Spedali Civili Brescia
1th Department of Anesthesiology and Intensive Care
Director: dr. Gabriele Tomasoni


give birth without pain

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by dr. Salvatore R. Calabrese
Head of Obstetric Anesthesia and Analgesia



The birth of a child is an emotionally engaging event for the woman, both for the expectations developed during the previous nine months, and for the anxiety related to labor. Many women are able to deal peacefully with labor without any technical or analgesic therapy. For others, however, pain and anxiety can prevent from living this event in a serene way. Some women eventually choose to receive pain relief using a pharmacological analgesia.

epidural analgesia

Epidural analgesia is currently considered the most effective and safe technique to control the pain of labor. In few minutes it determines the disappearance or the reduction of pain. The uterine contractions are felt and in the second stage of labor you feel the urge to push.
Transitional changes in fetal heart rate are reported without any consequences for the child. Analgesia of childbirth usually shortens the dilating phase, and can prolong the duration of the second stage of labor. The use of cesarean section is not increased by this technique. Furthermore, the analgesia increases the cases where it is necessary to resort to the Kristellers’ maneuver (compressions exerted by the midwife on the woman’s abdomen), the use of the suction cup and the administration of oxytocin through a drip.

how do you

A small area on your back will be injected with a local anesthetic to numb it. A needle is then inserted into the numbed area surrounding the spinal cord in the lower back. After that, a small tube or catheter is threaded through the needle into the epidural space. The needle is then carefully removed, leaving the catheter in place to provide medication either through periodic injections or by continuous infusion. The catheter is taped to the back to prevent it from slipping out. The procedure takes a few minutes, is usually not painful, because it runs after anesthetized skin. The presence of the catheter does not prevent the movements of the mother. If labor is in progress, analgesia can be initiated at any time you require it, regardless of cervical dilation. It should be noted, however, that because of anatomical details, the technique may be difficult to perform or achieve only a partial benefit. In our series, we found 2% of failures.

situations where it is contraindicated

Epidural analgesia can be used on the vast majority of pregnant women. However, there are some contraindications, as in the presence of bleeding disorders, septic syndromes with fever, severe neurological diseases or in the presence of skin diseases or tattoos in the area where the catheter should be placed.

is it safe?

If properly performed, epidural analgesia is a safe technique, with rare drawbacks and side effects:

Like all medical techniques, the analgesia has rare but possible complications:

alternative methods

As an alternative, in some particular clinical situations, it is possible to use the subarachnoid analgesia (always an injection into the spinal area) or the administration of analgesics intravenously. However, the latter technique is less effective and has possible repercussions on the fetus.

how do you get

If you want to give birth with an epidural you have to attend a briefing held by the anesthesiologist every Monday at 14.30 at the “Montini” classroom of the "Spedali Civili" of Brescia. During the last trimester of pregnancy you will have to submit to a medical examination with the anesthesiologist, who will assess your medical condition and eventually will prescribe some clinical tests. On that occasion you will express your informed consent to the procedure. Whenever you will go into the delivery room, you will be assigned to a midwife, who will follow you throughout labor. If you will decide to give birth with the analgesia, your midwife will notify the anesthesiologist.

clinical tests

To receive the analgesia is necessary to have the following blood tests: PT, PTT, Emocromo, Fibrinogeno.
It is appropriate that at birth these tests are not older than 30 days (they are not necessary at the time of the visit with the anesthesiologist). On that occasion you will express your informed consent to the procedure. Whenever you will go into the delivery room, you will be assigned to a midwife, who will follow you throughout labor. If you will decide to give birth with the analgesia, your midwife will notify the anesthesiologist.

information and reservations

To book a visit to the anesthesiologist, you have to:

In you will not receive the call, you are requested to make contact with the Office of Communications and Public Relations (030.3995808 from 9.00 to 12.30 and from 14.00 to 16.00).

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