Drugs for labour and birth Your three best bets

Margot Ber­tels­mann gives the lowdown on your pain re­lief op­tions

Your Pregnancy - - Contents -

LABOUR DAY IS

dawn­ing and you’re con­sid­er­ing your pain re­lief op­tions. Will you be squeez­ing your birth part­ner’s hand and breath­ing through your labour as you go drug-free and au na­turel, or are you lean­ing more to­wards “knock me out at the first twinge of pain and wake me when the hair­dresser ar­rives”? You can choose dif­fer­ent lev­els of in­ter­ven­tion. They all have their ben­e­fits and draw­backs. Let’s look at the main three meth­ods of pain re­lief.

GAS AND AIR (ENTONOX)

WHAT IS IT? A mix­ture of ni­trous ox­ide and oxy­gen gas, which has an anaes­thetic and mus­cle-re­lax­ing ef­fect. It’s also known as laugh­ing gas. HOW IS IT AD­MIN­IS­TERED? You breathe the mix­ture in through a mouth­piece, which you hold over your mouth, for about 20 sec­onds as a con­trac­tion be­gins. An ad­van­tage is that you there­fore con­trol the dosage as you ad­min­is­ter it your­self. Many ma­ter­nity hos­pi­tals de­liver entonox via wall-mounted pip­ing. HOW WILL IT AF­FECT ME? It’s only a mild painkiller and won’t take away all sen­sa­tion. It’s not yet com­pletely clear how it works to lessen pain. Other ef­fects are feel­ing light-headed and gig­gly – a “happy drunk” sort of feel­ing. The gas is cold to breathe in and can cause a dry mouth. Some women re­port get­ting drowsy af­ter us­ing it. HOW WILL IT AF­FECT MY BABY? Entonox is not thought to cross over to the baby’s body, so it’s safe for your baby. WHAT IS IT? Pethi­dine is a syn­thet­i­cally man­u­fac­tured opi­oid, which means it’s de­rived from the poppy plant and re­lated to mor­phine. It’s of course po­ten­tially ad­dic­tive, but it’s un­likely that you will use it again soon af­ter labour, so this isn’t a huge con­cern. It’s used for mod­er­ate to strong pain. HOW IS IT AD­MIN­IS­TERED? You’ll re­ceive a pethi­dine in­jec­tion into your thigh. It takes ef­fect in about 20 min­utes and stays in your sys­tem for about four hours.

HOW WILL IT AF­FECT ME? Pethi­dine blocks the pain re­cep­tors in your brain. It does have some side-ef­fects, such as nau­sea and vom­it­ing, it also has a se­dat­ing ef­fect and can cause con­sti­pa­tion, sweat­ing, dizzi­ness and re­ten­tion of urine. Some women be­come con­fused and it has an ef­fect on their per­cep­tion of what’s go­ing on around them. Re­views of pethi­dine are mixed: some women find it too se­dat­ing, oth­ers say it doesn’t block enough pain. Ob­ste­tri­cian and gy­nae­col­o­gist Dr Nir­vashni Dwarka says pethi­dine is often ad­min­is­tered to­gether with at­erax (hy­drox­yzine di­hy­drochlo­ride). “It has a se­dat­ing, and mild anti-anx­i­ety and anti-emetic (vom­it­ing) ef­fect, so that pre­vents some of the side-ef­fects of pethi­dine but also am­pli­fies its ef­fect.” HOW WILL IT AF­FECT MY BABY? Pethi­dine does cross the pla­centa and is de­tectable in breast­milk, so it can af­fect your baby. Some ba­bies have breath­ing dif­fi­cul­ties, be­cause pethi­dine can re­press the baby’s res­pi­ra­tory cen­tre. For this rea­son, doc­tors try not to ad­min­is­ter pethi­dine when the birth is close, to min­imise the amount of the drug left in the baby’s sys­tem af­ter birth. Ba­bies born to mothers who re­ceived pethi­dine are also more likely to de­velop jaun­dice. It can cause a baby to be “slug­gish” and strug­gle with the suck­ing re­flex and breast­feed­ing right at the be­gin­ning. There is a pethi­dine an­ti­dote (nalox­one) which can be given to ba­bies, and it takes ef­fect quickly, though, Dr Dwarka says.

EPIDU­RAL

WHAT IS IT? Only the most pop­u­lar method of pain re­lief for women in labour, that’s what. It’s rou­tinely avail­able in pri­vate health­care, but not al­ways in gov­ern­men­tal fa­cil­i­ties, and it can re­move 100 per­cent of the pain of labour be­cause it’s a re­gional anaes­thetic. This means it blocks sen­sa­tion in one part of your body com­pletely. Fine­tun­ing of epidu­rals has meant women can get partial epidu­rals, where pain is re­duced but sen­sa­tion is not blocked, or epidu­rals that wear off right be­fore the push­ing part of labour (so that you can push more ef­fec­tively), or even a flex­i­ble, “walk­ing” epidu­ral, which can be topped up, but which al­lows you to move around dur­ing labour.

HOW IS IT AD­MIN­IS­TERED?

A com­bi­na­tion of anaes­thetic and nar­cotic agents is de­liv­ered by in­jec­tion into the epidu­ral space – the fatty area in the spine be­tween the dura mater, a membrane, and the ver­te­bral wall. A catheter is left in place and “a mid­wife can top up or de­crease the dose as re­quired,” says Dr Dwarka. HOW WILL IT AF­FECT ME? You can re­main con­scious – even dur­ing a C-sec­tion – but pain-free. An epidu­ral can be a life­saver in a long and dif­fi­cult labour, and al­lows you to rest and gather your strength for the next stage. It can also en­sure you are not too trau­ma­tised by a dif­fi­cult de­liv­ery and gives you a more pos­i­tive birth ex­pe­ri­ence. Side-ef­fects can in­clude a sud­den drop in blood pres­sure, a se­vere headache, shiv­er­ing, and numb­ness. “Epidu­rals can pro­long the sec­ond stage of labour (the bear­ing down stage) be­cause some­times you can no longer feel the con­trac­tions,” Dr Dwarka says. “In this case the mid­wife or ob­ste­tri­cian will have to tell you when to push and there is an in­creased risk for an in­stru­men­tal de­liv­ery with for­ceps or a ven­touse to help de­liver the baby’s head.” She says headaches or back­ache for a day or two af­ter de­liv­ery can oc­cur, but they can be treated. “But it is un­com­mon to de­velop chronic back­ache from an epidu­ral.”

HOW WILL IT AF­FECT MY BABY?

“With an epidu­ral, there has to be con­tin­u­ous mon­i­tor­ing of the baby,” cau­tions Dr Dwarka. “This often means there are two belts around your tummy – one mon­i­tor­ing the con­trac­tions and the other the baby’s heart rate. Hence, is it not al­ways pos­si­ble to move around with an epidu­ral as most of our ma­ter­nity units do not have re­mote foetal mon­i­tor­ing units.” A baby might strug­gle to latch for a while af­ter de­liv­ery, but stud­ies are not unan­i­mous on this, or any other ef­fects there may be on a baby.

IS A TENS MA­CHINE FOR ME?

A TENS ma­chine is a tran­scu­ta­neous elec­tri­cal nerve stim­u­la­tor – in plain English, though, it’s a hand­held de­vice with elec­trodes that you stick onto your skin (usu­ally on your back), which pulse elec­tric im­pulses into your nerves to stim­u­late them. You con­trol the amount of charge that’s re­leased. As a con­trac­tion builds, you can ac­ti­vate the TENS ma­chine and in the­ory the cur­rent then stim­u­lates your body to pro­duce painkilling sub­stances. Re­ports on how use­ful it is dur­ing labour vary widely. Women say it works best af­ter about 30 min­utes of use. Of course, like other non-in­va­sive forms of pain re­lief, such as hyp­no­birthing, labour­ing in warm wa­ter, or us­ing breath­ing tech­niques, this labouras­sist­ing de­vice is com­pletely safe to use and has no ef­fect on the baby at all. It doesn’t have ad­verse ef­fects on the mother ei­ther: there are no phys­i­cal side-ef­fects such as nau­sea, and you ad­min­is­ter and con­trol it your­self. You can still move around dur­ing labour and you can use it with other pain re­lief meth­ods if you want to, ex­cept in wa­ter. You can buy a TENS ma­chine: for be­tween R1 300 and R1 800 you can get an ob­stet­ric TENS ma­chine from Neu­roTrac (tens­ma­chines.co.za/ wom­an­shealth.htm) or Ma­maTENS (ten­scaresa.co.za/prod­uct/ma­matens/). Speak to your mid­wife or doc­tor too – they may know where to get one. But by far the sim­plest way to get your hands on one is to hire it. For around R400 you can hire a TENS ma­chine for up to four weeks, so you have a chance to prac­tise be­fore you give birth, and you’ll still have it even if your baby is over­due. Check out Mother’s In­stinct on sup­port@moth­erin­stinct. co.za or moth­erin­stinct.co.za/birth_ pool__ten­s_rental, or Tens 4 Hire: ten­s4hire.co.za/rental-obs.htm.

DE­PEND­ING ON YOUR PREF­ER­ENCES, YOU CAN CHOOSE DIF­FER­ENT LEV­ELS OF IN­TER­VEN­TION

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