pumps harder and faster to push blood through the constricted vessels to the baby in the uterus. If there is no pain the heart is not under pressure, there is better supply of oxygen to the baby in the womb. This causes a relaxant effect in the uterus and it sometimes hastens delivery which may otherwise be prolonged due to severe pain. In case a cesarean section is needed then the same anesthesia could be used.

There are a few risks associated with this technique. Research indicates increased incidence of vaccum and forceps–aided deliveries. This may be due to the fact that the pain which acts as a driving force to “Bear down” is not there. So, the mother has to bear down voluntarily which may not be adequate. The needle is injected at the back into the vertebral column in the epidural space, as a result of which only the lower half of the body is anesthetized. Occasionally, the injection causes a headache. This is due to leakage of cerebrospinal fluid if the needle happens to go beyond the epidural space. The headache disappears after three to four days once the leak seals itself. There is a perception that the injection causes back pain but studies show that men given the same type of injection for surgeries did not complain of any such pain. Women usually have back pain after delivery due to calcium deficiency and loosening of ligaments to accommodate the baby and aid birth.

“There is a mother–in–law factor that influences decisions about whether to go in for painless labor or not”, reveals Dr. Belsare. Most feel that if they have managed to give birth without any pain relievers, their daughters–in–law ought to be able to do the same. Many also argue that it is against nature. However, Dr. Belsare stresses, “If that is the case, then practicing medicine itself is against nature! If you take medicines to relieve a headache then how is getting relief from labor pain any different from that”. Epidural analgesia is a tried and tested method for painless labor but it is available at cost. Charges vary from Rs 2,500 to Rs 3,500 depending on the time taken for the delivery.