Pain relief in labour

Labour analgesia was first practiced way back in 1847 when chloroform was used by a Scottish physician called James Simpson. The only problem was that the new mother would wake up three days after the delivery and refuse to believe that she had delivered. Later on, prominent people like Queen Victoria also did experience ‘painless labour’.

Then, many were of the opinion that opting for painless labour was immoral and escapist. But that has gradually become a thing of the past as more and more people are going in for pain relief during labour by way of medication or other forms of therapy.

Some common methods of pain relief are:

• Medication (allopathic)
• Prepared child birth (Iamaze) including relaxation techniques, and breathing exercises
• TENS (Transcutaneous Electrical Nerve Stimulation)
• Hypnosis
• Acupressure and acupuncture
• Physical therapy like massage, counter pressure, hot/ cold compresses, light stroking
• Distraction
• Intra dermal injections of sterile water

Medication
Analgesics and sedatives
They are administered either by intramuscular injection (in the buttocks or forearm) .or intravenously in the form of a drip. Various kinds of sedatives and analgesics are available. All sedatives and analgesics have some side effects on the mother and child. The doctor will choose the ones that have the least side effects.

Local anaesthetics
These can be given during episiotomy to reduce the pain. The same agents can also be given to block the nerve supply to the cervix (paracervical block) and the vaginal vulva (pudendal block) thus one stops sensing the pain.

Epidural and spinal anaesthesia
These are by far the most popular and are the most commonly followed methods. Both are similar but epidural is preferred for a variety of technical reasons. In epidural anaesthesia, a local anaesthetic agent is injected inside the vertebral column in the region of the lower back. This reduces the backache and abdominal pain during labour. The doctor may inject the anaesthetic by a special needle (single shot EA) or more preferably, pass a thin plastic tube into the vertebral column through the needle.

The needle is removed and the plastic tube kept in place. The anaesthetic agent is injected through this plastic tube at periodic intervals depending upon the need of the patient-no matter how long the labour. The catheter is kept for some time after delivery and then removed.

This can also be used to give anaesthesia during C-Section should the need arise. In spinal anaesthesia, the anaesthetic agent is still injected into a region of the spine, but the needle is removed after injection, meaning you cannot top up if the drug wears off. Spinal anaesthesia is therefore unsuitable for labour but is highly recommended for C-Section delivery.

Other methods of pain relief
Transcutaneous Electrical Nerve Stimulation (TENS)
This is another method which is growing popular. Here, small pads are placed on the lower back (on specific areas) and the nerves are stimulated by giving small electrical impulses. These impulses then join the other pain impulses coming from the cervix and the uterus and thereby decrease the pain perception. This acts by ‘distracting’ the pain fibres so that you feel more at ease.

Hypnosis
Contrary to the misconception that people have regarding this technique, hypnosis in qualified hands provides a legitimate and medically acceptable method of pain relief. There is nothing mysterious about hypnosis. Technically, it is just suggestions and power of mind over matter. It is done over a period of weeks to months before labour.

Acupressure and acupuncture
These are old Chinese methods where pressure over specific body parts and skin punctures with needle are used respectively. The action is similar to TENS.

Acupressure
This technique involves applying pressure on a body part with the finger tips. You could do it yourself or have your partner do it for you. A few techniques for relieving the discomforts of labour and postpartum period are described below.

• For relieving head, neck and upper backache, apply circular pressure on the muscles at the top of the shoulder in a vertical line with the nipples near the back.
• Massaging the centre of the soles, below the ball of the feet will relax the lower body.
• To relieve low backache, pelvic discomfort or pain, press firmly in an inward direction on either side of the vertebral column, below the waist level. Circular pressure is applied during contractions and intermittent pressure between contractions.
• Heat and cold applied to the upper and outer part of the buttocks relieves hip and upper thigh pain on the same side.

Acupuncture
This technique involves using needles and puncturing specific sites on the body to relieve pain. This can only be done by an expert.

Physical therapy
Massage
Given by a professional masseuse or your spouse, massage can provide pain relief. Massage can be customized to suit individual requirements. You can ask your spouse to massage more over areas which provide most relief.

Counter pressure
There are various ways to give counter pressure. Your partner can use the fist or heel of hand on your back to reduce pain. You can direct him to the exact location. The point will move lower as labour progresses. You can go on all fours and your partner can squeeze your hips with both hands from the sides.

Another counter pressure for relieving backache is called ‘knee press’. Sit on a straight back chair with a folded towel or small pillow behind the small of the back. Your partner sits in front of you with hands on your knees. During contractions your partner leans forward and presses your upper legs towards the back of the chair.

Hot and cold compresses
Heat provides soothing relief and cold provides pain relief by numbing. For this, hot water bottles, electrical pads, warm and wet towels. ice bags or rubber glove filled with ice can be used. This can be applied on your back by your partner.

Light stroking
This you can do on your own or by your partner. During contractions place your finger tips on either side of the midline, just above the pubic bone and tightly stroke upwards to the top of your abdomen and then outwards and downwards, back to the beginning part. Continue this in circles using light stroking movements.

Intra-dermal injection of sterile water
This is a new technique where small amounts of sterile water are injected directly under the skin to form blisters like bumps. These cause intense stinging followed by relief of backache for 60 to 90 minutes. This may be due to release of substances called ‘endorphins’ in the blood, which act as natural painkillers}’

Which method is most suitable for you?
Of all these techniques, some are ‘Do it yourself’ but others mayor may not be available at the place where you deliver, depending on equipment and level of expertise required. So you may have to speak to your doctor regarding the availability of the techniques or any substitute for the same if the one you want is not available.

Cost is always a concern. You should explore the cheapest way to get the pain management you desire. Many doctors can devise packages that will include the cost of the pain management in the whole labour and delivery cost. In the majority of cases, where delivery is done in a large institution or hospital with all facilities available, epidural analgesia is preferred. This is because it does not interfere with your level of consciousness, and it allows you to participate fully in the labour process, it also does not lead to any major complications.

However, you must realize that you may not be able to push as effectively in the second stage of labour. This is because part of your natural reflexes may be blocked. Hence you will require constant supervision and encouragement to push or bear down. This is done by your doctor and/ or anaesthesiologist. There may be an increased need for assistance with vacuum or forceps to help you deliver your baby. This should not cause any additional problem in well-selected cases.

In most cases of ‘first time’ labour, some form of pain relief is helpful as the duration of labour is longer. It is a question of individual choice. however. You should discuss all these options with your doctor well in advance. Most importantly, keep your calm and resolve, and do not lose control while in labour. Convince your mind that motherhood is a pleasure-and some amount of pain is worth it. Labour is not necessarily painful as is shown in movies or as is described by some people. Consider it your journey and you are the captain of the ship! Your doctor is your navigator and will guide you in the best possible manner!

END: PG 23 /44-45