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Pushing Without Pain

Modern-day labour pain management certainly debunks the ‘no pain no gain’ adage. Mothers-to-be can now choose from the latest trends in pain management for a cringe-free birth experience.

The birth of her baby is the most exciting, euphoric and emotional time for a woman. When she holds her bundle of joy for the very first time, the bond that she shared with her child inside of her is instantly strengthened with a seal marked ‘forever’.

This crucial event also brings with it the fear of being in acute pain and the nagging doubt in every expectant mother’s head of whether she will be able to ‘manage’ it. Relax! Your experience needn’t look right out of a Hollywood flick, with all the screaming, cussing and gasping for breath! WTM gives you the absolute ‘low down’ on how to pull off a happy, hassle-free delivery in a calm and controlled environment.

THE MIGHTY EPIDURAL
Our Expert: Dr Reeta Singh, anaesthesiologist at Awali Hospital
“An epidural is the most effective labour pain reliever there is,” says Dr Reeta. “The procedure entails administering pain relieving medications into the space outside the covering of the spinal cord called the ‘epidural space’. This numbs the nerves coming from the womb and birth canal.”

Once the cervix has dilated to about three to four centimetres, the patient is positioned curled up on her side or in a sitting position and encouraged to be still.

A local anaesthetic is given to make the epidural insertion pain-free. The epidural space is then identified, and a catheter is threaded in and taped in position. After an initial test dose, the medication can be continuously administered through an infusion pump to provide pain relief until the baby is born.

“It takes around 15 to 20 minutes to take full effect. The legs might feel heavy, but contractions can be felt and when the time comes, the mother is encouraged to push,” says Dr Reeta.

The patient’s blood pressure, contractions and baby’s heart rate is closely observed during the procedure and is reviewed again after the catheter is removed. Every step is taken to minimise any side effect or complication.

A new trend is the ‘walking epidural’, where a low dose and minimum concentrations of local anaesthetic is used. It allows mothers to actively participate in the birth of the baby.

“The patient may be allowed to sit up, stand and walk small distances under close supervision. It is the preferred method these days,” says the expert.

AN ALTERNATIVE — IV or IM
Our expert: Dr Lena Koshy, consultant anaesthetist at King Hamad University Hospital
Certain medical conditions like back problems and bleeding disorders contraindicate the use of an epidural. This is when intramuscular (IM) or intravenous (IV) labour analgesia is a handy alternative.

July-2014_Wellbeing1_1“Traditionally, the IM method is used, where the medication is injected into the muscle. Absorption of the drug is gradual and effects are experienced for a longer time, but cannot be externally controlled,” says Dr Lena. “In Europe, the IV method is widely used. A new trend is the patient controlled analgesia, where the mother controls her pain at the press of a button. There is no chance of overdosing and is a moderate form of pain relief.”

Fentanyl and Remifentanyl are drugs typically used. Their short-acting effect averts any lasting negative effects. The administration of IV/IM analgesia is relatively simple and quick to take effect, ideal for sceptics of epidurals, or for those who need an instant shot of pain relief towards the last stages of labour.

The downside of both these methods is the chance of the drug crossing the placenta. Other side effects are nausea, vomiting, drowsiness and possible respiratory depression. However, several studies suggest that moderate use of these narcotics with close monitoring of the baby do no harm. When one is in good hands and within a capable setup, these problems can be easily tackled, the expert asserts.

SHIFTING FOCUS: HYPNOBIRTHING
Our Expert: Anna Thompson Hall, Holistic Integrative Therapist
Hypnobirthing is a fast emerging trend for labour pain management. This is a completely natural technique that more expectant mothers are considering to manage labour. Hypnosis is simply a deep state of concentration.

“You’re hypnotised while you watch television; or you’re crying or laughing over a movie. You know it’s not real, but the emotions in your body feel real,” Anna explains. “Once a woman decides she wants to deliver using hypnosis, I empower her, and her partner, with the tools to feel confident about taking control of that choice.”

The objective of the hypnotherapist is to find what works best for the individual and train her to self-hypnotise.
Some of us respond better to visual cues. We can close our eyes and imagine being transported to a blissfully peaceful beach or forest. Others are auditory and prefer to listen to words or music. Kinaesthetic mothers may prefer rhythmic movement, or hold something tactile that comforts them.

There are various techniques to help women feel comfortable and calm during labour, like imagining contractions as a soft wave of gradually fading colour, or that part of the body being dipped in anaesthetic and a cool, numbing sensation being transferred to wherever it is needed.

However, there shouldn’t be any pressure to ‘do it naturally’. If a woman feels she will cope better with some medication, she can use hypnotherapy to complement it, thereby minimising the use of drugs. Even in the event of a C-section, evidence shows that mothers who use relaxation techniques such as hypnosis recover far quicker, with less need for medication.

It is known that our endorphins are 200 times more powerful than morphine. Having experienced the phenomenal effects of her own endorphins following a serious burn incident, Anna is now fully convinced that they can see a woman through a comfortable and relaxing delivery. Her message to expectant mothers is to have faith.

“Prepare yourself well so that you are really confident. And when the day comes, enjoy the process and trust yourself to go with the flow,” she adds.

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