Labour and childbirth: Pain relief options

David Emvula

Labour pain is among the most severe types of physical pain women may experience during their lifetime.

The level of discomfort varies with each woman and each pregnancy.

Thus, pain relief is an essential part of medical care during childbirth.

Labour is a series of progressive, rhythmic contractions of the uterus.

These contractions help the cervix open and become thinner, which allows the baby to travel through the birth canal.

Labour pains and maternal stress are associated with the poor progress of labour, which could lead to complications for mothers and babies.

Fortunately, there are several pain management strategies, which include non-pharmacological interventions and pharmacological interventions.

The World Health Organisation (WHO) recommends adequate pain relief during labour to ensure a positive childbirth experience.

Non-pharmacological methods, such as relaxation techniques, manual techniques, acupuncture and birthing balls are considered safe.

Research has consistently demonstrated that women greatly value and benefit from the presence of someone they trust during labour and childbirth to provide emotional, psychological, and practical support and advice.

The supportive care may include having someone who is continuously present and who reassures and praises them, assists with measures for physical comfort, and undertakes any necessary advocacy on their behalf, such as helping the mother articulate her wishes to healthcare workers and others.

Epidural analgesia is regarded as the leading and most effective treatment for labour and delivery pain.

Epidural analgesia requires a specialist anaesthesiologist to insert a tiny tube, called a catheter, in the lower part of your back.

The catheter is left in place for the delivery of medication as needed.

This method has an 8,5% failure rate, and its limitations include costs, accessibility, prolonged labour, a reduction in women’s sense of control and their participation in the labour process, and could have adverse effects, such as a drop in blood pressure or a headache after delivery.

A specialist anaesthesiologist and a midwife would closely monitor the patient for possible complications.

Opioids are commonly used for pain relief during labour, as they are widely available, easy to use and are affordable.

Their main advantage is that they produce analgesia (pain relief) with milder side effects.

Opioids can be combined with other simple but effective painkillers like acetaminophen (Panado) given intravenously.

Most medications cross the placenta and may affect the baby.

Women in labour should engage their obstetricians regarding their preferences for pain management prior to the onset of labour, as well as facility protocols, and available resources in order to have a positive childbirth experience.

  • Dr David N Emvula is a specialist obstetrician and gyneacologist at Ob-gyn practice.

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