When giving birth, some women indulge in the natural pain component. Still, for other women, the pain of childbirth is a significant obstacle to overcome. It limits the mother’s active and peaceful participation in the birth of her child.
Childbirth pain sedation is not an alternative to natural childbirth but a tool offered by medicine to allow mothers to make the free and conscious choice to participate in the event.
The pain of childbirth
The pain of childbirth has unique characteristics:
- It has a limited duration in time;
- It is followed immediately by the well-being, joy, and gratification of the birth of the baby;
- Every woman experiences it differently, depending on her pain threshold, previous experiences, and cultural level.
Childbirth labor is divided into several stages, associated with the presence of uterine contractions, which become progressively more painful:
- Dilating stage: The pain is similar to that experienced during menstruation, visceral in nature, deep, diffuse, and torpid, not well localized, but felt around the umbilicus and in the lower back. It is due to dilation of the cervix and uterine contractions.
- Expulsive stage: The fetus progresses into the birth canal. The pain is well-localized, intense, moving from the abdomen to the vagina and up to the anus. It is due to pressure and distension of the pelvic structures and perineum.
- Secondment stage: It begins at birth and ends with expulsion or manual placenta extraction.
Epidural analgesia
Analgesia is the use of techniques or drugs to relieve pain during labor. Performed on demand and without special contraindications, analgesia allows the mother-to-be to participate in a calm and focused manner in the birth of her child.
The most widely used birth analgesia is the epidural (or peridural). Practiced for more than a century, it is now universally recognized as the best technique for controlling pain during childbirth.
Benefits for mothers and babies
The drugs act directly on nerve roots. Thus, uterine contractions are felt, but they are not painful. Analgesia is effective at reduced dosages, with decreased maternal and fetal side effects.
It ensures the disappearance or dramatic reduction of pain during labor while maintaining skin sensitivity, motility, and the sensation of contraction and pushing so that labor or delivery is not affected.
Should it then become necessary to perform a cesarean section, analgesia avoids the need for general anesthesia. This does not exclude the possibility of modifying the technique, possibly using subarachnoid anesthesia or general anesthesia. Finally, analgesia in no way compromises the possibility of breastfeeding.
How is analgesia delivery performed?
The epidural catheter insertion procedure involves two steps: First, there will be local anesthesia at the level of the lumbar area where the catheter will be introduced, then a thin catheter will be introduced into the lumbar epidural space through a special needle.
The catheter remains in place throughout labor for repeated administration of boluses of local anesthetic that can be combined with very small doses of opioids.
Analgesic childbirth: Complications and side effects
Peridural anesthesia is a safe and generally complication-free technique when performed by experienced and qualified personnel. The most common complaint after delivery is back pain. This transient pain is probably due to the readjustment of posture. It is, in fact, present even in women who have not undergone this procedure.
The most frequent complication (about one case in a thousand) is headache, which appears the day after delivery if, due to anatomical and technical problems, the dura mater membrane is perforated while performing the maneuver. With supine rest, hydration, and analgesic therapy, the symptoms resolve in a few days.
Continuous monitoring of vital functions before, during, and after anesthesia/analgesia helps prevent any complications that might occur due to the maneuver. In the delivery room, this device represents a safety tool: once positioned, should an emergency potentially endanger the health of the mother and/or baby arise at any time, by changing the concentration or composition of the drugs, it is possible to convert an analgesia into an anesthesia and promptly perform a safe cesarean section.
On the delivery day, the patient can request analgesic childbirth when labor has started. The obstetric-gynecologic team will then notify the anesthesiologist. Around the 36th week of pregnancy, an anesthesiological examination is required to assess whether this option is suitable.
This visit includes:
- Assessment of the woman’s health status;
- Detection of any gynecologic and/or obstetric contraindications;
- Interview to answer questions and request information about epidural analgesia;
- Completion of the anesthesiologic evaluation chart;
- Collection of informed consent to the procedure.
