Can childbirth really be pain-free?

A male doctor examining a pregnant womanChildbirth is associated with pains and some women will prefer such pains to be relieved. But a new assessment of the several pain relieving methods offered to women to make labour pain-free are however, suggesting that, after all, a pain-free and drug-free labour is impossible, reports Sade Oguntola.

FOR many women once they become pregnant they would have come to learn that a day will come that labour pains will set in as the womb contracts to bring the new baby to the world. Some women are able to bear the pain more easily than others. For this group of women with very low pain threshold, they are taught how to reduce pain through breathing through the mouth. Some on being told about anaesthetic methods, result to take this easy way out of pain.

However, the question is: Can labour be total pain free? A new assessment of the several pain relieving methods offer to women to make labour painfree are however, suggesting that, after all, a pain-free and drug-free labour is impossible, a dream that is shattered by reality. A review of 32 studies of women’s experiences of childbirth has revealed that hope too often triumphs over reality. The experiences of most women differ markedly from their expectations, which can lead to disappointment when labour does not go according to plan in a review published in the online journal BMC Medicine.

Studies of women’s expectations of pain relief found, unsurprisingly, that women wanted access to effective pain relief. There was a wide range of preferences, ranging from women wanting no drugs at all during labour to those requesting enough medication to make labour more manageable or pain-free. Several studies identified a gap between the expectation of labour pain and reality, focusing particularly on the underestimation of pain. The studies largely showed that women underestimate the intensity of the pain they will have. In one study, more than half of the women received pain relief despite having said previously that they would not use it. If women are not able to have more realistic expectations about pain in labour, they will not be able to prepare themselves appropriately for labour.

In one study, more than half the women who said they would not use pain relief ended up needing it. In a Swedish study, women were able to give the pain a positive meaning, as when one mother said: “I think it’s a happy pain, though its hell.”

Researchers concluded that positive attitudes to pain reflected satisfaction with the way they had coped with it, rather than the pain itself. In most studies, the pain was worse than expected – in only one was it better than expected. The study found that even if the birth was not natural as planned, women were still pleased with the experience if they felt they had been in control of the decisions.

The evidence lends support to the argument that it is important to clarify with each woman, which are the most important issues to her during labour. Is it control or is it minimum pain or adequate pain relief? Clarification of what is important to each woman permits support throughout labour.

Researchers from Newcastle University’s Department of Public Health, lead by Joanne Lally, was of the opinion that “Childbirth is one of the most painful events that a woman is likely to experience and a woman’s lack of knowledge about the risks and benefits of the various methods of pain relief can heighten anxiety,”

According to her, antenatal education programmes needed to adopt a more honest approach and “women should go into labour with hopes of what they want it to be but they should also be realistic about what it is likely to be.” “If they want a natural labour that is fantastic and they should be supported in that. But if the pain gets too much and the decisions are taken out of their control that is when it goes wrong and they can end up feeling disappointed. Women need to be fully equipped beforehand with the information to make decisions,”` she stated.

Be that as it may, physicians have found reasonably effective ways of diminishing the most excruciating labour pains through epidural anesthesia. Epidural analgesia involves injecting a local anesthetic into the lower back to block pain impulses from the uterus and birth canal But, Professor Donald Caton, an anaesthesiology at University of Florida‘s College of Medicine, said though on the surface, it seems to be such a simple issue that there is pain and that we can relieve it, yet there are many philosophical and social ramifications, which have been viewed in very different ways through the years that determine those that would ask for their pain to be relieved.”

Caton said, “Childbirth is such a very personal thing, so you see a range of reactions. Today, some women refuse anaesthesia outright because they feel pain is part of the birth experience. Some refuse it for biblical reasons, citing the Book of Genesis story and it’s linking of punishment with childbirth.” Though women who receive epidurals during labour report less pain than those who choose opiates or natural childbirth, according to a systematic review of evidence, but epidurals bring an increased risk of delivery assisted by forceps or vacuum.

As a result, Dr. Millicent Anim-Somuah, at the Liverpool Women’s Hospital in England that carried out the systematic review of evidence both for and against epidurals in an issue of The Cochrane Library, said “Each woman will have to weigh how much it means to her to have a spontaneous vaginal delivery versus having more pain in labour.”

The study confirmed that the nerve block lengthens the stage during which the mother must push the baby through the birth canal. This leads to greater use of medication to stimulate contractions and a 38 per cent increase in risk of instrumental delivery. Finally, there are certain “rare but potentially severe adverse effects” associated with epidurals, says the review. These include spinal cord injuries and permanent paralysis in the mother. These are so rare that incident rates are currently unknown.

Meanwhile, Dr. Amby Rukewe, a consultant anaesthetist at the University College Hospital (UCH), Ibadan, assured that facilities to receive epidurals during labour is available in Nigeria and that its use has no side effects. He said no woman should be exempted from a pain free labour if she so desires, as it is a facility that people easily access in developed countries of the world. Also, Dr. Oladapo Olayemi, consultant obstetrics and gynaecologist at the University College Hospital (UCH), Ibadan, said women that will request for epidural anaesthesia to ensure a pain-free labour will require to be closely monitored and so can only be accesses where there are equipment and many nurses to monitor her to ensure all go on as planned.

He said the technique requires a specially trained anaesthetist to administer the anesthesia and so what is offered to most women is breathing exercises after they would have being psychologically prepared to cope better with the pain. Some walk around or stand up to help cope better, though these had not being scientifically proven to contribute to pain relieve.

He said epidural anaesthesia is not without its problems too. “It may affect the baby because the baby may not have enough oxygen and may require to help with forceps for delivery because some of the muscles used in pushing during delivery may be paralysed as well by the anesthesia used and so require help in the explosive stage. “In a situation that mothers are well prepared for labour during antenatal visits, they may not even ask for any pain reliever," he concluded.