Muslim Views . February 2017
23
Pain management during labour DR ANEEQAH HENDRICKS
LABOUR and delivery is a time of intense pain, which is often influenced by the psychological, emotional, social, cultural and physiological state of the mother. Maternal physiological responses to labour pain may influence maternal and foetal well-being and labour progress. Pain, stress and anxiety cause the release of stress hormones. The sympathetic nervous system response to pain leads to a marked increase in circulating catecholamines that can adversely affect uterine activity and uteroplacental blood flow. There are multiple methods of alleviating pain during the birthing process available. Whether you choose pharmacological methods, such as morphine or an epidural, or nonpharmacological methods (water, hypnotism, acupuncture, acupressure) to make labour easier, be prepared for some degree of pain or discomfort. Effective pain management attenuates or eliminates these responses. As you prepare for labour, it is important to become familiar with the pain medications that are available, how they work, their risks and their benefits. Most commonly used are entonox (gas), opiates (morphine and pethidine) and epidural. Entonox works quickly, leaves the system quickly and is self administered, meaning that the patient has more control. It also helps focus the breathing, there are no known side effects to the foetus and can be used at home or
Dr Aneeqah Hendricks Photo SUPPLIED
in the birth pool. On the other hand, entonox can make you nauseous, ‘dizzy, not with it’ and out of control. The long-term effects on the baby are unknown. Pethidine and morphine work quickly, take the edge off the pain, act as sedatives and relaxes and calms the patient. They are best given in early labour. The disadvantages are that they can cause nausea and vomiting; possible reduced mobility could slow labour; they interfere with endorphin production; there is an increased risk of intervention; they interfere with prolactin (milk production hormone); they cross to the baby and, if given too close to birth, can affect the baby’s breathing and sucking. Epidural provides total pain relief when effective, does not cause drowsiness and lowers
blood pressure. The disadvantages are that there is reduced mobility; you’ll need an IV line; it can slow labour; there is an increased risk of intervention and instrumental delivery; you will need a urinary catheter; and it can cause itching and severe headache. Hypnosis: With a little practice throughout pregnancy, women learn the process of becoming deeply relaxed and free of fear so the uterine muscles can work with minimal pain. Acupuncture/ acupressure involves applying pressure to specific points in the body to provide pain relief and encourage an efficient labour. TENS (transcutaneous electrical nerve stimulation) provides relief for the first stage of labour (25-60% effective), and is good for backache. Therapeutic touch or massage in labour serves to communicate caring and reassurance. Painful contractions of the uterus can be treated by applying pressure with the hands to the woman’s back, abdomen, hips, thighs, sacrum or perineum. Touch reportedly reduces anxiety in patients. In a retrospective study of 30 patients, 77 per cent experienced ‘less pain’ when they were touched during labour, and 40 per cent reported less need for pain medication. Movement, like bouncing gently on a Pilates ball, and heat, like sitting in a warm bath, could also reduce pain. You may find that you want more pain relief than you’d planned or your doctor or mid-
wife may suggest more effective pain relief to help the delivery. Ask them to explain what’s available so that you can decide what’s best for you. Women have been serving others in childbirth for many centuries and have proven that support from another woman has a positive impact on the labour process. ‘Doula’ is Greek for ‘women’s servant’. A doula is a professional trained in childbirth who provides emotional, physical and educational support to a mother who is expecting, is in labour or has recently given birth. The doula’s purpose is to help women have a safe and empowering birthing experience. Most doula-client relationships begin a few months before birth. During this period, they develop a relationship in which the mother feels free to ask questions, express her fears and concerns, and takes an active role in creating a birth plan. Doulas do not provide medical care. However, they are knowledgeable in many medical aspects of labour and delivery. As such, they can help their clients gain a better understanding of the procedures and possible complications in late pregnancy or delivery. During delivery, doulas are constantly in close proximity of the mother. They are able to provide comfort with pain-relief techniques, including breathing techniques, relaxation techniques, massage and labour positions. They also encourage participation from the partner, and offer reassurance.
After the birth, many doulas will spend time helping mothers begin the breastfeeding process and encouraging bonding between the new baby and other family members. Numerous studies have documented the benefits of having a doula present during labour. A recent Cochrane Review, ‘Continuous Support for Women During Childbirth’, showed a high number of positive birth outcomes when a doula was present. With the support of a doula, women were less likely to opt for pain-relief medications and less likely to have a caesarean birth. Women also reported having a more positive childbirth experience. Other studies have shown that having a doula as a member of the birth team decreases the overall caesarean rate by 50 per cent, the length of labour by 25 per cent, the use of oxytocin by 40 per cent, and requests for an epidural by 60 per cent. The key to choosing a doula is to find one with whom you feel comfortable. Melomed labour ward staff encourages doula support in pregnancy and labour, and the doula and husband are allowed in the delivery room. Whether you decide to use pain relief during labour or not, there are a number of techniques that will help you be more relaxed, which can help you cope with the pain. Dr Aneeqah Hendricks [MBChB (UCT), FCOG (UCT), MMED (UCT)] is an obstetrician and gynaecologist at Melomed Tokai. Tel: 021 712 2691.
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For more information on our Melobabe Maternity Progromme, contact us at info@melomed.co.za or visit our website for more details.
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