Women in the UAE opt for labour pain relief methods

“Pain during labour is natural. Many women develop their own strategies to cope with this pain, but it is useful to know there are other forms of pain relief available to them,” said Dr Asha Elizabeth Philip, Specialist Anaesthesiologist, Al Rafa Hospital, Bur Dubai.

Speaking to Khaleej Times, Dr Philip said that compared to earlier times, the demand for pain relief methods was on the rise though the cost factor still remained a hurdle in the UAE.

Explaining the need for pain relief methods, Dr Philip said, “The first stage of labour pain is caused by contractions of the womb and the dilation of the neck of the womb (cervix). This stage can last for many hours, especially for a first baby, until the cervix is fully open. The contractions tend to get stronger as labour progresses and are felt mainly as pain in the lower part of the abdomen and back.”

She said that the second stage lasts from the time the cervix is fully open until the time the baby is actually squeezed out along the birth canal. “This stage is much shorter,” she added. “Labour pain is carried along nerves from the uterus and the vagina to the spinal cord. The spinal cord relays the message to the brain, but the way you feel it is affected by what else is going on in your brain — for example, if you are confident and happy or tense and unhappy.”

Talking about the best method of pain relief during labour, Dr Philip said that every labour was different and caused different amounts of pain so it was practically impossible to predict how much pain a particular labour would involve. “For this reason there is no ‘best’ method which applies to everyone,” she said.

On drug-free methods of pain relief, Dr Philip said that relaxation and breathing exercises could help reduce pain during labour. “They have no harmful side effects, but they don’t work fully for everyone,” she said.

The Birthing Pool is used for pain relief as well as for delivery. “Many women find it soothing and relaxing, and it can reduce or eliminate the need for other forms of pain relief. But this is not a very popular form of delivery now,” she said. “Then there is TENS — Transcutaneous Electrical Nerve Stimulation. Electrodes are applied over the back. Many people find TENS helpful, particularly in the early stages of labour.”

There are others like Entonox. It is a mixture of two gases: oxygen and nitrous oxide. It is very safe and an effective painkiller when used properly. It takes about 20 seconds to work, so it is important to start as soon as you feel a contraction rather than waiting for the pain to get really bad. Entonox is safe for both mother and child, according to the doctor.

Pethidine is a moderately strong painkiller and sedative, given by injection. It dulls the pain and makes one slightly drowsy and light-headed. The commonest side-effect is nausea (sickness) and vomiting. Because Pethidine also gets into the baby’s bloodstream it can make the baby drowsy too.

Epidurals involve an injection of local anesthetic in the back to numb the nerves from the birth canal as they run into the spinal cord. “The drug is not absorbed into the blood stream and it does not cause drowsiness, but epidurals take a little time to put in and can have side effects although these are rarely serious,” explained the doctor. Regarding the procedure, she said that a small area of the skin over the spine is cleaned with an antiseptic liquid, and then numbed with a local anesthetic. “Inserting the epidural needle is rarely painful with only a slight feeling of pressure as it is put in and used to guide fine, flexible, plastic tubing taped to the back so that local anesthetics can be administered as needed. The first dose takes about 15 minutes to be fully effective,” she said.

“The common, but temporary, side effects of epidurals include weak, heavy legs, low blood pressure and difficulty in passing urine, so you need to have a drip and a catheter put in. There may be a higher risk of needing a forceps or suction delivery or even a Caesarean section, but this is probably less of a problem with the low-dose epidural mixtures we use nowadays, where you can still move around and push,” she said. Dr Philip explained that rarer, but important, complications include a failure to work and spinal headache. “Most epidurals work perfectly but we never guarantee success. Total failure happens rarely — only to about one in every 60-70 women,” she said.

Pinal headache happens only to about one in 200 women and is more likely if you move while the needle is being inserted. A common question asked is whether epidurals cause backache. “A small sore area in your back, like a bruise, is very common but normally disappears in less than two weeks. Long-term backache occurs in many women after childbirth, whether or not they have had epidurals. There is no evidence that it is more common in women who do have epidurals than in those who don’t,” she explained.

“There is more ‘high-tech’ paraphernalia such as the drip, the catheter, the frequent, measuring of your blood-pressure and constant monitoring of the baby’s heartbeat. These make it difficult for you to move around freely during an epidural and you might not experience a ‘natural’ childbirth,” she added.

Guiding expectant mothers, Dr Philip said that ideally, the patient should get more information from obstetricians, anaesthesiologists, midwives or from other women who have had child births recently keeping in mind that the overall experience may not be identical to theirs.