Pain relief during labour

LABOUR and childbirth is a painful experience for most women. And since the intensity of the pain and the woman’s reaction to this is unique to each person, Dr Shantell Neely-James, consultant obstetriciangynaecologist at Trade Medical, Portmore, says that it is important to know the range of methods that are available to you, especially as you write your birth plan.

“Labour is the process by which products of conception (foetus and placenta) are expelled from the uterus.

There are many signs associated with the onset of labour, such as the passage of the mucous plug, cervical effacement and dilation.

Pain is usually associated with injury or trauma, but labour pain is unique in that it can occur in a predictable fashion, and its increasing intensity indicates that delivery is approaching,” Dr Neely-James explained.

She said that labour pain usually occurs in three stages: cervical effacement and dilation, the descent of the foetus through the birth canal, and the third stage — delivery of the placenta and membranes.

“There are many factors that can influence a woman’s experience of labour pain. Among these are preparation for labour, cultural beliefs, previous pain experience, maternal fears, anxiety and sleep deprivation, which can alter the labour pain perception.

Fortunately, there are a variety of ways that pain can be managed,” Dr Neely-James said.

She explained that there are two main types of pain management: medical and nonmedical.

While most expectant mothers opt for medical pain management, others choose non-medical approaches out of a desire for natural birth as well as to avoid medication.

“It has been shown that women who adequately prepare for labour have less anxiety and therefore their pain perception may be less.

Adequate preparation prior to labour involves having proper diet and exercise. Also, those who have decreased smoking and alcohol consumption have been shown to have decreased pain,” Dr Neely- James said.

In addition to these, there are antenatal classes which offer significant benefits because they prepare the expectant mothers for what to anticipate at the different stages of labour.

In addition, as a part of natural therapy, Dr Neely- James notes that the presence of partners and other support can reduce anxiety.

Transcutaneous electrical nerve stimulation (TENS) is also another relatively safe method for mothers, which involves the use of a small handheld device to stimulate nerves in the lower back.

While some women desire a natural approach and they may have been adequately prepared during the antenatal period, Dr Neely-James reasons that pain is synonymous with labour, and sometimes non-medical options may not be adequate.

“When medical therapy is required, the three main options available are nitrous oxide, pethidine and epidural.

Nitrous oxide is commonly known as laughing gas, given at the start of the contraction. It doesn’t eliminate the pain, but it decreases intensity.

It doesn’t work for about one-third of women and is associated with side effects of nausea and vomiting,” she cautioned.

Pethidine, on the other hand, is an opioid pain reliever. This, the ob-gyn said, is a strong pain reliever that is injected into the muscle of the buttock. It is a commonly used method of analgesia in Jamaican hospitals, and in appropriately selected patients it is effective and safe.

However, it can be associated with nausea and vomiting and breathing problems in the mother. If administered too late in the labour period, Dr Neely- James said that it may also be associated with breathing problems in the baby.

“Epidural analgesia is the third method. It is the most effective pain relief available. It requires a trained specialist (anaesthesiologist) to inject the medication into the lining of the spinal cord. It is available in Jamaica, but the cost of this procedure usually limits how many women have this procedure,” Dr Neely-James said.

This procedure, however, can be complicated by a drop in the blood pressure and can also delay delivery.

About one per cent of women, Dr Neely-James noted, may have a headache immediately after the procedure.

Other local anaesthesia with lidocaine is used to numb the perineum (the muscular area between the vagina and the anus) for women who require an episiotomy which is done just before delivery to enlarge the vaginal opening.

This procedure is used routinely to speed up delivery and to prevent the vagina from tearing.