Epidural analgesia for pain relief in labor : Myths vs facts

The first step into motherhood, the process of giving birth,  is a multidimensional experience and when considering treatment, one must balance all aspects including physical, emotional, psychological, sociologic and sometimes religious considerations along with pain relief. Childbirth has been recognized as among the most painful experiences known.  Numerous strategies, both pharmacologic and nonpharmacologic, have been used as tools to relieve pain during labor from times immemorial.

The introduction of neuraxial analgesia into obstetric practice took place at the end of 19^th century. It is now most commonly performed to relieve labor pain. Compared with other techniques, it is the most effective form of analgesia. Recent innovations in drug combinations and delivery systems have resulted in a flexible technique that meets the needs of most parturients in a safe and effective manner.

An ideal labor analgesic should fulfill the following criteria:

• Effective pain relief
• Safe
• Minimal effects on progress or outcome of labor
• Minimal effects on the fetus or newborn
• Minimal maternal side effects

While use of epidural analgesia during labor is gaining popularity , there is still a vast majority of pregnant population with their share of doubts and inhibitions regarding the same.

Myths vs Facts :

• Myth: Epidurals can cause permanent back pain or paralysis in the mother.

• Fact:  Serious complications from an epidural, including paralysis, are extremely rare. Some women have discomfort in the lower back (where the catheter was inserted) for a few hours or days after the epidural, but it doesn’t last.

• Myth:  Epidurals can harm the baby.

• Fact: While most women fear and express concern that an epidural could cause cerebral palsy or be harmful to the baby, there is No evidence or research that corroborates these concerns. Additionally, the amount of medication that reaches the baby from the epidural is so small it doesn’t cause any harm.

• Myth: Epidurals can slow down labor or increase the risk of having a cesarean section (C-section).

• Fact: There is no credible evidence that an epidural slows down labor or increases your risk of having a C-section. If a woman has a C-section, other factors usually are at play, including fetal distress or slow progression of labor due to other issues. In fact, there is evidence that epidurals can speed the first stage of labor for some women.

• Myth: An epidural can interfere with the birth experience.

• Fact: Some women express fear that their legs will be numb and they won’t be able to walk, feel a contraction or push properly. In fact, your legs should not be so numb that you do not feel them.  You may be able to walk after an epidural, depending on the hospital’s policy; however, walking generally is not recommended immediately after the epidural is placed. Epidural procedures have improved significantly in the last 20 years, and you’ll receive enough medication to relieve the pain without taking away your ability to move. Furthermore, the epidural medications will not cause you to be groggy or tired. In other words, you’ll be able to feel contractions – they just won’t hurt – and you’ll be able to push effectively.

• Myth: There’s a limited window of time when you can get an epidural.

• Fact: You can get an epidural any time during your labor – in the beginning, the middle or even towards the end.

The use of low concentrations of local anesthetics, combined with lipid-soluble opioids does not impede the progress of labor or depress the newborn. The addition of patient-controlled epidural analgesia and innovations using new technologies enhance patient satisfaction.While neuraxial analgesia is versatile and safe, there are certain contraindications to the technique which include

• Patient refusal
• Lack of adequate equipment
• Lack of expertise or supervisory staff
• Severe coagulopathy
• Infection at the site of puncture 
• Raised intracranial pressure
• Hypovolemia