A World with Painless Births
Childbirth, a transformative and awe-inspiring journey. An experience uniquely individual yet universally profound. One can divide giving birth into three stages. Early labor: where the cervix begins to thin out and dilate to allow the baby to pass through the birth canal, contractions also take place here to help push the baby downwards. Delivery of the baby: here the cervix is fully dilated, usually at 10 centimeters (about the length of the long edge of a credit card), so that the baby can move from the uterus into the birth canal. The mother actively pushes during contractions to facilitate the baby’s passage through the birth canal. After the baby’s head passes through the birth canal, the entire baby is eventually delivered. The last step is the delivery of the placenta. This stage usually occurs within a few minutes to about 30 minutes after the baby’s delivery. This entire process can last 12 to 24 hours for a first birth (eight to ten hours for other births) and can be very painful. Childbirth pains are one of the reasons why many people refuse to have kids which is very understandable as most people giving birth give active-phase labor a pain score of 10 on a pain scale of 1 to 10, with no epidural or medication used. The child birthing experience may seem difficult, but Epidurals have made this process easier, they not only ease physical discomfort but also provide women the confidence to take an active role in giving birth.
The history of epidurals dates to the late 19th century when scientists and physicians began to explore the possibilities of regional anesthesia. James Leonard Corning, an American neurologist, stands as the visionary mind behind the early experiments that paved the way for the development of epidurals. James dedicated his career to exploring the realms of regional anesthesia, venturing into uncharted territory in the late 19th century. Corning’s “first experimentation involved injecting 20 minims (1.3 ml) of a 2% cocaine solution into the space between two inferior dorsal vertebrae of a young dog,” (Looseley 1) Corning’s goal with his experimental injections was to create a temporary state in the spinal cord that mimicked the physiological consequences of transverse myelitis or complete cord section. By doing so, he hoped to observe and comprehend how the introduction of cocaine into the epidural space might affect nerve signal transmission and induce a state of temporary anesthesia or numbness, like the effects seen in certain pathological spinal cord conditions. This experiment showed incoordination and weakness in the dogs behind. Cordings next subject was a man who suffered from ‘spinal weakness’ and ‘seminal incontinence’, “Corning injected 30 minims (2 ml) of 3% cocaine into the T11/12 interspinous space” (Looseley 1) which didn’t seem to take effect until repeated, after 10 minutes the subjects legs began to feel ‘sleepy’ and Corning noticed a significant reduction in sensitivity to pinprick and electrical current in the legs. Corning’s work was published and would lay the groundwork for future advances in the field.
While Corning’s experiments laid out the foundation for epidural anesthesia research, Sicard and Cathelin’s independent contributions represented a significant step forward for painless childbirths. Jean-Athanase Sicard and Fernand Cathelin were French physicians who in 1901 made history with their independent descriptions of the caudal approach to epidural anesthesia. The Caudal Approach involves the injection of anesthetic medication into the sacral hiatus, which is an opening at the lower end of the sacral canal. Sicard and Cathelin “described injecting dilute solutions of cocaine through the sacral hiatus to treat patients suffering from severe intractable sciatic pain or lumbago“ (Analg 1), and soon after while working separately Cathelin recognized that these injections can be used for surgery. Twenty years after Sicard’s and Cathelin’s papers, Spanish surgeon Fidel Pages describes a lumbar approach. The Lumbar approach involves the administration of epidural anesthesia by targeting the lumbar region of the spine. Pages was the first person recorded successfully performing surgery with an epidural, he injected a local anesthetic into the epidural space to achieve pain relief during surgery, specifically for a patient undergoing a procedure on the pelvic organs.
(Right) Injection going into the l\Lumbar region (Left) Injection going into the sacral hiatus
These professionals focused on the use of Epidurals for many types of treatment and surgeries, but it wasn’t until 1931 that Eugen Bogdan Aburel spoke about epidurals and laboring women. In Aburel’s paper, he describes blocking the lumbar plexus during early labor followed by a caudal epidural injection, “His technique was to administer a sacral epidural anesthetic of dibucaine with adrenaline in the first stage of labor; if additional medication was needed, it would be administered through a needle catheter placed into the caudal canal during the second stage of labor or into the lumbar aortic plexus during the first.” (wiki) Aburel is a hero in the labor pain relief world, he dedicated the greatest part of his profession to figuring out how to ease labor pains.
I have gone over the basis of the very lengthy history of the epidural. But how do today’s epidurals work? Epidurals are medical interventions for pain management during childbirth or surgery and work on complex scientific principles that combine anatomy, pharmacology, and neurophysiology. The anatomy of the spine is critical because the epidural space, which is nestled outside the spinal cord membrane, is the target for medication delivery. Through the administration of a carefully calibrated combination of local anesthetics and opioids, the mechanism of action unfolds. As Cleveland Clinic said, you “think of it as a liquid sleeve around your spinal cord.” (clevelandclinic)
Local anesthetics restrict nerve signal transmission by blocking sodium channels, which reduces action potential production, opioids also operate on spinal cord receptors to reduce pain signal propagation. The placement of the epidural involves the insertion of a needle into the lumbar region, guided by anatomical landmarks and imaging techniques. While epidurals offer effective analgesia, dose control is also critical because it allows healthcare practitioners to tune drug doses for the best pain relief, the procedure is also not without risks, necessitating careful monitoring for potential complications.
Epidurals can change a person’s labor experience, this localized pain reduction helps women enjoy childbirth with less discomfort, allowing them to concentrate on the happy moments of welcoming a new life into the world. Childbirth is a physically demanding process that can result in severe pain and exhaustion. Epidurals enable women to cope more effectively with the stresses of childbirth by allowing for relaxation and energy conservation during an exceptionally demanding labor. Stephanie, a woman interviewed by Cosmopolitan describes her experience, she explains how she wanted to have a drug-free birth if possible but after being awake for 30 hours during labor, she decided to go for an epidural. In her own words “It took a few minutes for the epidural to work but, to me, it was totally worth it. I had relief very quickly and didn’t feel pain again until after it wore off post-birth. With the epidural, I was able to finally sleep before a long night of pushing.” (Stephanie) This goes to show just how this injection can benefit mothers out there, for Stephanie’s second labor she asked for an epidural right away! A woman’s state of mind during labor is critical for a joyful and powerful experience and epidurals play a significant role in reducing anxiety and fear associated with the anticipation of pain. According to Lidija Fumić Dunkić and Gorka Vuletić “Studies have shown that the emotional state of anxiety lowers tolerance to pain and can also enhance pain experience” (Dunkić and Vuletić) meaning the more anxious a woman is the more pain she is likely to feel. If you take away this pain, then you also lower the anxiety.
On February 8th, 2017, a study was conducted that measured shifts in anxiety in a sample of women requesting epidural anesthesia during the various stages of childbirth, 133 women who asked for epidurals were asked to answer questionnaires. The first one was asked before the epidural, the second was 45 minutes after the epidural, and finally 24 hours after the epidural. The data came from two hospitals, a public and a private one. This study showed that “Women’s anxiety decreases significantly after applying epidural anesthesia, and it remains low 24 h after delivery (Taylor and Francis online) further proving that epidurals are worth getting.
My mother’s recent pregnancy has been a huge source of inspiration for me, and it has piqued my curiosity to learn more about labor and pain management. As we talked about her firsthand experiences, I noticed a distinct difference between her delivery experience with me and the modern options accessible now. Learning that no epidurals were used during her birth and that the anesthetic she got was not as advanced as current standards shed light on the revolutionary development in the delivery process. The significant difference in pain management methods between her previous and current pregnancies motivated me to investigate the evolution of epidurals, their benefits, and their impact on the delivery experience. After my research, I truly recommend epidurals to any anxious pregnant woman out there.
