A pregnant lady took admission with 37 weeks of pregnancy with a ruptured membrane in my hospital. Her elder child was born in another hospital almost five years ago by traditional normal delivery which was painful. But this time, she was administered medicines with her consent to drive the pain away. Without any complication, she delivered a healthy baby boy four hours later. I asked the mother about how did she feel. She said she did not feel anything and it seemed like magic. The painless delivery of the child was done by me and my team and it was the first painless child delivery at the hospital.
Normal delivery brings up the image of the would-be mother’s mind of tremendous pain. After bearing the child for almost ten months, a feeling of fear works – will the child be delivered in a normal way? Will caesarean section has to be done? How extreme will be the pain? It is great news that painless delivery of babies has started in Bangladesh, though in a limited sphere.
One may ask how normal delivery of a child can be done without pain? The mother is not totally unconscious. Only sensory (feeling of pain) is blocked. She will be able to move her legs. She can even walk if she likes. And when she is ready to deliver, it can be done through the delivery pressure that she will exert. When delivery pain becomes intense, the epidural catheter is introduced in the epidural space and the mother is administered pain removing Lignocaine or Bupivacaine through the catheter, which starts working within 10 to 15 minutes and 80 to 90 per cent of the pain goes away. If the mother starts feeling pain after 2-3 hours, she is administered the pain removing medication again. If everything is okay, delivery takes place without pain.
During this process the blood pressure may go down a little, she may have difficulty in urination and later on may feel back pain but proper monitoring of blood pressure, saline dose adjustment and urinary catheter administration may able to overcome the problems. Very few babies feel decreased heartbeat or breathing difficulties but they become normal within two to five minutes. The team attends to both the mother and child during this time.
We hope to achieve full confidence of the mothers on painless normal delivery. This method will bring down the number of caesarean section deliveries which was 23 per cent according to the government of Bangladesh.
As the process is of long duration, both the gynaecology and anaesthesia team have to be present full time with complete operation theatre support, work in close coordination and observe the patient closely as well as prepare for the delivery of the child. Rare but if there is any complication, a caesarean section can be done with previous epidural anaesthesia.
If the painless delivery of child receives government and non-government patronisation, the process can be revolutionary in reducing the number of the unnecessary caesarean section in Bangladesh.
The writer is a Gynaecologist.