Epidural labor analgesia (commonly known as: painless labor) is currently recognized as the safest and most reliable method of labor analgesia, and has become more and more commonly accepted by the Chinese population.
The epidural space is a potential cavity filled with nerve roots outside the spinal cord cavity. A tube (epidural placement) is placed in this part of the body, that is, an epidural needle is used to puncture the lumbar region, and after reaching the epidural space, a tiny catheter is introduced through the puncture needle as the route of administration of labor analgesia. During labor, analgesic medication is injected through this catheter into the epidural space and into the perineural area, thus providing continuous control of labor pain.
More crucially, in obstetric emergencies such as amniotic fluid embolism or uterine rupture, anesthesia time is greatly saved by injecting a surgical dose of local anesthetic directly without the need for any further manipulation. And at this time, time is life, and getting the baby born as soon as possible is necessary to ensure the survival of mother and baby. Moreover, this kind of anesthesia also avoids general anesthesia, which is the safest for mother and child. Therefore, it is still a “life-saving tube”.
Because of this, it is now advocated that in many high-risk women (e.g., trial of labor with scarred uterus, preeclampsia, morbid obesity, cardiac, hepatic, and renal insufficiency, etc.), a hypertubation is placed before labor pains occur to ensure the safety of mother and baby.
I have back pain now, is it caused by the anesthesia?
During the preoperative conversation for epidural analgesia, mothers and their families often ask, “Will the anesthesia leave sequelae of back pain?” Occasionally, after the procedure, patients will come up to me and ask, “I have back pain now, is it caused by the painless delivery?”
After the epidural catheter is removed, some patients will have some localized dull pain at the puncture site, but like a typical IV needle eye, it usually only lasts a few days as the tissue repairs. This pain rarely hurts enough to require oral pain medication. Back pain that lasts for months, or even years, after delivery is often not related to epidural labor analgesia.
Because the needle site for epidural analgesia is also in the lower back, it is natural to think that epidural puncture may be the culprit for postpartum low back pain. Women in labor are concerned about this issue, and healthcare professionals want to know if there is an association.
The prestigious 2012 UK meta-analysis (CochraneReveiews), which collected studies from around the world on this subject, with three cumulative studies of 1806 mothers, randomized to groups, compared the incidence of low back pain in 913 women who did not use epidural labor analgesia with 893 women who did, and the two groups – 361 (40%) and 337 (38%) women who used epidural labor analgesia, respectively – showed an association with low back pain. and 337 (38%) patients with chronic low back pain, respectively. The hypothesis that low back pain is associated with epidural analgesia was completely rejected. Moreover, it also made it known that the incidence of postpartum low back pain is around 40%.
The overall feeling is that Chinese anesthesiologists are more skilled in doing this type of operation than American doctors, and the damage may be less. The painless delivery China trip doctors brought the video of the Chinese doctors’ operation to the famous Harvard Massachusetts General Hospital and received a lot of praise.
Some women who visited the hospital for postpartum low back pain did manage to find some localized pressure pain at the eye of the needle, and during the follow-up, these were transient manifestations. No signs of chronic low back pain were seen.
Postpartum low back pain really has nothing to do with “painless delivery”!
Why do other patients who also had epidurals rarely come for follow-up because of low back pain? Is it because women are prone to low back pain? Is there any reason for postpartum low back pain?
It is now believed that there are several main causes of postpartum low back pain.
Pregnancy causes great changes in the endocrine system, and the ligaments connecting the pelvis become lax in order to deliver the fetus smoothly during labor. In addition, the increasing size of the uterus gradually increases the lumbar support force of pregnant women, resulting in the relaxation of the sacral ligament, which in turn causes lumbago.
After delivery, the endocrine system changes and does not return to the pre-pregnancy state soon, the pelvic ligaments are still in a relaxed state for a period of time, and the abdominal muscles also become weaker and weaker, so the uterus does not reset completely soon, causing low back pain.
During the second stage of labor, the mother is in a special position and exerts herself desperately for several hours to deliver the fetus, which adds a huge burden to the lower back. In addition, the mother needs to often bend over to take care of the baby after delivery, such as bathing, changing diapers, often picking up the baby from the cradle, etc., or poor drainage of malodorous dew causes pelvic blood stasis, are prone to induce lumbar pain.
Many women are less active after childbirth, always lying or sitting in bed to recuperate; coupled with weight gain, abdominal fat increased, increasing the load on the lumbar muscles, resulting in lumbar muscle strain and lumbago.
After childbirth do not pay attention to rest so that the body is overworked, or often long standing, squatting, sitting or girding waist too tight, etc., can lead to lumbar muscle strain, inducing lumbago.
Often take improper or not relaxed posture to breastfeed the baby, so that the lumbar muscles are always in a state of non-relaxation, and the lumbar muscles are damaged.
The normal position of the uterus is forward leaning and forward flexion, if prolapse of the uterus occurs, it will be displaced downward along the vagina, causing back pain. In addition, pregnant women are very prone to calcium deficiency, careless living, lumbar disc herniation and other such physiological changes during pregnancy, changes in position, position during childbirth, and problems related to the puerperium can all cause low back pain.
This also explains why women who give birth by cesarean section under general anesthesia can have back pain after delivery. If you know your elders, colleagues and friends who did not have a child with labor analgesia, you will know that postpartum low back pain is a very common problem.
One may then ask if epidural labor analgesia is contraindicated in pregnant women who had sciatica or other low back pain during or before pregnancy.
These conditions are not contraindications to epidural labor analgesia. However, it is worth noting that after labor analgesia, the existing back pain may be reduced, and care should be taken not to put the limb in a position where it could not be put before, so as to avoid the possibility of aggravating the original symptoms after the labor analgesia is stopped.
What should I do if I have “postpartum back pain”?
According to the above causes of low back pain, targeted and possible methods to prevent and treat postpartum low back pain are as follows.
Pay attention to prenatal prevention: eat reasonably, avoid overweight and increase the burden on the waist, causing damage to the lumbar muscles and ligaments. Moreover, an oversized fetus can cause many difficulties and even complications for the mother in childbirth. Weight control has also become an important part of preventing birth injuries.
Pay attention to the position before and after delivery: keep enough sleep after delivery, change bed position frequently, avoid frequent bending and standing for a long time, avoid overexertion, don’t run or walk far too early to avoid back pain caused by posterior position of the uterus or uterine prolapse.
Proper calcium supplementation during the perinatal period: drink more milk, eat more calcium-rich foods such as sesame seeds, and get more sunlight to promote calcium absorption. While preventing low back pain, it also provides sufficient calcium for the fetal baby.
If low back pain occurs, appropriate lumbar massage and physical therapy cannot be relieved, you should go to the hospital promptly.
Epidural nerve closure with the same needle as epidural labor analgesia is routinely an effective way to treat chronic low back pain.
Therefore, when choosing epidural labor analgesia, it is not necessary to worry about the sequelae of chronic low back pain.