PAINLESS LABOUR

Labor pain has been described by most as the most painful experience a woman can have in her lifetime. Efforts have been taken for centuries to remove this labor pain. But it has never been easy in the past as in the present. Despite of this entire negative attitude by many 85% women prefers some methods like epidural for labor pain management.

Question of painless or painful labor was raised only about one and half century back with the advent of anaesthesia in medical sciences. Only three months after Morton’s historic demonstration of ether as an anaesthetic for the first time in 1846, James Young Simpson anaesthetized a woman with ether for childbirth. Queen Victoria unable to tolerate labor pain wanted anaesthetic. First lady anaesthetised for labor in United States was Fanny Longfellow wife of famous American poet Henry Wadsworth Longfellow. She wrote- “This is certainly the greatest blessing of this age.”
But certainly the acceptance of painless labor starting from its early age to its adulthood in modern times has never been so easy in different social classes. Like the earlier times when British clergymen argued that painless labor is a sin against the will of God who has made the childbirth painful; a few modern experts opine that labor pain makes a good bondage between mother and child.

The reasons of controversies in this issue are several. Those who do not like pain-free childbirth have the following excuses. Firstly, the childbirth is a natural process, which should not be disturbed. Secondly, the mother should cherish the joy of motherhood at the time of delivery and so no pain should be felt. Thirdly, pain is a psychologically regulated subjective feeling and proper antenatal education and relaxation may give painless childbirth. Fourthly, as mentioned earlier, labor pain makes a good bondage between mother and child. Fifthly, every medication has some side effects, which should be avoided.

But certainly these excuses seems to be ridiculous to those who are in favor of painless labor and think non-interference of severe pain of childbirth when one has the safe options is an offence. In the modern age of scientific and technological excellence many natural phenomenon are modified in such a way that it becomes beneficial for human lives. There are so many examples; a dam is build to produce electricity; in agricultural fields, modifications has improved the quality and quantity of crops; similarly, artificial and parenteral foods are often given to the patients to save their lives.

When the question of motherhood arises the term misery comes along with. But why it does not come with fatherhood? Fatherhood consists only of pleasure and mothers has only to sacrifice and has to forget their sufferings for the sake of motherhood even if you have safe alternatives?

Labor pain has been described as severe most pain that one can experience in her lifetime. Yet, when one tells that labor pain can be psychologically modified by proper training one question arise. Every pain can be modified in such way. Then, why so many analgesics (pain killer) has been discovered and used regularly? And people are not discouraging such uses. Why anaesthesia is necessary before any operation if people can modify them by proper education?

People never say that the caesarian section operation may be done without any form of anaesthesia to have very strong mother child bondage. On the other hand how the bondage between father and child can be ignored where fatherhood is earned without any form of physical sufferings?

Coming to the point of safety, every medicine has some form of side effects, even simple paracetamol may kill a patient. The percentage of serious side effects is more important. Ether, which was used in earlier days for painless labor is now obsolete as better options with fewer side effects are now available.

At present one has the following options for painless labor.

1) Analgesics (pain killer)- Morphine group of medicines are only effective but used mainly in earlier stages when the pain is not so intense. It has serious side effects on baby, so used rarely.

2) Oxygen and nitrous oxide mixture- this mixture is inhaled to get rid of pain. It is very safe to both mother and baby, but not very effective, good amount of pain persists.

3) Other methods (TENS etc.): not so effective.

4) Epidural analgesia and anaesthesia- It is the most effective, most safe for both mother and baby and so, most widely used in western country. More than 85% of expected mother prefers this method at present days in western countries and available since 1960s. A fine catheter (tube) is introduced in the back between two lumber vertebrae in a space called epidural space, which lies immediately outside the outermost layer of the spinal cord (There are three layers or membranes which cover and protect spinal cord.). Whenever there is pain, a liquid (diluted anaesthetic medicine mixed with other medicines) is introduced via the indwelling catheter and there is almost instant pain relieve. Some ambulatory pump introduces the medicines contineuously. Here only the pain sensation of abdomen and lower limb goes away. The patient is fully conscious, can move her legs and all other sensations are present.

Unfortunately in India incidence of painless labor by epidural anaesthesia is very rare even in these days. Reasons are many.

1. Lack of proper set up (including training of doctors & para-medical staffs)
2. Ignorance of expected mother and their family members. Most of them do not know that they have safe painless option of childbirth.
3. Doctors and midwifery staffs should be more sympathetic to deal with the intense pain felt by expected mother.