Every woman is entitled to painless labour

Brenda had known pain intimately and she wanted out. This is how she found her way to my office.

Ten years back, at 26, Brenda lay curled up on the bed in the labour ward, waiting to die. She was in labour for 14 hours. She was alone, frightened and exhausted. Her cries of agony with every contraction went unanswered as activity went on around her.

Every so often, the midwife would come in, take her blood pressure and listen to the baby’s heartbeat. Every four hours, the doctor would examine her vaginally, reassure her that she was doing well and labour was on track. She did not believe him. It felt as if her back was being sawed in half and the pressure and pain she felt in the deep of her pelvis was beyond description.

Eventually, the baby was ready to come out. She was wheeled into the delivery suite delirious. Everyone was barking instructions, encouraging her to push the baby out. She did her best to comply but she clearly was not doing a good job of it.

The doctor walked in, gloved up and asked for a vacuum. She passed out. When she came to, she could hear the wails of a newborn from a distance. The power saw that was hewing her back in half had been turned off but somebody was tightly pulling at her vaginal area.

The midwife who settled her down explained that during the delivery, she was too exhausted to push her baby out and needed help. The doctor had to give her an episiotomy, a cut down at the vaginal area, to make room for the baby to come through.

Breathing complications
Thereafter, he used a special hand-held gadget to hold the baby’s head and pull her out during a contraction. Little Sofia* was literally yanked out of mommy in a bid to hasten her delivery and prevent her from developing breathing complications.

Brenda was sore for days. As her episiotomy healed, aided by crazy acrobatics to sit in a bath of warm, salty water in her tiny bathroom, her nipples developed cracks that would light up in unbearable pain whenever Sofia attempted to breastfeed. What was meant to be a wonderful fulfilling journey in motherhood began to pale.

Like many mothers, Brenda was told to chin up and keep going. Motherhood would get better, they said; she would settle in and start to enjoy it, they added. None of these things came to pass as three months later, her husband was diagnosed with an aggressive stomach cancer. In exactly 21 months since his diagnosis, Brenda stood by his grave laying flowers, a widow with a toddler by her side.

It had taken several years for Brenda to heal and love again. But she always told Jason* she was not ready to go through labour again, should they ever consider having babies. This is how she walked into my office demanding a caesarian delivery.

After a lengthy conversation, Brenda was willing to try labour, aided by epidural analgesia. As far as she was concerned, these options did not exist in our corner of the third world. She was pleasantly surprised to learn that she would not be the first to deliver painlessly in Kenya. She began to look forward to the delivery.

Forbidden fruit
Once she was admitted to the labour ward, the pain doctor inserted the flexible epidural catheter into her lower back and strapped it on firmly. He then loaded the pain medication and attached it to a pump that Brenda would use to release the medication whenever she felt pain beginning to build up. She was in charge of her pain.

Brenda could feel the tightness of the contraction on her belly and the pressure in her pelvis but it was not painful. She even managed to complete a work assignment on her tablet during the early part of labour. Eventually she was on the delivery couch pushing little Amanda* out without needing an episiotomy.

Her doctor left the pump in place for the first day after delivery to keep her comfortable, relieve the soreness of delivery and tame the contractions caused by breastfeeding. As Brenda left the hospital, she could not help but compare the two experiences. Epidural pain relief is not a privilege. It should be a routine choice offered to every mother in labour. 

Pros and cons
Once started, your epidural should continue until after your baby is born, your placenta is delivered and any stitching you need has been done.

Pros
● You should be able to have an epidural at any point.
● It is better at relieving pain than opioids.
● It is not linked to a longer first stage of labour or an increased chance of having a caesarean section.
● It is not linked to long term backache.
● You may be able to have a type of epidural that you can top up yourself.

Cons
● You may not be able to move around as much after you have had a few top-ups.
● Epidurals are linked to a longer second stage of labour and an increased chance of an assisted birth.
● You can only have it in hospital, because it needs to be given by an anaesthetist.
● There can be side effects, including low blood pressure, loss of bladder control, itchy skin, feeling sick, headaches, infection and nerve damage.

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