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Dealing with labour pains

<p><span style="font-family: helvetica;"><img src="/nairobi/PublishingImages/Maternal%20and%20newborn.jpg" alt="" style="margin: 5px;"/></span> </p><p><span style="font-family: helvetica;">
</span></p><p><span style="font-family: helvetica;">The journey of pregnancy is very different for different women. For some it may be smooth and fun but for others it may be tumultuous and trying. 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 fueled by the thought and reality of labour pains. Those who have gone through it are well aware of the extent of it, some even traumatised by it.</span></p><p><strong style="font-family: helvetica;">Is labour the same for everyone?</strong></p><p><span style="font-family: helvetica;">The pain of labour and delivery is different for every person. Even for the same woman, the experience may be different with each pregnancy. There are those who 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.</span></p><p><strong style="font-family: helvetica;">Does labour pain have any negative effects?</strong></p><p><span style="font-family: helvetica;">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 with it quite well without any negative consequences.</span></p><p><span style="font-family: helvetica;">The pain itself causes one to breath 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.</span></p><p><span style="font-family: helvetica;">In women with heart problems, the excessive pain can cause changes in blood circulation that overwhelms the sick heart. Labour pain can also cause psychological trauma that leads to postpartum depression, anxiety disorder and post-traumatic stress disorder (PTSD).</span></p><p><strong style="font-family: helvetica;">Are there any options for dealing with labour pains?</strong></p><p><span style="font-family: helvetica;">There are generally two options of managing labour pains: medical and non-medical.</span></p><p><span style="font-family: helvetica;">The medical options work in varying degrees and at different times of labour and delivery process with the aim of reducing pain. Some examples in this category include various types of injections, inhaled gas and epidural.</span></p><p><span style="font-family: helvetica;">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.</span></p><p><strong style="font-family: helvetica;">What are the medical options available for dealing with labour pains?</strong></p><p><span style="font-family: helvetica;">There are some medications that 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.</span></p><p><span style="font-family: helvetica;">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 doesn&#39;t take the pain completely away and may cause nausea, vomiting and feeling sleepy.</span></p><p><span style="font-family: helvetica;">Some injections can be given to numb the muscles surrounding the birth canal and reduce pain during delivery of the baby. This is especially important when there is a need for use of instruments to help with delivery of the baby. Sometimes the mother is too tired to push the baby out or the baby&#39;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&#39;s head or forceps can be used to help pull out the baby, and this requires good pain control.</span></p><p><span style="font-family: helvetica;">Epidural is a form of pain control that involves introduction of a small catheter in the lower back through which pain medications are given during the course of labour. It is a procedure that is usually done by a medical professional trained to do it and needs close monitoring by the doctors and a team of nurses also trained in the same. It is generally safe and eliminates pain effectively but its main limitations are cost and availability of experts who can do it. 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&#39;s blood pressure drops. Measures are always taken to prevent, monitor for and treat these side effects as they arise.</span></p><p><strong style="font-family: helvetica;">What are some of the myths surrounding epidural?</strong></p><p><span style="font-family: helvetica;">There are many myths about epidural. Many people believe that epidural causes long term low back problems but this is not true. Many women suffer low back pain issues during their lifetime which is caused by many things including simply being pregnant and giving birth. Others also believe that if one is on epidural they will be unable to push the baby out but this is untrue as epidural does preserve the ability to push the baby out. In line with this belief, people tend to wrongly think that epidural increases rates of caesarean delivery or instrumental delivery for example using a vacuum cap or forceps to help pull out the baby. Another false belief about epidural is that it causes autism in babies.</span></p><p><strong style="font-family: helvetica;">How do I decide which pain option to take?</strong></p><p><span style="font-family: helvetica;">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 about the options of labour pain control available to you from as early as your antenatal visits and once admitted in labour. This is to facilitate planning especially financial if considering epidural or organising for the non-medical options of labour pain control such as a birth companion. When such discussion has not been initiated, you can take a personal initiative and make inquiries into it. In the event that you are already in labour and feel the need for pain relief, you can also ask your nurse or doctor about the same.</span></p><p><em style="font-family: helvetica;">By Dr Joan Okemo, Consultant Obstetrician Gynaecologist at Aga Khan University Hospital, Nairobi</em></p><p><span style="font-family: helvetica;">This article was first published in Business Daily on June 10, 2022

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