NEW DELHI: A drug that has been on the market for several decades and is a go-to for lakhs of women in labour across the world is barely ever used in govt hospitals in Delhi.Lady Hardinge Medical College (LHMC) is now trying to change that by offering women epidural analgesia to relieve labour pain.Though labour analgesia, especially epidural analgesia to relieve labour pain, gained popularity in the 1990s, over three decades later, it is unavailable to most women who deliver in public facilities.According to doctors at LHMC, poor availability of anaesthetists who can offer epidural anaesthesia for labour is one of the major reasons for the low usage, along with high patient load. Lady Hardinge does about 900 deliveries a month. “Since the bulk of patients who come to govt hospitals to deliver are poor, they are not aware of the option of pain relief for childbirth. Many believe that to have a baby one must go through pain,” explained Dr Ranju Singh, the head of the department of anaesthesia, who has pushed to make these services available at the hospital with support from the obstetrics and gynaecology head, Dr Ratna Biswas.Starting from the end of May this year, an average of two to three women are being administered epidural anaesthesia at LHMC every day. What costs anything between Rs 5,000 and Rs 20,000 in the private sector is being offered free of cost. An epidural is usually performed by administering medications through a catheter inserted into the spine. The medications, usually a combination of local anaesthetics and narcotics, target the pain nerves to reduce pain during labour.Epidural analgesia remains the gold standard for pain relief during childbirth, providing a level of precision and safety that systemic alternatives cannot match. “With the advent of newer drugs and techniques, the worry about epidural anaesthesia affecting the mother’s ability to push during childbirth is no longer a problem. It has been proven in multiple international high-quality studies that labour analgesia does not increase the rate of instrumental delivery nor the rate of caesarean delivery,” explained Dr Singh. Modern obstetric practice recognises that labour analgesia is not a luxury but an essential component of respectful, patient-centred maternity care.“We didn’t have enough resident doctors and faculty or machinery. Labour analgesia requires a dedicated team managed 24×7 by the anaesthesia department. It also requires individualised and protocolised care, and intensive monitoring once you administer something for pain relief, as you have to watch the mother and the baby continuously. But it was my dream to start labour analgesia in this hospital where I also gave birth,” said Dr Singh. It became possible when she hired a former student as assistant professor, Dr Parul Upreti, who has four to five years’ experience in labour analgesia in the private sector.Dr Upreti is on duty in the labour analgesia room through the day and is able to train postgraduate students of anaesthesia and senior residents in epidural anaesthesia for labour. Dr Singh has ensured that an anaesthesia technician and all the monitoring machinery were made available for the labour analgesia room.“We counsel the patients and reassure them that the epidural will not affect their baby or their ability to push the baby out. Once they experience pain-free labour, they are the best ambassadors. They encourage other women in the ward to opt for it,” said Dr Upreti. In case the normal delivery has to be converted to a C-section, the same epidural can be used for delivering anaesthesia for it, added Dr Upreti.“It makes a big difference to the patient. There is less screaming, which is good for the patient and for other women in the ward and our own stress levels,” said Dr Monica (who goes by a single name), a senior resident doctor in the obstetrics and gynaecology ward. Even as they cheer the success of the launch of labour analgesia, they also worry about the increased patient load once the word gets out that the hospital offers pain relief during labour.It is not like the option is not available in other govt-run hospitals. Doctors, however, say very few women opt for it. Doctors blame a combination of low awareness, concerns about prolonged labour, overcrowded maternity wards and staff shortages, despite the necessary infrastructure being available at many hospitals.At Delhi’s Safdarjung Hospital, doctors said epidural-assisted deliveries are technically feasible but are rarely requested by patients.“We have the infrastructure and expertise to provide epidural analgesia during labour, but there are hardly any takers,” said a doctor from Safdarjung Hospital, requesting anonymity. “Most of the patients we cater to come from backgrounds where awareness about painless delivery is limited. Even when counselling is provided, many patients and their families hesitate because labour can sometimes be prolonged after an epidural is administered.““There is often apprehension about having a catheter placed in the back for several hours. Families are also concerned about the possibility of delayed labour. In recent years, I have hardly seen a case of an epidural-assisted normal delivery here,” the doctor said.According to specialists, staffing constraints further complicate matters. Unlike epidurals administered for caesarean sections, labour epidurals require continuous monitoring by anaesthetists and trained nursing staff throughout the delivery process.“If more than one patient opts for labour epidural at the same time, manpower becomes a challenge because these patients require close observation,” the Safdarjung doctor said.Doctors at Deen Dayal Upadhyay (DDU) Hospital echoed similar concerns. As per a gynecologist at the hospital, epidural techniques are routinely used for surgeries and caesarean sections but are uncommon during normal deliveries.“We regularly administer epidural and spinal anaesthesia for surgeries, including C-sections. In caesarean deliveries, the epidural catheter can also be used for post-operative pain relief, reducing the need for intravenous or oral analgesics,” the doctor said.However, DDU Hospital largely caters to high-risk pregnancies, making labour epidurals less common.“Nearly 90 per cent of our obstetric patients are high-risk cases with associated comorbidities. When counselling women about labour epidurals, we also inform them that labour may become prolonged and, in some situations, a caesarean section may be required if labour does not progress adequately. Many patients and attendants decline after hearing this,” the doctor added.
