Labour pains — Do you need anaesthesia?

Women who have previously given birth do not ordinarily have good news for those who have never done so. Labour is painful, a different kind of pain. Inexplicable.

Josphine Kihi says, ‘There is nothing like labour pain. I cannot describe it. I have never felt that way in my life.’

From these expressions, new mothers have enough reason to worry, sometimes unnecessarily, as each woman reacts differently to different levels of pain. No one can predict what your pain will be like. Pain reduction methods are therefore welcome news for many women.

Zero familiarity

According to most women bearing their second or subsequent babies, it would be naive for any woman to imagine that since she has been through the pain once, she is familiar with it. Previous labour pains offer zero familiarity since the next delivery could be better or worse. Each delivery is a journey by itself.

Why the pain?

A religious version of labour pain is that it is simply a curse Eve received from God for tasting that sweet apple. It was punishment for tricking Adam to it.

On a lighter note, labour pain is like the exact opposite of an orgasm. The pain cuts deep into the flesh and bone in the same way an orgasm makes one pulsate with pleasure.

The biological version explains that uterine contractions which work to expel the baby from the womb are the cause of the pain. These contractions lead to reduced blood supply (ischaemia) to the muscles of the uterus that are working hard and thus need the blood, resulting in discomfort and pain with every contraction. As the cervix dilates (opens up) to create room for the baby to pass, one feels more pain. During delivery, the baby distends (exerts pressure on) the sensitive vagina and perineum (area underlying tissue between the anus and the vagina) leading to even more pain.

In order for the baby to be ejected, the cervix softens, opens and dilates up to 10 cm. At the peak of a contraction the baby expels through the fully dilated cervix.

The power of the mind

Some people have a very low threshold for pain tolerance and even the slightest level of pain seems unbearable to them. During delivery, such women are likely to experience more pain because of their fear, anxiety and preconceptions. That is why some women scream because the pain is overpowering, while others take in the contractions with perseverance. You would not know that the latter are in pain until you look at their facial expressions. Even then, you might occasionally catch the trace of a faint smile, the smile of a mother-to-be. Such is the power of the mind, which determines one’s ability to cope with pain. The mindset plays a key role in how a mum-to-be will face delivery.

To reduce the pain, you need to accept that it will be inevitable. Also remember that no one knows how painful it will be. It may end up being a little pain and therefore there is no need to fear. Do not focus on the stories of screaming women and tragic deliveries. Each day, millions of women deliver babies without screaming. Millions also deliver healthy babies safely. Moreover, labour pain, like many other conditions, is not permanent. Once it starts, you should count each minute as your success in reducing the amount of pain remaining and recognize you are getting closer to seeing your baby. Your focus must be on your baby, not the pain.

Form of delivery determines the applicable pain relief technique

Caesarian Section

Abdominal delivery refers to delivery of the child through an incision into the uterus through the abdominal wall. This procedure is commonly referred to as a caesarian section.

Vaginal Delivery

Natural delivery is the complete expulsion or extraction of the baby, placenta and fetal membranes through the birth canal. It is also referred to as vaginal delivery. In normal vaginal delivery the head appears first (known as vertex presentation). In a few cases the child may come out buttocks first. This is known as breech presentation and requires special handling to reduce risks to mother and child.

Natural delivery ordinarily triggers and completes on its own.  This is referred to as spontaneous delivery. In this case the baby is delivered without any intervention or mechanical aid. However, certain conditions may necessitate instrumental delivery, where the baby’s exit is facilitated using instruments. One such technique uses forceps — a surgical instrument with two blades used in the second stage of labour to extract the baby’s head. Another technique uses a vacuum extractor instead of the forceps. A metal cup is attached to the fetal scalp by suction and a gentle traction (pull) synchronized with uterine contractions is applied, thereby hastening the baby’s delivery.

Different approaches to pain relief during labour and delivery

There are two distinct approaches to relieving pain during labour and delivery — anaesthesia and natural techniques.

Anaesthesia is a state in which the body (or part of it) is insensitive to pain, feeling or sensation ordinarily as a result of artificially induced drug or gas (anaesthetic) into the body. Regional anaethesia is when only a part of the body numbs. This is different from general anaesthesia (whole body). Analgesia is lack of sensitivity to pain as a result of administration of drugs or other methods. Most people first experience analgesia when getting an injection in hospital, or at their dental clinic during a tooth extraction or cavity repair.

If your doctor deems it necessary, you may have pain medication during delivery. For instance a regional anaesthetic via the spinal cord. An injection of anaesthesia is administered in the area around the lumbar (lower back) region. It numbs the vagina and perineum (area between the vagina and anus) and results in short-term pain relief.

Epidural Analgesia

A local analgesic is injected into the epidural space in order to block the spinal nerves. This is applicable by either of two routes at the lower back: the caudal region or the lumbar region. The anaesthetic is injected into the space around your spinal cord where the nerves pass as they leave the spinal cord, which numbs the body from the waist downwards, including the uterus.

The lumbar option is more reliable than the caudal block. In the latter case the anaesthetic agent is administered through the lower part of the backbone (sacrum) to the nerves in this region that conduct the pain sensations upwards towards the brain. It is not easy to get the needle to the right place at this point and so the method is rarely applicable.

A-Z: Natural Tips of coping with labour pains

• Ask for information: This helps you to relax since you know what is happening to you.
• Breathe rhythmically and relax as you breathe out. Think about R-E as you breathe in and L-A-X as you breathe out.
• Cuddle your partner or birth companion.
• Drink sips of water in between contractions.
• Eat energy-rich foods when you feel hungry and especially at the start of labour.
• Fan yourself with a small electric fan or hand fan. The cool breeze helps you to relax.
• Groan and moan: making noise is a great form of pain relief, but be mindful of others!
• Hold your partner’s hand in a loving way.
• Imagine your baby moving down through your pelvis with every contraction.
• Joke. See the lighter side of the whole scenario. Joke about past events. During laughter, endorphins are hormones produced within the brain and nervous system. These hormones create an analgesic effect by modulating pain perceptions.
• Kiss and accept kisses from your partner if he is with you. Close your eyes and lose yourself!
• Listen to your favourite, soothing music to help you relax.
• Hove around to make yourself as comfortable as possible. Standing also helps the baby to move down due to gravity.
• Nestle down (cuddle/ settle comfortably and warmly) in a large pile of pillows.
• Open your pelvis as wide as possible to help your baby descend, for example by kneeling on one leg with the other leg out to the side.
• Positive thinking: ‘Each contraction brings me closer to holding my baby.’
• Question whatever is not clear to you; fear and anxiety due to uncertainty will only make the pain worse.
• Rock your pelvis round and round and back and forwards with each contraction.
• Sigh out gently with every breath. Then rest.
• Trust yourself. You are going to make it.
• Understand the treatment and care being offered to you then cooperate and make it easier.
• Visit the toilet; a full bladder will slow your labour. However, make sure you first consult with your midwife because while you may feel the urge, it could actually be the baby pressing on your rectum.
• Walk around. It will help you to ease aches and pains. The baby will also descend faster because of the contractions.
• Xcellent work. You are doing a fine job and the baby is almost here.                                                           Yell and then quickly try to get back into a good breathing pattern, but don’t waste a lot of your energy yelling.
• Zzzzzzz Rest in-between contractions. If they are still far apart, take some time and doze off.

Spinal anesthesia

This is very similar to the epidural block but the anaesthetic is injected in a space closer to the spinal cord where the fluid surrounding the cord (cerebral spinal fluid) is found.

Pudendal Block

Sometimes you may get an anaesthetic injected into the perineum directly especially if you are to have an episiotomy. The local anaesthetic infiltrates the pundendal nerve which is situated deep in the perineum. This is called a pudendal block and is achieved by a special technique through the vagina.

Who Needs Epidural Analgesia?

Conditions which may necessitate an epidural block include a ceaserian section, breech labour and delivery, prolonged labour, certain forceps procedures, cases of hypertension, multiple or preterm deliveries and maternal cardiac or respiratory diseases. A patient can also voluntarily request to receive an epidural block, especially in cases of excruciating labour and delivery. A low-concentration anaesthetic may also be administered. This results in partial numbness and allows the mother to still make movements (be mobile) during labour and delivery. This is known as a mobile epidural.

Other forms of pain relief

These include injections (such as pethidine and tramal) and gases (such as nitrous oxide) that are inhaled during labour. Unlike the regional anaesthetic these drugs get into the blood of the mother and also cross the placenta to the baby. They therefore have effects on both the mother and the baby.

Effects of Anaesthesia

On the mother: Some drugs may make you a bit drowsy, dizzy or nauseated. Sudden hypotension (blood pressure falling below the normal range) and toxic reactions to the drug can occur.

On the child: Certain medications may affect the child by depressing the breathing centre in the brain. Sudden hypotension (blood pressure falling below the normal range) may lead to diminished oxygen tension in the body tissues of the fetus. Others interfere with the baby’s breathing, making sucking inefficient or causing the baby to be drowsy after birth.

It is therefore crucial that anaesthesia is done under controlled conditions where monitoring mother’s maternal blood pressure and fetal heart rate is prioritized. You need to consult with your doctor and understand pain relief during your antenatal clinics and in any case before requesting for it during labour and delivery. It is better to understand this subject during pregnancy as you may have very little time or focus to fully appreciate its explanation once you are in labour.

 

END: PG 2/40-42