For Those Considering Painless Delivery
Labor pain occurs as the uterus contracts and the birth canal expands, and these pain signals are transmitted to the brain through the spinal cord.The “epidural anesthesia” used for painless delivery is a type of “regional anesthesia” that affects only part of the body and is performed to relieve such pain.This method reduces labor pain by blocking pain signals from the uterus and birth canal at the level of the spinal cord.In addition, unlike surgery where the nerves are completely numbed, the goal is to reduce pain while allowing the mother to retain the ability to push during labor and proceed with delivery safely, which is why it is also called “epidural assisted delivery.”However, even when the same medication and method are used, the degree of pain relief varies from person to person, and in some cases, pain may not be relieved as effectively as expected.
There are disadvantages, and careful management is required.
There are two types of painless delivery: the “on-demand type,” in which anesthesia is administered after labor begins or after the water breaks, and the “scheduled painless delivery,” which is planned in advance.At our hospital, we provide scheduled painless delivery using epidural anesthesia.
We are a registered facility of JALA (Japan Association for Labor Analgesia-related Academic Societies and Organizations)
Our hospital is certified as a registered facility based on the registration system operated by JALA (Japan Association for Labor Analgesia-related Academic Societies and Organizations).For details, please refer to the official JALA website.
JALA (Japan Association for Labor Analgesia-related Academic Societies and Organizations) (Japanese)
Methods of Painless Delivery
Method of Anesthesia
A catheter is inserted into the lower back area to administer anesthetic medication.After the catheter is inserted, labor-inducing medication is used to initiate contractions.Once contractions become regular and at the timing requested by the patient, painless delivery will begin while carefully monitoring the situation.The effects of the anesthesia usually appear within several tens of minutes.However, during labor, the position of the catheter may shift, which can affect how the anesthesia works or cause differences in effectiveness between the left and right sides of the body.In such cases, the catheter position may be adjusted or reinserted, and additional anesthetic medication may be administered as needed.
Policy
Depending on the condition of the cervix (such as softness and degree of dilation) and the size of the baby, the delivery schedule may need to be adjusted shortly before delivery.For scheduled delivery, hospitalization is generally planned around 38 to 39 weeks of pregnancy; however, if labor starts naturally or the water breaks before then, painless delivery may not be possible.In addition, if reservation slots become available due to cancellations, patients on the waiting list will be contacted in order and informed of the hospitalization schedule.
Painless delivery is not essential for vaginal delivery.Therefore, depending on emergency responses for other patients or the overall situation, it may not always be possible to accommodate requests for painless delivery. Thank you for your understanding.
Procedure
You will be asked to lie on your side and slightly round your back.Your back will be disinfected, and local anesthesia will be administered around the lower back area to minimize pain.Next, a thin catheter will be inserted into your back, and a small amount of anesthetic medication will be used to confirm that the tip of the catheter is positioned correctly.After that, anesthetic medication will be administered in several doses while checking whether the anesthesia is taking effect.A “cold test,” which uses a cold object to check sensation, will also be performed to confirm whether pain relief is effective in the intended area.
Your condition and the baby’s condition will be monitored using devices such as a blood pressure monitor, electrocardiogram (ECG), pulse oximeter, and fetal heart rate monitor.Not only the progress of labor, but also the effectiveness of the anesthesia and any side effects will be checked regularly.If you experience sudden pain during labor or feel that the anesthesia is working differently on each side of your body, please do not hesitate to inform the staff.Once all post-delivery procedures are completed, the catheter in your back will be removed.
Indications and Contraindications
Indications
- When requested by the patient
- When it is preferable to reduce physical strain due to underlying medical conditions
※ Patients with obesity (BMI of 30 or higher by 20 weeks, or BMI of 32 or higher by 36 weeks) are not eligible according to our hospital’s criteria.
Applicable Medical Conditions
Painless delivery may also be performed for patients with conditions in which an increase in blood pressure is undesirable, such as heart disease or IgA nephropathy. Please feel free to consult us.
Contraindications
Cases involving blood coagulation disorders, severe spinal disease, infectious diseases, etc.
Benefits
By relieving labor pain, stress caused by pain may be reduced, and the mother’s physical recovery after delivery may be faster in some cases.
Disadvantages
Painless delivery may involve certain side effects and risks.After epidural anesthesia is administered, the mother’s electrocardiogram, blood pressure, and oxygen saturation will be continuously monitored, and the doctor will observe her condition.The baby’s heart rate will also be continuously monitored.If side effects or complications occur, appropriate measures will be taken promptly.However, even with careful management, some complications cannot be predicted, and not all possible risks can be explained in advance.The following are representative examples, but please understand that other possibilities may also exist.
Common Side Effects and Complications
- Prolonged labor：Labor may take longer. In such cases, the likelihood of requiring medical interventions such as labor-inducing medication or vacuum-assisted delivery may increase.
- Low blood pressure：Blood pressure may decrease during painless delivery.
- Decrease in fetal heart rate：This can occur during natural delivery, but the baby’s heart rate may also decrease during painless delivery. In such cases, treatment such as administering oxygen to the mother will be provided; however, if the heart rate does not recover, an emergency cesarean section may be required.
- Fever：A fever of 38°C or higher may occur due to epidural anesthesia or muscle strain caused by prolonged labor.
- Itching：You may experience itching due to the effects of the anesthetic medication.。
- Lower back pain and nerve problems in the lower limbs：After delivery, lower back pain or nerve-related problems in the legs may occur. These may be caused by the anesthesia, but they may also be caused by the delivery itself.
Extremely Rare but Serious Complications
- Local anesthetic toxicity：This may occur due to an overdose of anesthetic medication or accidental injection into a blood vessel. Early symptoms may include numbness around the mouth or ringing in the ears, and convulsions may also occur.
- High spinal / total spinal anesthesia：If the catheter enters a deeper space than intended, the subarachnoid space, symptoms such as inability to move the legs, numbness in the arms, respiratory arrest, or loss of consciousness may occur.
- Epidural hematoma / abscess：When inserting the anesthesia needle or removing the catheter, a hematoma may form around the nerves in the back, compressing the nerves and causing numbness or motor impairment. In addition, bacteria may enter the catheter insertion site and form an epidural abscess, in which pus accumulates. If symptoms occur, both conditions require imaging tests such as MRI and surgical removal by an orthopedic surgeon.
- Drug allergy / anaphylactic shock：An allergic reaction may occur to the medications used. In severe cases, it may lead to anaphylactic shock, causing a sudden drop in blood pressure or impaired consciousness.
Risks
Because pain is reduced, detection may be delayed if an abnormality involving severe pain occurs, such as uterine rupture or placental abruption. In addition, after delivery, uterine contractions may become weaker, and together with the effects of painless delivery or vacuum-assisted delivery, the amount of bleeding may tend to increase. These events can occur not only in painless delivery but also in regular delivery. Since the situation during delivery is constantly changing, unpredictable complications may occur, and emergency medical treatment may be required in such cases.
Effects on the Baby
If excessively strong contractions occur due to the use of labor-inducing medication, the baby may temporarily experience oxygen deficiency. Therefore, continuous fetal heart rate monitoring is used during delivery.Vacuum-assisted delivery or fundal pressure may also become necessary, which may increase the burden on the baby. Because this differs from natural delivery, it may take some time for the baby to adapt to the environment. Hospitalization and treatment may be required, and rooming-in with the mother or discharge may not proceed as scheduled. At our hospital, we have a system in place to respond appropriately in emergencies.
An adequate staffing system is necessary in order to respond to the above risks.If it is determined that securing sufficient staff is difficult depending on the situation on the day, or if it is determined that the baby is under significant stress, painless delivery may be discontinued or changed to a cesarean section.
Flow After Hospitalization
1. The dilation of the cervix will be evaluated by internal examination, and the plan for labor induction will be determined.
2. After securing an IV line, an epidural anesthesia catheter will be inserted. (This may be done before or after labor induction.)
3. Labor induction will begin.
- If Cervical Ripening Is Favorable at the Time of Admission
- Labor induction will begin with an intravenous infusion of labor-inducing medication.。
- If Cervical Ripening Is Unfavorable
- On the afternoon of the admission day, cervical dilation will be performed using a device such as laminaria, which expands by absorbing fluid, or a small balloon. (This procedure alone may cause labor to progress from the evening onward.) From 9:00 the following morning, labor induction will begin with an intravenous infusion of labor-inducing medication. In some cases, the balloon may be replaced with a larger one to further dilate the cervix.
- Timing of Starting Anesthesia
- Anesthesia will be started based on a comprehensive assessment of how you feel pain and the progress confirmed by internal examination. You may be asked to tolerate the pain for a while.
※Depending on the condition of the cervix, labor may not progress as scheduled, and admission may be postponed or management may be changed to after spontaneous labor begins.
Even with induction, effective contractions may not occur and labor may hardly progress. In such cases, you may be discharged once and asked to wait for spontaneous labor to begin.
How to Spend Time During Epidural Anesthesia
- Walking
- Because anesthesia may temporarily make it difficult to move the leg muscles, there is a risk of falling. After anesthesia begins, bed rest is generally required.
- Urination
- You will not be able to go to the restroom. In addition, urination may become difficult, and if necessary, a urinary catheter will be inserted to drain urine.
- Meals
- Because anesthesia may slow gastrointestinal movement, you will be required to fast, and fluids and nutrition will be provided by intravenous infusion. You may drink water or clear beverages.
Symptoms to Watch For
- Shortness of breath or feeling unwell
- Changes in sensation or unusual sensations
- Pain is not relieved at all
→ If you experience any of these symptoms, please call the nurse immediately.
Fees
Painless Delivery Fee: JPY 130,000
- Painless delivery is not covered by health insurance.
- Our hospital uses a flat fee system per delivery.
※No additional charges will be incurred even if the delivery continues into the next day.
- If requested, the painless delivery fee will be charged in addition to the standard delivery fee.
Additional fees may also apply depending on the progress and circumstances of the delivery.
- For painless delivery, charges begin once the epidural catheter has been inserted.
Fees will still apply even if a cesarean section becomes necessary or if adequate pain relief cannot be achieved in time or is ineffective.
Pamphlets / Handout Materials
