How Painful Is Normal Delivery With An Epidural

Dr (Prof) Sadhana Kala, a US-trained Robotic and Laparoscopic Surgeon, is Sr Consultant Gynecologist at Apollo Cradle Hospital, New Delhi

The pain of childbirth is not remembered. It’s the child that’s remembered.

Childbirth is a joyous but painful experience for women. “Labor pain is the mother of all pains.” But many women believe that the pain cements the bond between them and the baby. They also fear the side effects of medicated births and epidurals and decline even the painkiller injections that are usually given during labour. That is, they opt for ‘total natural birth.

But a few women have a low pain threshold. And in a few women, anticipated pain and discomfort may cause anxiety. These women may then opt for ‘painless delivery’. What does a painless delivery mean?

What Is A Painless Delivery?

In this procedure, the woman has to bear the initial labour pain which can be mild to acute depending on the individual. These early labour-pains can be managed with warm showers, massages and exercises.

After the labour has progressed to a certain stage and the uterus is sufficiently dilated (mouth open about 3 cm, and at least 3 contractions in 10 minutes), an injection of epidural is given in the spinal cord by the anaesthetist who tops up the epidural from time to time as the labour progresses. Epidural takes 10 minutes to place and another 10 to 15 minutes to begin to work. Epidural makes actual delivery nearly painless. pros & cons of the procedure are explained to the patient at length before she opts for epidural.

What Are The Disadvantages Of An Epidural?

The disadvantages of epidural are:

Labour is prolonged
The woman is unable to self-help
The chances of delivery through forceps or vacuum increases. Forceps or vacuum delivery has certain risks of injury.

In one study, these chances increased from 16.4% in non-epidural to 37.9% in epidural delivery.

What Are The Side Effects Of Epidural?

Itching
Nausea and vomiting
Fever
Soreness
Low blood pressure
Difficulty urinating

What Are The Risks In Forcep Delivery?

The risks to the baby from forceps delivery, though rare, are:

Minor facial injuries due to the pressure of the forceps
Temporary weakness in the facial muscles (facial palsy)
Minor external eye trauma
Skull fracture
Bleeding within the skull
Seizures

Forceps Delivery Risks To The Mother Are:

Pain in the perineum — the tissue between your vagina and your anus — after delivery
Lower genital tract tears
Difficulty urinating or emptying your bladder
Short-term or long-term urinary or faecal incontinence (involuntary urination or defecation) if a severe tear occurs
Injuries to the bladder or urethra — the tube that connects the bladder to the outside of the body
Uterine rupture — when the uterine wall is torn, which could allow the baby or placenta to be pushed into the mother’s abdominal cavity
The weakening of the muscles and ligaments supporting your pelvic organs, causing pelvic organs to drop lower in the pelvis (pelvic organ prolapse)

Most of these risks are also associated with vaginal deliveries, but these are more likely with forceps delivery.

What Are The Risks Of Natural Birth?

Natural births have risks too. Especially if the mother has a medical problem, or if an issue prevents the baby from naturally moving through the birth canal. Other concerns are:

Tears in the perineum (area behind the vaginal wall)
Increased pain
Haemorrhoids
Bowel issues
Urinary incontinence
Psychological trauma

Tips Tp Help Labour And Delivery During Natural Birth?

Massages
Acupressure
Taking a warm bath or using a hot pack
Breathing techniques
Frequent changes in position to compensate for changes in the pelvis

What Is The Optimum Method Of Childbirth?

When advising you about the optimum method of labour and delivery for you, the Obstetrician will consider:

Overall health and emotional well-being of the mother
Size of the mother’s pelvis
Mother’s pain tolerance level
Intensity level of contractions
Size or position of the baby

Hopefully, the information in this write-up will help you make an informed decision, in consultation with your obstetrician, about the optimum method of baby-birth for you: total natural birth, natural delivery, painless delivery, or a caesarean section. If you have more questions, please do write to us and we will have them answered for you.