Journal of Anesthesia and Critical Care: Open access

Research Article Open Access

Experience of using epidural labour analgesia in

developing countries: effects to feotus and mother
Abstract Volume 13 Issue 1 - 2021
Background: Epidural analgesia is regarded one of the one techniques used to relieve
pains associated with labor among women used and recommended by many among the 21st
Noor Mohammad,1 Han Xueping,2 Tarikul
century modern obstetric practitioners. The technique has advantages and disadvantages Hasan,3 Chen Miao,4 Samim Ara5
1
PhD student, Department of Clinical Anesthesiology. The first
but also there is myth surrounding the practice such as its impact towards the mother and
affiliated hospital of Zhengzhou University. China
the baby. 2
Professor and Director, Department of Day Care Anesthesia,
Objectives: The major objective of this study was to investigate and assess the effect(s) of The First Affiliated Hospital of Zhengzhou University. China
epidural analgesia in regard to labor progress, baby, mother and the mode of delivery. The
3
Specialist anaesthetist, Square Hospital Limited, Bangladesh
study further aimed at finding out complications associated with the technique in regard to
4
Attending doctor, department of anesthesiology, The first
Affiliated Hospital of Zhengzhou University, China
neonate and the effect of the practice in regard to APGAR score. 5
PhD student, Department of Radiology, The first affiliated
Methods: This study was conducted in a period of one year from April 2016 to February hospital of Zhengzhou University, China
2018 at Square Hospital Limited, Panthapath, Dhaka Bangladesh. 50 women were given
epidural analgesia as a technique to relieve pains during labour, and other 50 women were Correspondence: Noor Mohammad, PhD Student, Clinical
put in group serving as a control. Anaesthesiology, The first Affiliated Hospital of Zhengzhou
University, Zhengzhou Henan China, Tel +8613256729165,
Key areas of interest during the study were; the duration of active first and second stage(s), Email
The APGAR score, the mode of delivery, reaction after giving epidural analgesia, and
Mother’s satisfaction rate. Received: January 22, 2021 | Published: January 29, 2021

Results: There was no huge difference in the two groups in regard to deliveries as a result
of operation; control group stood at 8%, while study group was at 6%. There was also
comparable need of oxytocin. The study also observed no life threatening side effect with
very good rating of satisfaction in regard to relieving pains. The study credits Epidural
analgesia is for high rate normal delivery and a small percentage of lower segment
caesarean option.

Keywords: Labour duration, epidural analgesia, Neonatal outcome

Introduction leave severe side effects on the foetus because uncontrolled labour
pains can in the end cause change in metabolic as well as flow of
Studies indicate that labour pains experienced during labour catecholamine levels of the mother.
periods are perhaps the most severe a human being to experience.
This agony of pain can get worse especially at the advance time of Indeed, studies indicate that women in labour their most concern
labour. Some scholars argue that nervousness and anxiety can as well and fear is labour pains, adding that the pain experienced by women
make the situation worse making pains almost unbearable. Therefore, during labour differs. However, depending on how labour pains maybe
it can be argued that delivering a baby without experiencing such managed, this has effect both short and long including psychological
pains is every mother’s wish. Indeed, in his scholarly work titled impacts4 and according to Walker’s 1997 article – “Do labour
“On the administration of chloroform during parturition”, Snow medications affect breastfeeding5” depending on the type used, the
J, M.D observes that; “The delivery of an infant into the arms of method can as well cause impact when it comes to breastfeeding as
a conscious and pain free mother is one of the most exciting and well as affect the the relation or interaction of mother and the new
rewarding moments in medicine”1. Other than anxiety it causes born baby.
labour pains effects according to Boudou M. et. Al., 2007 scholarly Despite the known known effects related with epidural labour
work “Association between the intensity of child birth pain and the analgesia, American College of Obstetricians and Gynaecologists
intensity of postpartum blues”, labour pains have other effects such as (ACOG) contends6 that if it’s at the request of the woman in labour,
affecting the flow of uterine blood, the expectant mother losing her it is enough for to go for labour pains relief. It is important to note
consciousness and hypercarbia2. that there are various methods that can be used in relieving pains
Previous studies such as Bandyopadhyay, et al’s.,“Labour in labours well as several strategies that can help one to cope with
Epidural analgesia: Past, present and future.3” contend that labour pains. They include for example breathing exercises and also medical
pains if continuous, other than the side effects on the mother, it can techniques like epidural analgesia. What is important is that no matter
1
Snow J, M.D On the On the administration of chloroform during parturition. 4
Christiansen P, Klostergaard KM, Terp MR, Poulsen C, Agger AO, Rasmussen
Assoc Med J. 1853;1(25):500 – 2. KL. Long-memory of labour pain. Ugeskrift for Laeger 2002;164(42):4927–9.
2
Boudou M, Teissedre F, Walburg V, Chabrol H. Association between the 5
Walker M. Do labour medications affect breast feeding. Journal of Human
intensity of childbirth pain and the intensity of postpartum blues. L’Encephale. Lactation 1997;13(2):131–7.
2007;33(5):805–10. 6
American College of Obstetricians and Gynecologists (1996). ACOG
3
Bandyopadhyay KH, Afzal M, Mishra AK, Paul A. Labor epidural analgesia: technical bulletin Obstetric analgesia and anesthesia. International Journal of
past, present and future. Indian J Pain. 2014;28(2):71. Gynecology & Obstetrics, 54, 281-292.

Submit Manuscript | http://medcraveonline.com J Anesth Crit Care Open Access. 2021;13(1):5‒10. 5

©2021 Mohammad et al. This is an open access article distributed under the terms of the Creative Commons Attribution License,
which permits unrestricted use, distribution, and build upon your work non-commercially.
 Copyright:
Experience of using epidural labour analgesia in developing countries: effects to feotus and mother ©2021 Mohammad et al. 6

the method opted, the method opted for while trying to ameliorate the 2. Compare foetal result(s) between both groups in terms of APGAR
maternal discomfort as a result of labour pains should be safe for the score, NICU admissions.
mother and the foetus.
3. To study and compare the duration and course of the first and
With intention of studying and understanding both chronic and second stage of labour, investigate the need for caesarean section
acute pains in women, International Association for the study of pain in parturients with or without epidural analgesia.
in 2007 indicated that labour pain can help and found it can be used
as a model in studying and treating of acute pain. Sengar and Ohary Materials, methods used during study
(2009) in their scholarly work “Observation on effects of lumbar This study was conducted at Square hospital Limited, in the
epidural analgesia for painless labour”7 contends that continued department of Obstetrics and Gynaecology starting from April 2016 to
studies of pharmacotherapy and physiology have inevitably improved April 2017. The study involved 50 patients deemed to be at a low risk
understanding, debate and research in training of obstetric of labour primgravida and in labour who went through physical examination.
pain easing. During this process, patients were classified with those who came as
Using epidural analgesia first surfaced in early 1946 and since then physical status ASA 1 were subjected to epidural analgesia purposely
it’s now more common especially in developed countries for example to serve as a case in this study.
in the United Kingdom, estimations indicate that 20%8 use it while
The Inclusion criteria
58%9 of women in the United States of America use it.
The study considered Primi gravida with full-term singleton
In their published work: “Epidural ropivacaine versus bupivacaine
pregnancy14 with vertex presentation.
for labour: a meta-analysis”10, scholars Halpern SH and Walsh V
(2003) observes that, epidural analgesia can help in reversing what In the table below (Table 1), the study considered demographic
could be severe ventilatory effects of pain which is can result into profiles15 for patients in the two groups of which both are comparable.
increasing oxygen which is much needed for mother and the foetus As indicated in the table, 21.90 is the average number of age control,
which is necessary in case of maternal and foetal hypoxia11. 21.96 on the other hand represented study group. 22.35 represented
average BMI is for patients in control group, and 21.98 was considered
Despite the fact that epidural analgesia can result into effective
for study group. Average gestational age for patients placed in control
pain relief during labour, it’s been reported that sometimes it can
group is 38.46 and 38.44 represents study group. The current number
contribute to inadequate analgesia which may be caused by factors
of study is 60.0% of the patients are placed under study group, 54% of
like different spread of anaesthetic. Indeed, there have been some
patients which is placed in control group came on basis of emergency
reported maternal complications as a result of the practice; including
admission, and 40% and 46% are in study group and control group
reduced blood pressure, sudden hypotension which all can cause a
respectively all were are patients where were booked.
clinically significant low utero-placental blood flow and hence disturb
the foetus by causing inadequate reserves. Also, there have been some Table 1 Demographic data the two groups indicating age, BMI, gestational age
side effects12 like itches, developing fever, drowsiness and also cases & registration status
like where some women develop urinary retention (Eberle, 1996).
Group control Study group
Therefore, basing on the above, epidural analgesia as a method
of relieving pain during labour is best to be recommended if the Mean age 21.90± 3.20 21.96 ± 3.07
expecting mother(s) has no contraindications13. However, this method
has several merits. Mean BMI 22.35 21.98

Aims and objectives Age- Mean gestational 38.46 38.44

1. Investigate side effects and complications of the procedure. Registration status 54 60

7
Sengar S, Ohary R. Observation on effects of lumbar epidural analgesia Table 2. In the table below, shows the period or duration of first
for painless labour. Int J Sci Stud. 2016;3(12):244–7. Available at <https:// and second of labour.
www.ijss-sn.com/uploads/2/0/1/5/20153321/ijss_mar_oa47.pdf> accessed 20
As indicated in the table below (Table 2), operative delivery rates
September 2018.
8
Department of Health. Statistical Bulletin-NHS Maternity Statistics, placed in control group stood at 8%and 6% for study group – making
England:2003-2004. London, UK: Department of Health, 2004. it less significant. Average duration in first stage of labour for control
9
Declerq E, Sakala C, Corry M, Applebaum S, Risher P. Listening to mothers: group was at 6.77% while the number stood at 7.24 for study group
report of the first national survey of women’s childbearing expe- riences. New (also making it less significant).
York: Maternity Center Association/Harris Interactive, 2002.
10
Halpern SH, Walsh V. Epidural ropivacaine versus bupivacaine for labor: a At second stage, the average duration of labour for patients in
meta-analysis. Anesth Analg. 2003;96(5):1473–9.
 control group was 45 minutes, and 41.12 minutes in study group.
11
Papalkar J, Shrivastava D, Labour EA. International journal of biological and As indicated in the table, need for oxytocin as well as side effects of
medical research. Int J Biol Med Res 2013;4(1):2707–12.
 drugs administered for the groups were very comparable. Indeed, in
12
Buggy D, Gardiner J. 1995. The space blanket and shivering during ex- group of control, of the 5 patients there, 3 recorded deed transverse
tradural analgesia in labour. Acta Anaesthesiologica Scandinavica 1995; arrestwhile 2 patients recorded inadequate bearing efforts. Lastly, the
39(4):551–3; Eberle RL, Norris MC. Labour analgesia. A risk-benefit analysis.
average duration in second stage of labour is 45 and 41.12 minutes for
Drug Safety 1996;14(4):239–51.
13
Paddalwar S, Nagrale M, Chandak A, Shrivastava D, Papalkar J. A control group and study group respectively.
randomized, double-blind, controlled study comparing Bupi- vacaine 0.125%
and Ropivacaine 0.125%, both with Fentanyl 2lg/ml, for labor epidural Considered pregnancy of 37 – 41 weeks.
14

analgesia. Indian J Pain. 2013;27(3):147.. This included age, BMI, Status of registration, as well as gestation age.
15

Citation: Mohammad N, Xueping H, Hasan T, et al. Experience of using epidural labour analgesia in developing countries: effects to feotus and mother. J Anesth
Crit Care Open Access. 2020;13(1):5‒10. DOI: 10.15406/jaccoa.2021.13.00462
 Copyright:
Experience of using epidural labour analgesia in developing countries: effects to feotus and mother ©2021 Mohammad et al. 7

Table 3 During this study, as a result of deep transverse arrest, the patient’s life, the most observed or registered side effects in the
three patients who were in placed in control group were subjected to current study include the feeling of rigor, body itches/pruritis as well
LSCS. As a result of pronged labour, in both control and study group, as hypotension as indicated in the table (4) bellow;
one patient was subjected to LSCS. In study group, there were also
Table 5. start here As indicated in the table below (table 5),
other identifiable indicators of LSCS in patient, an example of such
when you compare study group and control group, there is really a
indicator was foetal distress.
significant VAS score indicating a easiness and pin relief which is as a
Table 4.Though not showing sign of serious effect like threatening result of going for epidural anaesthesia.

Table 2 In the table below, shows the period or duration of first and second of labour

First stage of labour labour control group study group x2-value p value
1<8 hrs[1] with no oxytocin 11 representing 22% 9 (18%) 0.69 0.87NS, p >0.05
<8 hrs with no oxytocin 30 representing 30% 29 (58%)
2Btn[2] 8-12 hrs without oxytocin 8 (16%) 11 (22%)
>12 hrs 1 (2%) 1 (2%)
Total 50(100%) 50(100%)
Second stage labour Labour control group study group x2value P value
<1 Hr 45 (90%) 49 (98%) 2.83 0.09NS, p>0.05
>1 Hr 5 (10%) 1 (2%)
Total 50 (100%) 50(100%)

Table 3 How patients were distributed considering their mode of delivery

Delivery mode control group study group x2-value p value

Vaginal 44 (88%) 42 (84%) 1.47 0.47 NS, p > 0.05
LSCS 4 (8%) 3 (6%)
Instrumental 2 (4%) 5 (10%)
Total 50 (100%) 50 (100%)

Table 4 List of Identified effects of epidural analgesia

Signs and symptoms number of patients Percentage rate

Vomiting 4 8.00%
Backaches complaints 3 6.00%
Rigor 2 4.00%
Itching/Pruritis 2 4.00%
Hypotension 1 2.00%

Table 5 Showing Arrangement of the patients in regard to VAS technique score in the two groups as observed at different labour stage

VAS score Control group study group t value p value

0 minute 7.80 ± 0.88 7.94 ± 0.91 0.78 0.43, NS
30 minutes after drug drug 7.92 ± 0.92 2.68 ± 0.86 29.26 0.0001, s
Second stage of labour 8.62 ± 1.06 1.94 ± 0.61 38.28 0.0001,s

Table 6. As indicated in the table below; neonates in the two 3. Registered a very normal foetal heart rate pattern at the beginning/
groups - that is control group and study group, APGAR score is at > before induction time.
in duration of 8 minutes. Also important to note is there is that in both
4. The women placed in active labour stage has been confirmed
groups – that is study and control groups, there is no increase when we
and established as diagnosed result of a result of constant urine
consider the rate of NICU admissions.
contractions and also cervical dilatation is registered at more
1. As a result of ultrasound and clinical examination(s), obstetric more than 4 cent meters.
high-risk was ruled out.
Exclusion criteria
2. Registered a very normal foetal heart rate pattern at the beginning/
1. Any kind of infection especially at local site of catheter placement
before induction time.
2. Need to study Allergy to study drug.

Citation: Mohammad N, Xueping H, Hasan T, et al. Experience of using epidural labour analgesia in developing countries: effects to feotus and mother. J Anesth
Crit Care Open Access. 2020;13(1):5‒10. DOI: 10.15406/jaccoa.2021.13.00462
 Copyright:
Experience of using epidural labour analgesia in developing countries: effects to feotus and mother ©2021 Mohammad et al. 8

3. Anatomical deformity of spine. 5. Medical disorder which can/may complicate pregnancy.

4. Maternal septicaemia. 6. Any case(s) of Cephalopelvic disproportion.

Table 6 Arrangement of patients in regard to neonatal outcome in the two groups

APGAR score 5 minutes control group study group x2-value p value

>8 39 (78%) 40(80%) 0.21 0.89NS, p > 0.05
5–8 8 (16%) 8 (16%)
<5 3 (6%) 2 (4%)
Total 50 (100%) 50 (100%)
NICU Admissions control group study group x2-value p value
Yes 7 (14%) 7 (14%) 0 1.00NS,p >0.05
No 43 (86%) 43 (86%)
Total 50 (100%) 50 (100%)

First time expectant mothers/primigravida who in fulfilment This study considered normal duration in a woman who is pregnant
inclusion criteria came for antenatal services in labour room and for the very first time/ primigravida to be eight to 12 hours’ while the
antenatal clinic were given epidural analgesia as an option. For study considered a prolonged 1st stage as; the duration which is 12
controls, the study considered 50 parturients not subjected to and more hours. The study further considered 2nd stage of labour as;
analgesia while 50 parturients willingly opted for epidural analgesia. calculated starting from or between the full dilatation of the cervix
In the study, we ensured a clinical report was done including a and removal of foetus from the birth canal. The study further recorded
clear and complete relevant history of patient. After precisely and normal duration in primigravida where there was no use of epidural
in simple terms explaining to the parturient and her attendants both analgesia as one hour while two hours where epidural was used.
merits and demerits of analgesia and its process, the parturient and Principles of active management aided the management of labour,
her attendants or relatives were requested to write a consent note where by in incidences where uterine contractions were measured
showing willingness for epidural analgesia. Also done was lignocaine to be less than 3 in ten minutes, oxytocin infusion was added.
sensitivity, regular investigations along BT/CT and lastly, the epidural Where CTG abnormalities were discovered or found, instrumental
catheter was inserted into parturient(s). Blood pressure, SpO2, heart deliveries were preferred and consequently performed while Lower
rate and FHR were all recorded. segment caesarean section or (LSCS) was performed to aid obstetric
induction. There was some epidural analgesia related effects such as
Procedure of Epidural analgesia. Before epidural catheter was
nausea, vomiting, hypertension and pruritis. During the study, patients
inserted, intravenous ranitidine was given to the parturient. Using a
who complained of vomiting and cases of nausea were treated with
partograph, BP, effacement, maternal pulse, uterine contractions were
ondansetron and intravenous ranitidine.
all recorded. Ringer lacte solution of 10ml formed the preloading part
and, a 16G epidural needle was positioned in space of L2-L4. After The indication of Oxytocin during active labour (>4cm).
this dose test, a 1.5% inj lidocaine was administered or injected and
a. In incidence where uterine contraction is measured to be less than
this followed close observation and monitoring for in case there was
3 in 10 minutes where by it has t last for 20 to 40 s.
pulse rise. Numbness as well as nondeveloment of cases like tingling
worked as evidence for for proper insertion of epidural catheter. At 0 b. The study observed that, save having observed good uterine
minute, a solution of bupivacaine/ropivacaine 0.125% and fentanyal contraction, no dilation was observed for two hours.
10ml and 2mcg respectively were given administered on patients.
During this study, we used inferential and descriptive statistics to
The monitoring of patient after epidural catheter was inserted. do statistical analysis which we based on Chi-square test and students
During monitoring process, the Patient(s) was(were) moved to as well as student’s unpaired T test. The study further employed a
labour room where cases like blood pressure and pulse were closely software known as SPSS 17.0 version, GrapPad Prism 5.0 version and
monitored in interval of every after 30 minutes while cervical EPI-IINFO 6.0 version. Also considered is p\0.05 which was observed
dilatation was closely monitored on interval of two hours. Partograph as level of significance.
was used to record and monitor the progress of labour, while CTG
helped in monitoring heart rate. Relatives and or a nurse remained The discussion
in company of the patient supporting her. Either on the request of
There are several techniques which including regional and
the patient or after a confirmation of regression of sensory level16up
non-regional that can be followed and used to to determine labour
to when the patient delivered, top up doses were given in interval
analgesia. However, it is important to note that epidural analgesia
of 60 to 90 minutes. VAS scale was used to grade the level of pain
remains the most effective one analgesia when it comes to labour pain
in patient. The duration of first stage was reached at by calculating
managing.
and adding the time interval between when a patient entered active
stage of labour, epidural catheter inserted, and then entire dilation of Notable demographic characteristics included; body mass index,
cervix done. The duration of second stage of labour was reached after registration status, age, and gestation age. Both results reached in this
calculating full dilation of cervix till the expulsion of the foetus or study - that is control and study group are and were indeed comparable.
baby from birth canal.
During this study, there was not any case registering failure of
16
after two segments. procedure, not even a case of complaint’s such as inadequate block.

Citation: Mohammad N, Xueping H, Hasan T, et al. Experience of using epidural labour analgesia in developing countries: effects to feotus and mother. J Anesth
Crit Care Open Access. 2020;13(1):5‒10. DOI: 10.15406/jaccoa.2021.13.00462
 Copyright:
Experience of using epidural labour analgesia in developing countries: effects to feotus and mother ©2021 Mohammad et al. 9

Like other published studies such as in Papalkar et al.,’s article17, motor blockade which can reduce on maternal mobility which further
during our study, there was no any significant difference observed in decreases maternal efforts especially in second stage of labour.
duration of the first stage of labour in the two groups – that is the study
During this study, seven lower segments caesareans were conducted
and control group respectively. Relatedly, another published study
in total, of these three were performed on a study group while four in
published in Journal of Clinical and Diagnostic Research entitled;
control group. These cases were as a result of prolonged second stage
“The Effect of Epidural Analgesia on Labour, Mode of Delivery and
of labour. Three patients in control group were subjected to lower
Neonatal Outcome in Nullipara of India, 2011-2014”18 authors Dipit
segments caesareans while only one of our patients in study group also
et al., in their study they observed that there was a short duration
underwent lower segments caesareans as a result of prolonged second
of first phase in epidural study group. This scarily can be explained
phase of labour. In both groups, (control and study), one patient was
by factors such as having used ropivacaine which may explain the
subjected to lower segments caesareans because of prolonged first
reported reduction inhibitory effect of catecholamines on uterine and
stage of labour while in study group, one patient was subjected to
even contractility thereby causing rapid cervical dilatation as the study
the process (lower segments caesareans) after a foetal distress was
suggested. This concurs with other published19 studies (Thorp,et al,.
diagnosed. When we compare with other published studies such as
1986).
Anwar et al,. (2015), largely, lower segments caesareans in their
Other scholars such as Hinch et al, in their 2014 scholarly work study groups were carried out as a result of foetal distress which
“Epidural analgesia during labour: a retrospective cohort study on their study observed to have been done due to meconium stained
its effects on labour, delivery and neonatal outcome”20 observed that liquor and deceleration or cardiotocogrsphy. In our study, we carried
the average duration of the first stage in their study was prolonged, out seven lower segments caesareans of which two were done after
an explanation for this maybe that as a result of high usage of local administering top-up dose of epidural while the remaining five lower
anaesthetic dose may contribute to such findings. In our study we segment caesarean were performed under the general anaesthesia.
further observed that during second state duration of labour in Throughout this study, we did not register any of our patient with
both study and control groups was largely comparable and there abnormal cardiotocragraph after epidural anaesthesia was done.
was no prolonged duration at second stage of labour. Appropriate
Our study’s most reported and observed side effects are nausea,
usage of analgesic dosage and adequate hydration of patients can
vomiting, rigor, itches/pruritis and hypotension.Other published
be advanced as the reasons for this scenario. When together taken
studies such as; Palpalkar et al,. (2013), Labor et al.,21 (2008) Smouh
into consideration, results for this study can be compared with other
et al,.22 (2005) observed in their studies that hypotension, nausea,
scholars’ findings such as Papalker et al (2013) findings. Non the less,
vomiting, and rigor were some of reported side effects during their
other published studies for example Dipti et al,. (2014) observes that
studies. Other side effects observed during this study among our
in second stage of labour, it was reported to have been prolonged
patients were minimal and not very life threatening and often were
in the group where the patients were given epidural. This may be
managed by symptomatic treatment. This scenario can be attributed
attributed to reasons such as weak pelvic floor muscle and motor
to more does administered to our patients.
blockade which can result into lowering effective maternal pushing
and hence involuntary bearing down flex. In our study, both operative Our study observed and recorded good results as far as effectiveness
and instrumental deliveries did not record increase. This concurs with of epidural analgesia is concerned considering the rate of satisfaction
other studies and are comparable with findings of published studies among our patients (women) as far as pain relief is concerned in labor.
such as in Papalker et al,.(2014) Dipti et al,. (2014) and in Hincz et This conclusion is derived from the meaurements of VAS scoring
al,. (2014) where these studies in patients who were given epidural system which we used in the study. Our results concurs with other
anaesthesia in labour, the studies recorded no increase in instrumental published results such as; Smouh et al,. (2005) and Desai et al,. where
delivery rates. Nonetheless, other studies such; Anwar et al (2015) both studies credit epidural analgesia for saving women labor pains.
in their scholarly work entitled; “Effect of epidural analgesia on
labor and its outcomes” and Hincz et al, (2014) recorded increased Another notable finding during this study is that there was a low
forceps deliveries inpatients that were given epidural analgesia. The rate level of acceptance when it comes to epidural analgesia. Many
observation as recorded above maybe attributed to factors such as women would rather go through labor pain while giving birth than
the existence of high concentrations of local anaesthetic which could going for this technique. This can be attributed to factors such as
have been used in past yet it had intermittent boluses thereby causing background of women – especially their social economic status.
Majority of them were from rural areas and had phobia for epidural
17
Papalkar J, Shrivastava D, Labour EA. International journal of
biological and medical research. Int J Biol Med Res. 2013;4(1):2707–
analgesia. Others see the technique as too expensive to manage hence
12.
Available from: <https://pdfs.semanticscholar.org/23cb/ opting for the traditional method no matter how painful it maybe.
fde038d8b9688f546ed21e58b2c8edc41c3a.pdf> accessed 20th September There is generally need for mass sensitization since majority of them
2018. seem not to know anything about the technique or all they know are
18
Agrawal D, Makhija B, Arora M, Haritwal A, Gurha P. The effect of epidural myths surrounding it.
analgesia on labour, mode of delivery and neonatal outcome in nullipara of
India, 2011–2014. J Clin Diagn Res JCDR. 2014;8(10):OC03. Available from: The number of neonates according to our study was generally high
<https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4253227/> standing at APGAR score >8 min, this was the case in our both groups
19
Thorp, JA, Parisi, VM, Boylan, PC, Johnston, DA. The effect of continuous (control and study group). Further to this, there was no significant
epidural analgesia on caesarean section for dystocia in nulliparous women. Am increment in number of NICU admissions in our two study groups.
J Obstet Gynecol. 1989;161:670–675. Our results concurs with other scholars findings and can be compared
20
Hincz P, Podciechowskil L, Grzesiak M, Horzelski W, Wil- czyflski J.
with studies such as Anwar et al,. Dipti et al, (2014); Papalk et al,
Epidural analgesia during labor: a retrospective cohort study on its effects on
labour, delivery and neonatal outcome. Ginekol Pol. 2014; 923–8. Available Labor S, Maguire S. The pain of labour. Rev Pain. 2008;2(2):15http://journals.
21

from:<file:///Users/mac/Downloads/45793-92678-1-PB%20(1).pdf> sagepub.com/doi/abs/10.1177/204946370800200205; Somuah M, Smyth R,

Howell C, Epidural versus non-epidural or no analgesia in labour, available at:
Accessed on 20 September 2018. http://journals.sagepub.com/doi/abs/10.1177/204946370800200205

Citation: Mohammad N, Xueping H, Hasan T, et al. Experience of using epidural labour analgesia in developing countries: effects to feotus and mother. J Anesth
Crit Care Open Access. 2020;13(1):5‒10. DOI: 10.15406/jaccoa.2021.13.00462
 Copyright:
Experience of using epidural labour analgesia in developing countries: effects to feotus and mother ©2021 Mohammad et al. 10

(2013); and Smoouh et al (2005). Nonetheless, Hincz et al, (2014); in during labor. The technique has been proven to be very effective with
their study entitled “Epidural analgesia during labor: a retrospective less life threatening side effects on the mother and the baby/foetus.
cohort study on its effects on labour, delivery and neonatal outcome” This study proves that with the technique, no prolongation in first and
reported a lower APGAR score at 1 min (<7) for babies whose mothers second stage of labor was observed. The study further did not record
delivered after receiving epidural analgesia. increase for instrumental delivery, neither was there observation of
threatening complication to mother(s). The study concludes that it’s a
Conclusion matter of time, the relief epidural analgesia provides women in labor
Considering the fears associated with labor pains, epidural will make it a best option for many in the nearest future.
analgesia provides a best option for patients (women) to get pain relief

Citation: Mohammad N, Xueping H, Hasan T, et al. Experience of using epidural labour analgesia in developing countries: effects to feotus and mother. J Anesth
Crit Care Open Access. 2020;13(1):5‒10. DOI: 10.15406/jaccoa.2021.13.00462