The experience of child birth ranges from agony to ectacy. One of the most thrilling and gratifying experience in mother life will be the birth of her child. Labour pain rank among the most intense pain, as recorded on McGill pain questionnaire 1 and it is typically worse than a toothache, back pain, & pain associated with a deep laceration. The analgesia for labour has always been a controversial issue, as we all know. The obstetric anesthesia has developed over the last 150 yrs and now grown up into dominant speciality. This development also signifies the change in thinking and attitude to the relief of pain in labour. It was traditional belief that “birth is a natural process” & “women should suffer” of the labour pain which was punishment to the women given by god. This concept is now changed and now it is accepted fact that a women has a right to get relief of pain. The more concern are now of mother & baby safety.
The obstetric anesthesia has had a turbulent history since it first used in Scotland in 1847 when James young Simpson administered ether to a women during delivery. Great opposition followed as pain relief during labour was not viewed as a biological process. Queen Victoria who received chloroform in 1853 during her 7th child birth prince Leopold & in 1857 during 8th child birth. John snow used chloroform on handkerchief to relieve her from labour pains. Since then, the search was on & various pharmacological & non pharmacological pharmacological techniques have been tried.
There is no technique which is immune to controversy; each technique has its own effect on labour & delivery process. Advances in newer pharmacological drug like LA – Ropivacaine & Levobupivacaine, Narcotics – Fentanyl, Sufentanyl & Remifentanyl, Adjuvant – Clonidine, Neostigmine, and various techniques such as combine spinal epidural – walking epidural & Patient Controlled Epidural Analgesia (PCEA) with background infusion offer some advantages & disadvantages.
Advances in Modern Obstetric Analgesia
➤ Technical Advances: USG guided localization of the epidural space used as visual aid/diagnostic tool or for teaching aid and Electrical stimulation by Tsui needle causes muscle twitch elicited with electrical stimulation during catheter insertion, indicate epidural needle localization.
➤ Technological Advances: Mobile pumps, PCEA/PCIV pumps, Elastomeric pumps, Epidural /spinal kits & catheters. These have leaded us to newer infusion regimes.
Provision of neuraxial analgesia early in labour has distinct advantages for maternal analgesia and satisfaction, with no negative impact on mode of delivery.
Birth isn’t something we suffer, but something we actively do and exalt in.