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Every woman experiences labour pains differently and there are different medications that can provide pain relief during labour and delivery. These can depend on the techniques available at your hospital, your mode of delivery, you and your baby’s condition, and your personal choice.
Depending on how the pain relief medication is administered, either in the affected area or throughout the body, labour analgesia can be divided into two categories: regional and systemic.
Regional analgesia for labour
3 types of regional analgesics are employed to relieve pain from being felt in a particular region of the body during labour.
#1 Epidural analgesics
Also known as epidural block (EDB), epidural medication is injected into the ‘epidural space’ (usually the lower or lumbar area of the spine), which can expand up to 4mm in width during labour. An epidural is used shortly before a Caesarean section delivery, in cases when vaginal birth requires use of forceps or vacuum pump, long labour, high blood pressure, posterior baby, twins and premature baby.
It takes about 10 to 20 minutes for the medication to take effect. An epidural does not slow down labour and can be used through out the length of the labour. However, you may experience some side effects like inability to empty bladder, soreness and itchiness at the site of injection, fever and headache for a few days post delivery.
#2 Spinal analgesics
Like epidural block, spinal block is injected into your lower back to numb the lower half of your body, as you sit or lie on your side in bed. The spinal block is administered only once during labour and in amounts smaller as compared to an epidural medication. It is injected into the sac of spinal fluid below the level of spinal cord to provide immediate relief.
Spinal block, when combined with a stronger medication like an anaesthetic is often used for C-section delivery, and also in vaginal birth if the baby needs to be pulled out using forceps or vacuum extraction. Spinal analgesics cause the same side effects like epidurals and are treated in the same manner.
#3 Combined spinal/epidural (CSE)
A combined spinal-epidural block provides the quick relief offered by spinal component and pain relief throughout the duration of labour through epidural component. Some women are able to walk around once the block is in place; for this reason CSE is sometimes also referred to as the ‘walking epidural’.
Systemic analgesia for labour
Systemic drugs are delivered through IV into your bloodstream or injected into a muscle. They affect the entire body and not just your lower body; however, unlike anaesthetics they do not make you unconscious. Systemic drugs can be classified as:
These are the most commonly used pain relief medication for labour analgesia. Most commonly used opioids are pethidine, fentanyl and remifentanyl. Common side effects of opioids are increased maternal temperature, headache, vomiting, and drowsiness. The newborn may suffer from foetal heart rate abnormalities and decreased muscle tone.
Though not commonly used, tranquilizers help to relieve anxiety and promote a restful feeling in the early stages of labour or before C-section delivery. The drug takes 10 to 20 minutes to take effect, and provides relief for up to three or four hours.
Nitrous Oxide, an odourless and tasteless gas, is another form of systemic analgesic that is administered using a face-held mask and takes effect in less than a minute. It is used to alleviate labour pains and can be used at any stage of the labour, either intermittently or continuously. Nitrous oxide will not provide you complete relief from pain but it will make the contractions bearable and provide general comfort. It is rapidly absorbed into the bloodstream through lungs and moves to brain, where it ‘depresses’ normal brain function to change perception towards pain. Side effects include increased drowsiness, nausea, and difficulty in breathing.
Work in consultation of your healthcare team to decide upon the best pain relief medication suited to your condition.
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