Dr Sandeepika Dogra
Labor pain is arguably the worst imaginable pain women endure during childbirth. McGill pain scale depicts this pain as severe, more than fracture pain or cancer pain. Although pain is essential as it makes the woman aware of labor and to find a safe abode to give birth, at the same time, it makes the labor very hard and exhausting.
What is Labour Analgesia and why is it important?
Labour Analgesia means providing pain relief during labor. This is popularly known as ‘painless delivery,’ although it is a misnomer as pain is not entirely abolished but it is reduced to a bare minimum.
Untreated labor pain has numerous negative consequences for the mother and her baby. Women enduring intenselabor pain generally request cesarean section without any other indication, increasing morbidity.Severe pain during labor can lead to increased stress on the body, which may result in elevated blood pressure and accompanying complications. Therefore,the role of Labor Analgesia becomes therapeutic in expectant mothers suffering from conditions like Preeclampsia and certain heart ailments. Post-traumatic stress disorder (PTSD) and chronic pain are the potential outcomes of unpleasant experiences during labor and childbirth. Mothers who experience reduced stress and discomfort during labor are often more likely to establish successful breastfeeding relationships with their newborns. It is also harmful to the babies as it can lead to acidosis, which can lead to impairment of cognition in babies and sometimes even death.
Methods of Labour Analgesia
Various methods are available to provide pain relief to women during labor, and they can be broadly categorized into two groups:
Non-Drug Methods: These techniques involve breathing techniques, touch and massage, acupuncture, water bath, and TENS (Transcutaneous Electrical Nerve Stimulation), among others.
Drug Methods: This category includes pain relief options using medications like inhaling Entonox gas (also known as laughing gas) and receiving intravenous or intramuscular injections of painkillers such as pethidine, fentanyl, or tramadol.
Among these options, the most popular and effective techniques involve administering pain relief medication directly into the spinal cord, known as Neuraxial techniques. Among the Neuraxial techniques, Epidural is considered the gold standard. Using Epidural, the intensity of labor pain can be significantly reduced from 100% to a much more manageable 10-15%, allowing the mother to experience the process of labor and childbirth with a sense of joy and comfort.
Labour Analgesia Practice in the Western World
The era of pain relief during labor in the Western world started in the early 19th century with James Young Simpson, who administered ether to a woman with a deformed pelvis during childbirth. However, the first Anaesthesiologist, John Snow, popularized labor analgesia by administering chloroform to Britain’s Queen Victoria during the birth of her eighth child, Prince Leopold. Today, the availability of pain relief during labor is considered a fundamental aspect of standard obstetric care in many countries, especially in Western countries like the United States, United Kingdom, Canada, and Germany, where the use ofepidural (gold standard) for pain relief is close to 80%.
In 2007, the International Association for the Study of Pain (IASP) introduced the slogan: “Real Women, Real Pain,” emphasizing the significance of providing pain relief during labor to enhance the overall maternal experience during childbirth.
Labour Analgesia practice in India
In India, labor analgesia remains relatively unpopular. There is a significant dearth of awareness surrounding available pain relief choices for women undergoing labor. With the exception of a handful of facilities that have successfully established comprehensive labor analgesia facilities, there is a general absence of nationwide awareness and approval for the practice of labor analgesia.
Myths and Barriers
There are several barriers to labor analgesia in our country. The biggest barrier is awareness of labor analgesia among birthing mothers. In major cities, some tertiary health care centres provide labor analgesia services as the women in these areas are educated and demand labor analgesia. However, there is inadequate education and information regarding labor analgesia in semi-urban and rural areas. Also, cultural beliefs and traditional practices discourage medical interventions for labor pains. People have myths that drugs used for pain relief are harmful to babies. They also believe that pain relief during labor hampers the normal process of labor, leading to increased chances of cesarean delivery. Last but not least, there is a huge gap in healthcare infrastructure between urban and rural areas. Additionally, the shortage of trained medical professionals and limited resources in certain regions contribute to the challenges in promoting and implementing labor analgesia nationally.
Breaking the barriers
It is possible to gradually break down the myths and barriers surrounding labor analgesia, allowing expectant mothers to make informed choices and access appropriate pain relief during labor. These can be achieved by adopting a multifaceted approach:
* Education and Awareness Campaigns involving healthcare professionals, midwives, and community health workers to conduct informative sessions for expectant mothers and their families.
* Counselling of expectant mothers and their families regarding the benefits of laboranalgesia during their antenatal visits to the Hospital. The focus should be to address their concerns and provide accurate evidence base information.
* Encouraging mothers who have undergone successful pain relief during labor to share their stories through various media like making videos, writing stories, etc. Visual aids such asanimations and infographics simplify complex medical information and make it more accessible to the general public.
* Advocatingimproved healthcare infrastructure and resources in rural and underserved areas to ensure equal access to labor analgesia services.
Establishing a protocolized Labor Analgesia Unit in an Institute
It requires careful planning, interdepartmental collaboration, and systematic implementation. Firstly, determine the resources, staffing, and equipment required to initiate and sustain the unit. A dedicated team comprising obstetricians, anaesthesiologists, midwives, nurses, and other relevant healthcare professionals responsible for designing and implementing the unit is paramount. Developing protocols and guidelines is vital for smooth functioning and Quality Assurance. Last, ensure that the labor analgesia unit is equipped with the necessary infrastructure, including dedicated administration, monitoring, and recovery rooms.
A protocolized labor analgesia service can be provided by fostering robust teamwork among healthcare professionals, administrators, and support staff. Thiswill offer consistent, secure, and efficient pain relief solutions during labor, enhancing mothers’ and newborns’ outcomes.
(The author is Assistant Professor, Department of Anaesthesiology, AIIMS Jammu)
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