Pain relief in Labor

The one sure blot in the joyful tapestry of pregnancy and childbirth is the prospect of labor pain. It is an accepted fact that labor is painful. Whether you do or you don’t subscribe to the claim that this is God’s punishment to womanhood for Eve’s original sin is beside the point. The fact remains.

The perception of the pain, of course, differs widely among individual women but many will tell you that labor was the most intensely painful experience of their lives.

The need for pain relief differs among individuals. The range is from those who are absolutely resolute that they do not want anything chemical or otherwise throughout labor to those who actually demand to be ‘put out’, an option which is of course unavailable in any labor ward repertoire.

There are four broad groups of pain relief in labor:

Ø General measures: which include mobility, breathing exercises and warm baths (as in water-birth)

Ø Light self-administered methods, which include the TENS machine and using entonox (‘gas and air’)

Ø Systemic opiates, including Diamorphine and pethidine (there are other related synthetic drugs used less often that are just as effective)

Ø The so-called "regional analgesia" in the form of an epidural.

Of all these, the epidural method is superior by a long way. It is the only method where complete pain relief can be promised and delivered. In a small minority of women, this is unfortunately not achieved. Moreover, in a small number of women, the epidural is not suitable or may even be contraindicated.

There are no absolute contraindications for any of the other methods.

Water birth may be unsuitable for some.

Overall, pain control in labor should be tailored according to the needs and wishes of the individual. One aspect that we have always regarded with dismay is a restrictive birth-plan. It is not unusual to find a birth-plan prepared prenatally which states categorically that "I do not wish to be offered an epidural under any circumstances at any stage of labor".

Such statements are commonly a result of pregnancy classes, where some so-called experts impose their personal opinions on unsuspecting and trusting women. It is a practice that cannot be justified.

It is the duty of anybody in that position of influence to present the facts and facts only to his or her clients and allow them to make up their own minds. In the area of pain relief, the enduring wisdom is for the woman to be open-minded and to consider all the options, depending on her needs at the time. This is as long as she knows what each of the options entails.

Those are the facts she should be offered in the prenatal class and the facts that are presented here.

Continues next page

Labor is almost invariably painful but the degree of pain varies enormously