INTRODUCTION
Labour is a physiologic process during which foetus, membranes,
umbilical cord, and placenta are expelled from uterus. Many factors are
involved in labour and are associated with unique experience by every
woman. Pain during labour is highest ranked among all other pains
experienced in life.1 Untreated labour pain leads to
chronic pain, post-partum stress syndrome, and psychological and
physiological consequences which are undesirable. Pain and anxiety
causes release of adrenaline which results in prolonged labour and the
increase in the level of noradrenaline by 25%, uterine blood flow
decreases by 50%. Maternal cardiac output, systemic vascular resistance
and oxygen demand will be increased.2 Labour is a
natural phenomenon which produces intolerable pain that requires
effective methods for pain relief which is often challenging and complex
task without regional analgesia.3 Labour pain
management during delivery plays an important role in woman’s
satisfaction.4 Pain is originated from cervix during
first stage of labour .The pressure on perineum by the descending foetus
causes additional pain during late first stage. It causes stretching,
distension and tearing of pelvic fascia, subcutaneous tissues and
muscles of the perineum.5 Painful stimuli from cervix
and lower uterine segment are transmitted to tenth, eleventh, and
twelfth thoracic and first lumbar spinal portions via sympathetic nerve
fibres after entering the spinal cord.8 Sensory
impulses from vagina and perineum carried to second, third and fourth
spinal segments via pudental nerves. Additionally, pressure on a single
or more root base of the lumbo sacral plexus causes hurting, burning, or
distress in the lower limbs and back. 9Lumbar epidural
analgesia is most widely accepted method used to reduce labour pain.
This involves blocking of painful senses by injecting local anaesthetic
into lower region of spine.11It is usually very
effective and very safe.