Tackling labour pain with 'walking epidural'

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A few months before she was to deliver, 35-year-old Riana Sachdev had convinced herself that she would opt for a natural birth but she was quite perturbed by the severity of labour pain and wanted to have a pain-free normal delivery. Her gynaecologist advised her to go in for a 'walking epidural,' which would not only ensure a pain-free natural delivery but will also allow her to move around in a limited way and not be dependent on someone in the final hours of delivery. Sachdev did just as she was advised, had an almost pain-free delivery and is now blessed with a baby girl.

"Epidurals have been around for a while but it is only in the last few years that we have tailored the epidural for labour in such a way that the dose requirement is minimally concentrated. They allow the mother to have pain relief and at the same time no motor loss and no weakness in the leg muscles. So the woman can actually move around, and do basic things such as walking in the hospital corridors, going to the washroom independently," says Dr Anita Roy, consultant anaesthesiologist with Motherhood hospital at Kharghar in Mumbai.

An epidural is essentially regional anaesthesia which provides relief from acute labour pain during the period of childbirth, by blocking the nerve roots. Until recently, as much as about six years back, the standard epidural was most used for mothers who wouldn't want to undergo the trauma of severe labour pain. However, along with providing respite from pain, the standard epidural would also lead to a lot of weakness especially in the lower limbs and the inability to walk and move around independently.

"Earlier, may be 10 years ago, concentrations of the drug was 0.25 per cent to 0.5 per cent. They caused pain relief but not without some form of muscle weakness and we were not confident to let the ladies walk by themselves during labour. Cut to now, we have what is known as the mobile or walking or ambulatory epidural in which the concentration of the drug is as low as 0.1 per cent, as it is now mixed with an opioid called Fentanyl, in order to provide pain relief with no muscle weakness at all of the lower extremities. I have a high number of cases where women opt for a low concentration walking epidural as it is too intimidating to have to undergo labour pain which really can put you down. and even if there is 70 per cent loss of the pain, that's great for the lady," explains Roy.

In cases of labouring patients when the labour does not progress and for some obstetric reason the mother needs a caesarean section, the walking epidural can be converted into a surgical anaesthesia. "So the main difference is that earlier we were using only the local anaesthetic in a higher concentration but now we are taking very low quantity of the same local anaesthetic and mixing it with an opioid—a combination which works like a charm. Epidural analgesia relieves labour pains effectively with minimal maternal and foetal side effects. In fact, in the west almost 80-90 per cent of women opt for epidural, which mean walking epidurals. In a month, 30-35 per cent of women opt for ambulatory epidural," says Dr Anu Vij, an obstetrician practising in Navi Mumbai.