The journey of pregnancy is different for every woman. For some, it may be smooth and fun but for others, it may be tumultuous. All in all, most pregnant women look forward to the end of the journey with mixed feelings such as excitement, uncertainty, and even fear. This is especially fuelled by the thought and reality of labour pains.
Is labour the same for everyone?
The pain of labour and delivery is different for every person. Even for the same woman, the experience may be different with each pregnancy.
Some experience severe pains and those for whom it is mere cramp-like pains and pressure. The duration of labour varies from person to person lasting from minutes for some to hours on end for others. Labour depends on many things including the size of the baby and the way it is positioned in the womb.
The pain is usually mild early on in labour, but gets worse as one gets closer to delivery. The pain can come both from contractions (when the uterus tightens) and later, from the birth canal stretching as the baby is pushed out.
Does labour pain have any negative effects?
Labour pain has some effects on both the mother and the baby. However, most times as long as the mother and baby are healthy, they are both able to cope.
The pain itself causes one to breathe shallow and fast which reduces oxygen supply to the uterus, consequently affecting labour progress and causing baby heart rate abnormalities or low oxygen levels in the baby when it is born.
The low oxygen levels can cause light-headedness and even loss of consciousness in the mother. It can also cause sluggishness in the digestive system which can lead to anaesthesia complications in case an emergency caesarean section is needed.
In women with heart problems, excessive pain can cause changes in blood circulation that overwhelms the sick heart. Labour pain can also cause psychological trauma that leads to post-partum depression, anxiety disorder and post-traumatic stress disorder (PTSD).
Are there any options for dealing with labour pains?
There are generally two options for managing labour pains: medical and non-medical.
The medical options work in varying degrees. Some examples in this category include various types of injections, inhaled gas, and epidural.
The non-medical options are not intended to make the pain go away but rather to help one cope and maintain a sense of control during labour and delivery hence reducing suffering.
Examples of non-medical ways of lessening pain include the following: changing body position during labour, relaxation and breathing exercises, taking a shower or bath, lower back massage, applying heat or cold on the lower back, listening to music, taking a walk and having a companion during labour such as a close friend, partner or doula.
What are the medical options available for dealing with labour pains?
Some medications are given as muscular injections during early labour. These do not get rid of the pain completely but rather just the edge of it and should not be given when the baby is about to be born since it can make the baby sleepy at birth. Some of its side effects include vomiting, nausea and feeling drowsy.
Inhaled gases can also be used to control labour pains, the common one being Entonox. This is timed with contractions and one is expected to breathe on it correctly, with each contraction, for it to be effective.
Its absorption takes place in the lungs. You begin to breathe it in when a contraction is about to start and stop at the peak of it. You do this for as long as you need. It also does not take the pain completely away and may cause nausea, vomiting and feeling sleepy.
Injections can be given to numb the muscles surrounding the birth canal and reduce pain during the delivery of the baby. This is especially important when there is a need for use of instruments to help with the delivery of the baby.
Sometimes the mother is too tired to push the baby out or the baby’s heartbeat is misbehaving or the mother has medical problems such as heart conditions that could endanger her life if she pushed hard, and she has to be assisted to ensure safety for both mother and baby.
During such times, instruments such as a vacuum cap placed on the baby's head or forceps can be used to help pull out the baby, and this requires good pain control.
Epidural is a form of pain control that involves the introduction of a small catheter in the lower back through which pain medications are given during labour. It is a procedure that is usually done by a medical professional trained to do it and needs close monitoring. It is safe and eliminates pain effectively.
Some possible side effects of epidural include a drop in blood pressure, nausea, vomiting, body itching, hotness of body, urine retention, headache and temporary baby heart rate abnormalities especially if the mother’s blood pressure drops.
What are some of the myths surrounding epidural?
There are many myths about epidural. They include:
: Long-term low back problems. Many women suffer low back pain issues during their lifetime which is caused by many things including being pregnant and giving birth.
: Epidural makes one unable to push the baby out. Epidural does preserve the ability to push the baby out.
: Epidural increases rates of Caesarean delivery or instrumental delivery for example using a vacuum cap or forceps to help pull out the baby. This is not true.
: Epidural causes autism in babies. This is not true.
How do I decide which pain option to take?
Every individual deals with pain very differently. One should not be made to feel less of a person/mother for needing pain relief during labour. Your health provider should discuss with you the options available to you.
Dr Okemo is a consultant obstetrician gynaecologist at Aga Khan University Hospital, Nairobi