by Dr Mama-Asu Peprah
For expectant parents, understanding the various pharmacological options for pain management during labour is crucial. This is part 2 of the pain management blog. Have a look at part 1 entitled: how to cope with labour pain: Your guide to non Pharmacological Options for Pain Management.
Here’s a guide to help you make informed decisions:
1. Entonox (Laughing Gas)
Entonox, often referred to as “laughing gas,” is a gas mixture consisting of 50% oxygen and 50% nitrogen. It is inhaled through a mask during labour, typically during the later phase of labour, during contractions. However, its effectiveness is limited, with only about a 20% success rate, similar to a placebo. It gives you a “high” feeling, I have never actually seen any mother laugh during labour. It does however cause you to focus on your breath- which you all know is key in managing labour pains.
Positives:
- Safe
- Self-administered so you are in control.
- Easy to use.
Trade-offs:
- Central Nervous System (CNS): Drowsiness, hallucinations
- Gastrointestinal (GIT): Nausea, vomiting
- Respiratory (RESP): Hyperventilation and reduced oxygen
2. Pethidine
Pethidine is a milder and safer form of morphine, administered through injections in the buttocks every six hours. It doesn’t directly alleviate pain but helps keep you calm. It is the most commonly used and extensively researched form of pain relief in labour.
Positives:
- Reduces anxiety.
- Promotes a sense of therapeutic rest.
Trade-offs for baby:
- Impacts fetal heart rate.
- Respiratory depression.
- Low Apgar scores.
- Hypothermia.
- May inhibit breastfeeding .
- Makes baby sleepy.
Trade-offs for mom:
- Sedation can impair decision-making.
- Nausea and vomiting
- Hypoventilation, hypotension (low BP)
- Prolonged labour.
- Urinary retention.
3. Mild sedative: Aterax/Phenergan
This is an injection also injected into the buttocks every 6 hours. It often used in combination with pethidine. It reduces anxiety and stops the nausea and vomiting (which is a side effect of the pethidine).
4. Epidural
An epidural involves the injection of a local anesthetic into a safe space in the spine, providing extensive pain relief. This is a complex procedure and needs to be done by a skilled anaesthetist in the hospital’s labour ward.
Indications:
- Pain relief
- Reduction of premature pushing
- Suitable for high-risk scenarios
- Useful in multiple pregnancies, breech deliveries, and prolonged labour
Benefits:
- Highly effective and instant pain relief.
- Some versions aim to preserve sensation and minimize motor impairment.
- Minimal impact on the mother and baby.
Trade-offs:
- Risk of complications is low at Overall 0.3-1.24%
- Less mobility
- Requires more intense monitoring so you will be connected to monitors and intravenous lines.
- It may not work on you.
- Headache especially after
- Drop in blood pressure.
- Infection risk
- Trauma to the spinal cord (extremely rare)
- It can prolong labour.
- Some reports show higher rate of needing extra help when pushing like vacuum and forceps and extra medications.
5. Nurofen and Panado
Over-the-counter pain relievers like Nurofen and Panado are not recommended during labour. Panado offers no relief and nurofen slows down labour and can cross the placenta and potentially affect the baby’s heart.
Conclusion
In summary, the choice of pain management during labor needs to be individualized. These methods should be used in combination to create the best approach for each unique situation. While no method guarantees a completely painless experience, these options can help you manage and cope with the challenges of childbirth.
Disclaimer
This information is for educational purposes only. The options provided are not exhaustive and refers to obstetric care in South Africa. It is essential to consult with your healthcare provider to make an appropriate choice based on your specific needs. Additionally, these methods should only be used in a hospital setting with close monitoring of both the mother and the baby. Your safety and well-being are of utmost importance during this significant life event.
References
- Clinical obstetrics a south African perspective. 3rd edition. Cronje HS, Grobler CJF. Obstetrics in Southern Africa. 2nd Edition. Pretoria: Van Schaik Publishers; 2003.
- Edmonds DK, editor. Dewhurst’s Textbook of Obstetrics and Gynaecology. 8th Edition. West Sussex: Blackwell Publishing Ltd; 2012.
- Jones L, Othman M, Dowswell T, Alfirevec Z, Gates S, Newburn M, Jordan S, Lavender T, Neilson JP. Pain management for women in labour. Cochrane Database of Systematic Reviews 2012, Issue 3. Art. No.:CD009234.
- Mulder R. 6th year anaesthetic notes. UCT. Rose July 2006
- http://www.slideshare.net/souvikmaitra1/labour-analgesia-souvik
