Monday, 3 September 2007

Thoughts on pain relief (reply to Michal)

Thank you for your comments on pain relief in labour. You raise many points. All of them are valid and ones that are raised on a daily basis and by most women that I encounter. I am not really sure what you are trying to say, but it would appear that you disagree with epidurals for pain relief in labour. This is a totally different analgesia that is administered to women in labour and it is a medical procedure that involves the skill of an anaesthetist. Because the drugs used in the epidural have the potential to lower the woman’s blood pressure rapidly, there is the need to administer intravenous fluids to counter the side effects of the low blood pressure. If the woman’s blood pressure falls rapidly, then the baby in utero (fetus) drops its heart rate (bradycardia). This is usually transient and recovers very quickly to normal. Incidentally, the fetus has no actual rights of its own until expelled from the womb (Jones and Jenkins 2002. The Law and the Midwife). So you could argue that the woman’s right to a pain free and stress less labour takes precedence over the fetus. Many studies and research have proven that if the women is pain free and not suffering from great surges of adrenalin that are a natural response to the pain impulses, then the fetus will be less stressed and more able to cope with the arduous and dangerous journey of labour.

On your other points re ARM, induction/augmentation etc. these are although related to labour separate points and as such need to be addressed on a different post. If you are trying to say, that ARM and augmentation are linked in some way to epidural analgesia for labour, then yes, there is strong research and evidence to prove that if a woman has an epidural for pain relief then there follows a cascade of intervention. The epidural can sometimes and I stress sometimes, slow the progress of labour hence the need for a hormone infusion of Oxytocinon. This increases the levels of adrenaline and thus a cycle of intervention takes place which can lead to an increase in the need for an instrumental or c.section for delivery. But, there is also other evidence that suggests that this would have occurred anyway and that being in severe pain and frightened by the pain could cause this cycle of intervention.

Finally, if the women you know are not being informed of the risks of pain relief or any procedures that are carried out on them whilst in hospital, then, the hospital is breaching its policy of informed consent and belongs in the ‘dark ages’ where that culture used to exist many, many years ago. I suggest that you do some research and find out just exactly how many maternity units are practising in this barbaric way – I can assure you that everywhere I have practised in the last 20 years, I have never encountered this approach to women centred care. All women have a right to the facts. Not only about pain relief but all aspects of their care whilst pregnant and beyond.

What would you suggest is the best form of pain relief for women in labour?


Michal said...

I was reacting to the question you posed in your previous post: Do they seriously think that health professionals, namely midwives, would administer anything that is going to ‘harm the baby’ or ‘make the baby drowsy?’

And my answer should be yes, unfortunately. I am speaking for my part of the world, Jerusalem, Israel.

I agree with you completely on everything you say about epidurals, and I am not against them. I just see very often that women are not told the (whole) truth about epidurals and other common hospital interventions such as AROM.

An epidural is potentially harmful for the baby, because of the effects it has on the mother (as you stated, her blood pressure might drop, and the cascade of interventions. I am not against epidurals, but I am against the fact that they are administered as if they're a kind of candy, and that women are being told that they are *not* harmful for the baby. They are not being told the whole truth, so that they are not able to make an evidence based decision.

Pethidine, which is also widely adminstered here, is known to make the baby drowsy. I've attended a birth where the midwife actually told the woman to take pethidine at 9.5 cm dilation, to prevent her from pushing prematurely.

Michal said...

And I wanted to add:
I don't think that there is 1 specific form of pain relief that is the best. Every form has its advantages and disadvantages, and all circumstances should be taken into consideration.
I always say, there is a time and a place for everything.

Maxim said...

Greetings. Very good site. By the way, my mum too reads it.

Sarah Stewart said...

Hello Anna, just dropped into your blog via igoogle and a 'blog search' feed. Enjoyed your post. I am a midwife and lecturer in New Zealand, although originally came from Salisbury, Wilts.Best wishes Sarah

mm said...

Interesting convesation... as a person who is on a very volitile list of women who have had surgery (caesarean section).... The joke of the day is "INFORMED CONSENT".
Many women are given the choice of arom, combine that with a poorly aligned baby... an inevitable c/s is done. Many have epidurals, heartrates lower and scare tactics pulled... out come the scalpels. =(
sad sad sad...
Iotrogenic caesarean is my catch phrase.
On the topic of pain relief. It took almost two hours for the anaethetist to figure out what to do with me, in transition, low blood pressure, hyper-emesis blah blah blah... oh yeah and a baby who decided to do a sommersault in utereo at about five cms along...
That was not a pleasant experience, he gave me a very small dose spinal and prayed they would get babe out and me stiched up before it wore off.
Needless to say. I stayed home with midwives (the plan for the first too, but no midwives to be found in that Province who would attend me) and had my long slow, crazy wonderful labours... knowing full well, an epidural might send me back to an OR.
I'll take pain over major abdominal surgery any day!
ahem... I'll stop rambling now.
okay after this...
As a doula... what ever works for mom, do long as she is fully informed! Pain is pain, every one is different!

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pain management emr said...

Nice thoughts! I think there is a painless delivery just ask your doctor about it. Thanks for sharing.