What is painless delivery (epidural) and how is it carried out? 

Epidurals are the most common type of anaesthetic used for pain relief during labour. You should know what to expect before you receive an epidural, including information that dispels some common myths. 

When and how is an epidural administered for labour pain? 

A physician anaesthesiologist will place a needle and a tiny tube, called a catheter, in the lower part of your back if you choose an epidural. After removing the needle, the catheter remains in place to allow the medication to be delivered through the tube as needed. You can begin an epidural at any time during labour - at the beginning, in the middle, or even toward the end - in consultation with your doctor. 

A hollow needle and a small, flexible catheter are inserted into the space between the spinal column and the outer membrane of the spinal cord (epidural space) in the middle or lower back. A local anaesthetic is used to numb the area where the needle will be inserted. Once the catheter has passed through the needle, it is removed. It remains in place. The anaesthetic medicine is injected into the catheter to numb the body above and below the injection site, as needed. If more medicine is needed, the catheter can be used again. 

Does it hurt when the epidural is administered? 

The physician anaesthesiologist will numb the area where the epidural is administered, which may cause a momentary burning or stinging sensation. Due to this numbing, there is very little pain associated with epidural injections. Most patients will feel some pressure as the needle is inserted. 

What does an epidural do? 

Epidurals create a band of numbness from your belly button to your upper legs. It allows you to be awake and alert during labour as well as to feel pressure. To deliver your baby, you need to be able to feel the second-stage labour pressure. Pain medication takes about 15 minutes to work. 

How long does the pain relief last? 

Epidural pain relief can be continued for as long as you need it. If necessary, you can increase or decrease the amount of medication you receive through the epidural. 

Can epidural slow labour or lead to a caesarean delivery (C-section)? 

Furthermore, there is no credible evidence that it does. There are usually other factors at play when a woman needs a C-section, including the size or position of the baby or slow labour progress due to other reasons. Although you might be able to feel contractions with an epidural, they won't hurt, and you'll be able to push effectively. According to some evidence, epidurals can speed up the first stage of labour by allowing the mother to relax. 

Can epidurals harm the baby? 

The amount of medication that reaches the baby from an epidural is very small, and there is no evidence that it causes any harm to the baby. 

Are there risks and side effects? 

Epidurals are extremely safe; serious complications are rare. As with all medications and medical procedures, there are potential side effects. 

• · The medication may lower your blood pressure, which may slow your baby's heart rate. For this reason, you will receive extra fluids through a tube in your arm (IV), and you may have to lie on your side. Sometimes, your physician anaesthesiologist will give you medication to maintain your blood pressure. 
  

• · Your lower back may be sore where the needle was inserted to administer the medication. It should not last more than a few days. There is no evidence that epidurals cause permanent back pain. 

• · When the needle pierces the spinal cord covering, a headache can result for a few days if left untreated. Discuss the treatment options with your physician anaesthesiologist if such a situation arises. 
  

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What is combined spinal-epidural anaesthesia? 

During labour, a spinal block can be used in combination with an epidural to provide immediate pain relief. Like an epidural, a spinal block involves an injection in the lower back. A small amount of medication is injected into the spinal fluid to numb the lower half of the body as you sit or lie on your side in bed. The medication relieves pain quickly and starts working right away, but it only lasts for an hour or two and is usually only used once during labour. After the spinal block wears off, the epidural provides continued pain relief. 

In addition to their commitment to patient safety and high-quality care, physician anaesthesiologists possess the knowledge necessary to understand and treat the entire human body. 

What are the Pros and Cons of Painless Delivery? 

Pros 

• · It helps women cope better with post-partum depression or exhaustion. 
  · The relaxation of the vaginal muscles allows the baby to descend more easily. 
  · The drug reduces the mother's blood pressure, which is good because the mother has high blood pressure in natural labour and there is a risk of the pressure reaching dangerously high levels and resulting in a stroke. 
  

During a normal delivery, it would cause damage to the pelvic muscles. 

Cons 

• · You may experience back pain, dizziness, or shivering. 
  · Slowing of the baby's heartbeat can be caused by a drop in the mother's blood pressure 
  · Fluid leaking from the spine can cause severe headaches. 
  · There is a chance of irreversible nerve damage in some cases. 
  · It has been suggested that babies born through a painless delivery procedure may be a little slow and have difficulties breastfeeding.

• Would you choose a painless delivery? 

Pregnant women are advised to prepare for normal delivery by building stamina, practicing labour exercises and breathing techniques, and selecting a birth partner. With the right support, you can cope well with labour pain without an epidural. 

References- 

https://www.motherhoodindia.com/specialties-page/pregnancy-care-3/type-of-deliveries/painless-delivery-epidural-detail/
https://www.healthline.com/health/pregnancy/natural-birth-vs-epidural 
https://timesofindia.indiatimes.com/blogs/methink/painless-childbirth/