Growing up, we were already aware of labour pains before pregnancy occurred.
The Grimace our mothers, sisters, friends, among others, give when they talk about labour pain is scary.
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Whenever women get pregnant, the fear of labour pain is always on their minds throughout the period of pregnancy.
In our setting, we mostly use the non-medical intervention to manage labour pain, and most people believe that “women who go through labour pain are the real mothers” which I strongly disagree.
Everyone’s pain threshold is different and should be managed accordingly.
What is labour Pain?
Labour pain is the pain experienced by a pregnant woman as a result of the uterus/womb contracting (that is tightening and relaxing) during childbirth.
From 37-40 weeks, labour is expected to start spontaneously if that doesn’t occur, in most cases, the labour is induced after a thorough examination of the mother and fetus.
During labour, the opening of your womb, the cervix, dilates fully (10cm). During this process, the uterus contracts and relaxes, which is accompanied by pain.
This pain can be managed in two ways:
Non-Pharmacological intervention (Natural Means)
Pharmacological intervention (medication)
Speaking to ten pregnant women prior to labour, eight of them are unaware of epidural or single-shot spinal anaesthesia, one was aware through an internet search, but she has never had experience.
The other person was aware of both interventions through her friend, who had an epidural during her first delivery in a private hospital.
With the natural means of pain management, such as deep breathing exercise, sacral massage, etc, all the 10 women were aware of the natural intervention, and they attest that it doesn’t really eliminate the pain is still unbearable.
However, they are unaware of the pharmacological intervention that is the epidural and single-shot spinal anaesthesia.
Non-pharmacological pain management during labour
This involves a physical and psychological technique to help cope with the pain and not necessarily eliminate or take away the pain.
Typically used in our setting includes;
Movement and positioning
Deep breathing exercise
Sacral massage
Labour Ball is used in some private hospitals
The pharmacological pain management
Epidural
Single-shot spinal anaesthesia.
Epidural
The use of medication to manage labour pain – most pregnant women are unaware of this management, and I believe with continued education, our women will be enlightened, and they will patronise it during labour.
This intervention can be given at any stage of labour.
However, it is best to administer the medication when the woman is in the active phase of labour, that is, when the cervix has dilated to about 4-5cm.
How it works
A specific catheter is inserted into the epidural space or lower part of your back, and medication (local anaesthesia) is given through it.
And it takes about 15 minutes for the medication to work.
What to expect
When the anaesthesia is given, it creates a band of numbness from your belly button to your upper legs. You remain awake throughout the labour.
When the drug starts to work, you become calm and relaxed, no screaming, no crying, etc The energy is rather reserved for the 2nd stage, where you are asked to push the baby out.
This medication does not take away the ability to feel the pressure during the second stage; the pressure still enables you to push your baby out when you are fully dilated.
The medication works throughout the labour; it can be increased or decreased per the progress of the labour after assessment of both mother and baby is done.
Single-shot spinal anaesthesia
This is a spinal block, which involves giving the medication at the lower back.
The medication is injected into the spinal fluid to numb the lower half of the body.
This brings good relief from the pain and starts working quickly
Unlike the epidural, which can be given throughout labour, single-shot spinal anaesthesia is usually given once, and it works for 3 hours.
It is usually given as and when needed and may or may not be repeated depending on the assessment of the foetus and the mother. Usually, when the mother has dilated to about 8cm, the dose won’t be given or repeated, and if the foetal heart rate is compromised, the dose won’t be repeated.
This is the point where I encourage pregnant women to have a discussion with their healthcare provider about their mode of delivery.
In a situation where nothing indicates that the woman needs a cesarean section (C/S) then the discussion on pain management during antenatal is very necessary.
There are some pregnancies where right from the word go, we know the mode of delivery is C/S.
Example 2: Previous C/S, however pregnancies that has a chance of spontaneous labour, the client should be given the chance to choose the pharmacological pain management available after a thorough assessment is done.
No “special award” is given to women who suffer during labour, even though they can afford the pain management.
The successful outcome of every pregnancy receives “congratulations” irrespective of the mode of delivery, the pain the woman goes through etc, why then should we suffer if we can actually receive some form of relief during the period?
On the other side, labour pain has a psychological effect on some men as they are unable to have the number of kids they intend to have because of the pain their spouse goes through during labour.
In conclusion, I have personally cared for women who received both epidural and single-shot spinal anaesthesia, trust me, they had pain-free labour, dilated fast and delivered successfully.
Not to end there, I personally had VBAC (Vaginal Birth After Cesarean Section).
During the labour, I requested for single-shot spinal anaesthesia because the pain was unbearable when I got to 4cm.
The pain I went through before the 4cm… hmmm, after receiving the medication, I was relaxed, and within 3 hours before the medication wore off, I was fully dilated to push the baby out. The push was successful, and I had my baby.
This should be a topic for discussion right from antenatal, if possible, it should be included to our procedures during labour, especially in the government sector.
To all pregnant women, if you fall into the category of vaginal birth, don’t hesitate to discuss pain management with your healthcare provider.
By RACHEAL HESSE MATEY
The Writer is the 2023 Best Practising Midwife GARH, Outstanding Midwife for the Neonatal Resuscitation Team GARH-Ridge 2024.
She is Obstetrical & Gynaecological Department
hesseracheal16@gmail.com
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