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Opinion - Labour and childbirth: pain relief options

2023-06-08  Correspondent

Opinion - Labour and childbirth: pain relief options

Dr David N. Emvula 

Labour pain is among the most severe types of physical pain that women may experience during their lifetime. The level of this discomfort varies for each woman and for each pregnancy. Thus, pain relief is an essential part of medical care during childbirth. Labour is a series of progressive, rhythmic contractions of the uterus. These contractions help the cervix open and become thinner, and this allows the baby to travel through the birth canal. Labour pains and maternal stress are associated with a poor progress of labour which can lead to complications to the mother and baby. 

Fortunately, there are many several pain management strategies which include non‐pharmacological interventions (that aim to help women cope with pain in labour) and pharmacological interventions (that aim to relieve the pain of labour). The World Health Organisation (WHO) recommends adequate pain relief during labour, to ensure a positive childbirth experience. 

Non-pharmacological methods such as relaxation techniques (ie, yoga, hypnosis, and music), manual techniques (ie, massage, reflexology, and shiatsu), acupuncture and birthing ball are considered safe. Research has consistently demonstrated that women greatly value and benefit from the presence of someone they trust during labour and childbirth to provide emotional, psychological, and practical support and advice. The supportive care may include having someone who is continuously present and who reassures and praises her, assists with measures for physical comfort (e.g., providing comforting touch, massage, warm baths, or showers, and promoting adequate fluid intake and output) and undertakes any necessary advocacy on her behalf (e.g., helping the woman articulate her wishes to health workers and others). 

Epidural analgesia is regarded as the leading and most effective treatment for labour and delivery pain. Epidural analgesia requires a specialist anaesthesiologist to insert a tiny tube, called a catheter, in the lower part of your back. The catheter is left in place for delivery of the medication through the tube as needed. This method has an 8.5% failure rate, and its limitations include costs, accessibility, prolonged labour, and reduction in women’s sense of control and their participation in the labour process and can involve adverse effects such as a drop in blood pressure or headache after delivery. A specialist anaesthesiologist and the midwife closely monitor the patient for possible complications. 

Opioids are commonly used for pain relief during labour, as they are widely available, easy to use and are of low cost. Their main advantage is that they produce analgesia with milder side effects. Opioids can be combined with other simple but effective painkillers like acetaminophen (Panado) given in the drip. Most medications cross the placenta and may affect the baby. 

Women in labour should engage their obstetricians regarding their preferences for pain management prior to the onset of labour and offered according to her wishes, facility protocols, and available resources in order to achieve a positive childbirth experience. 


* Dr David N. Emvula 

MBChB (Pret), MMed O&G (Pret) FCOG (SA) 

Specialist Obstetrician & Gynecologist at OB-GYN Practice

2023-06-08  Correspondent

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