Having a baby is hard work, and part of that work is getting through the pain. But don't panic. There are more ways than ever to manage it.
Every woman experiences and tolerates pain differently. Sometimes, focused breathing is all that's needed to get through labour, while others need pain relief. Here are some common options:
Non-pharmacological methods
In Singapore, non-pharmacological methods like hypnosis, hydrotherapy and acupuncture techniques are not widely used as most are not proven by studies to be effective.
Pharmacological methods
These involve the use of drugs. Examples include: inhalation of entonox gas, injection of opioids and epidural or combined spinal-epidural analgesia.
Entonox Inhalation
A gas mixture of 50 percent nitrous oxide in oxygen is administered via facemask. It should be inhaled as soon as contractions begin so that the maximal effect is achieved at the peak of contraction.
Advantages: readily available, does not stay in the body system and is easily administered.
Disadvantages: may cause drowsiness, light-headedness and nausea.
Opioid Injections
The most common opioid for labour pain is pethidine. This is usually injected into the muscles of the thigh. Each injection takes about 15 minutes to take effect.
Advantages: provides up to six hours of pain relief.
Disadvantages: can only be administered in early labour (cervix is less than 4cm dilated) as it can cause drowsiness in the baby if administered too close to delivery.
Epidural analgesia (EA) and combined spinal-epidural analgesia (CSEA)
These are the most reliable and effective ways to relieve labour pain. In EA, local anaesthetic drugs are administered through a small tube into the epidural space within the backbone canal. For a CSEA, an initial dose of drug is given into the spinal space, resulting in an even faster onset of pain relief.
Advantages: it is an effective analgesia with added advantage to help control blood pressure.
Disadvantages: numbness of the legs and lower part of the body occur but the effect wears off. Nausea is common, but is easily managed with medications. Occasionally, some women might experience a spinal headache after delivery that normally resolves with medication.
Common epidural myths
Long-term backache
No studies have linked long-term backaches with EA/CSEA. Backaches are common after childbirth with or without the use of EA/CSEA.
It's harmful to baby
EA/CSEA does not harm the baby, although some temporary changes in the baby's heartbeat may occur.
It can cause paralysis
The risk of permanent paralysis is rare: one in a million.
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By Associate Professor TAN Thiam Chye Head & Senior Consultant, Dr TAN Shu Qi Senior O&G Resident, Department of Obstetrics and Gynaecology, KK Women's and Children's Hospital
Sources:
The New Art and Science of Pregnancy and Childbirth 2008, World Scientific
Healthy Start for your Pregnancy 2012, Health Promotion Board Singapore
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