Nine months of excitement and anticipation have passed by swiftly. The time to welcome the little one has finally arrived.
Mum feels the uncomfortable abdominal cramps commencing. Fear grips her. Will she be one of the many women who describe labour pain as the most horrific pain possible? Pain that some people define as a rite of passage a mother must endure?
She must now make a decision about her pain relief options during labour.
Her contraction pain has lessened drastically. As dramatic as it sounds, a few hours ago, she thought the pain was horrid enough to “kill” her. She was administered an epidural for labour by the anaesthesiologist.
Since the epidural insertion, the journey to childbirth certainly seems tranquil and calm.
Hours have passed and she is bearing down. Trepidation grips her. Will she be able to push her baby out? Will she feel the pain as the baby squeezes thorough her birth passage? Will she feel the cut of the episiotomy?
Firm affirmations fill the room. “Take a deep breath, look at your tummy, and push.” She gives her strongest push and the room is greeted by the most beautiful cry she will always remember and hold dear. A little gift from the heavens is delivered. No pain, and only a sense of joy fills her.
Analgesia refers to pain relief. Seven years after the public demonstration by WTG Morton on the use of ether anaesthesia in 1846, labour analgesia saw its first introduction in 1853 when Queen Victoria gave birth to her eighth child, Prince Leopold.
Analgesia back in that time was administered via chloroform inhalation. The following years saw the introduction of more sophisticated methods of administering labour analgesia.
In the 1960s, labour analgesia was delivered via Entonox, a mixture of oxygen and nitrous oxide known popularly as laughing gas, or by administration of a pethidine injection. While the above methods provided some amount of relief, pain in labour remained a painful reality.
Epidural labour analgesia gained popularity in the 1980s. The epidural is now considered the gold standard for labour analgesia.
The severity of pain in labour is excruciating and cannot be made light of. When comparing the relative severity of pain with the McGill Pain Index, labour pain has been likened to pain suffered from an amputated digit.
Labour pain can be extremely stressful, especially for the first-time mother. It may add to the difficulty of the labour process, prolonging it and contributing to maternal distress.
Pain may not be tolerated well by expectant mothers who are deemed high risk, such as those with asthma, heart disease or preeclampsia (a severe form of hypertension in pregnancy).
When required, epidural analgesia may easily be converted to epidural anaesthesia should there be an indication for a caesarean section.
A mother in labour has the right to adequate analgesia. This right is upheld by the anaesthesiologist, when the mother requests for a labour epidural. The anaesthesiologist reviews the expectant mother, establishing a rapport and allaying anxiety, while examining her to determine suitability for the procedure.
Contraindications to the procedure are systemic or local skin infections, low platelet counts, bleeding disorders and a bleeding patient.
The epidural insertion must be performed by a trained anaesthesiologist. A comprehensive explanation and written consent is obtained prior to the procedure.
Strict aseptic technique is employed for the procedure. The site for the procedure is first localised, cleaned and draped. A small amount of local anaesthesia (LA) is administrated at the site to numb the surrounding area.
The epidural needle is then inserted as far as the epidural space. LA is injected into the space via an epidural catheter. The LA administered blocks nerve conduction and renders analgesia to areas supplied by the nerves.
Further administration of the LA is via the Patient-Controlled Epidural Analgesia (PCEA) apparatus. This enables the mother to control her pain levels via a pen-driven device.
Alternate methods of drug delivery include continuous infusion of LA.
Complications of epidurals are uncommon, but they do exist. Medical literature lists the commonly encounted complications as: hypotension (1 in 10), post-dural puncture headache (1 in 100), transient paralysis (1 in 10,000), or rarely, infection (1 in 100,000).
Backache is a common complaint following an epidural insertion. Myths about backache following an epidural insertion prevent some mothers from accepting epidural labour analgesia. Studies have proven otherwise. Poor positioning during the labour process, compounded with lax hip and back ligaments encountered during pregnancy, are thought to contribute to the development of backache.
Concerns that epidural labour analgesia may contribute to an increase in caesarean sections have been brought up. Studies have since disputed this claim, so, women can rest assured that an epidural during labour does not increase the chance of having a caesarean section.
Most hospitals in Malaysia are well equipped with labour analgesia services. Epidural labour services are available in 36 major Health Ministry hospitals.
Measures to ensure that this service is made available at every hospital is ongoing.
Anaesthesiologists at every hospital are at the forefront to ensure that such services are made available to all mothers in labour. We keep in mind that every mother has the right to enjoy a painless delivery.
The information provided is for educational and communication purposes only and it should not be construed as personal medical advice. Information published in this article is not intended to replace, supplant or augment a consultation with a health professional regarding the reader’s own medical care. The Star disclaims all responsibility for any losses, damage to property or personal injury suffered directly or indirectly from reliance on such information.