PAIN MANAGEMENT DURING DELIVERY
Many women, especially first time mothers-to-be, express fear about their impending delivery. But if you should ask further, many of them are more worried about labour pain specifically.
Labour pain is uncomfortable, there is no doubt about that. Hence it is not surprising that since time immemorial, one of pregnant women’s greatest concerns is the pain of labour.
The good news is there are many ways to cope with the pain currently. It is important to understand the different options available to relieve the pain. When you understand what to expect and know your options, you will feel more in control and less frightened. I always tell my patients that by eliminating the unknown, most of the fear would be allayed.
Like many other medical remedies, there isn’t a “one-size-fits-all” pain relief method for laboring women. There are many considerations when it comes to choosing the pain relief method that is most suitable for you. One basic consideration is the pain threshold of the woman. There are some women who are very stoic and can withstand the labour pain without any help. On the other extreme, there are some women who prefer to have a totally pain-free labour. Most women will fall somewhere in between.
Another consideration is the expected length of labour. Although nobody can predict with absolute certainty the duration of your labour, but there are some rules of thumb. For example, women going through labour for the first time usually have a longer labour compared to women who have had previous normal deliveries before. As such, first-time mothers may opt for epidural for better pain relief for their long labour, while a woman with previous normal deliveries may opt for simpler option like the entonox for their shorter labour.
The main options of pain relief in labour in Singapore could be categorized as follows:
A) Natural techniques
Basically these refer to methods to cope with the labour pain without the use of pharmaceutical agents. Listening to soothing music, relaxation techniques and breathing exercises may be enough to help some women to manage their labour pain. Others may get their partners to rub their lower back to relieve the discomfort. More and more women are choosing to immerse themselves in warm water bath during labour to relax themselves and to make the contractions more bearable. This is not to be confused with underwater birth and not all hospitals are equipped to provide this service.
Also known as “laughing gas”, this is a mixture of oxygen and nitrous oxide gas. This gas is delivered via a mask or a mouthpiece which the woman has to hold herself. The gas takes about 15 to 20 seconds to work, so the woman is advised to take slow deep breaths just as the contraction begins. If done properly, the effect of the gas will be in place just when the intensity of the contraction is maximum. The woman should stop using the Entonox in between contractions.
Entonox will not eliminate the pain totally, but it will make the woman feel “high” such that the pain does not bother them as much, hence making it more bearable. There are no harmful side effects to the baby but some women find that the gas makes them light-headed, giddy and nauseated. Many woman like Entonox because it is easy and painless to use.
C) Pethidine Injection
This is an effective form of pain relief which requires injection into the thigh muscle. Not only will it help the woman to relax, it effectively reduces the pain for the next three to four hours. The side effects of this medication include drowsiness, nausea and vomiting. Furthermore, if the baby is delivered within four hours of the injection, the baby may also be sleepy and not breathe so well. Should that happen, an antidote will be given to the baby.
While pethidine can be given in early part of the labour, it is not advisable to have it when the delivery is impending due to the effects it may have on the newborn. In other words, while pethidine is effective in early labour, it may not be used to relieve the labour pain in the later part; when the labour pain may be most intense.
D) Regional Anaesthesia
Epidural is probably the most well-known regional anaesthesia of all. Administered by an anaesthesiologist, it is the only option that may give the woman complete pain relief during labour. Epidural involves the anaesthesiologist placing a very fine tube into the woman’s back near the nerves that carry pain from the uterus. Through the fine tube, the anaesthesiologist will instill local anaesthetic around the nerves, numbing them such that the woman does not feel the painful contractions of the uterus.
Epidural is generally very safe. One of the side effects of the epidural may include a drop in the woman’s blood pressure. To prevent this, intravenous fluid will usually be given to the woman before the epidural. Due to the loss of sensation of the lower half of the body during epidural, the woman may find it difficult to pass urine during labour. If that happens, a small tube called the urinary catheter will be inserted into the bladder to drain the urine. Another common side-effect of epidural is shivering. But all these side-effects are temporary and will resolve after the epidural is stopped.
One of the most common question patients ask about epidural is “Will it cause backache?”. Backache is a very common ailment, among both men and women. Research has showed that women who had epidural are no more likely to get backache in future.
Regardless of the type of pain relief you may have planned to have before labour, you should always keep an open mind. It is not unusual for women to realize that they need more pain relief than expected. If that happens, do not regard it as a failure on your part. The most important thing to remember is to have a safe and comfortable delivery such that you can still have fond memories of this significant milestone in your life.