Previous article Table of Contents  Next article

COMMENTARY
Year : 2014  |  Volume : 8  |  Issue : 5  |  Page : 4-5

Labor pain relief for parturients: We can do better


Department of Anesthesiology and Critical Care Medicine, Nanjing Maternity and Child Health Care Hospital, Nanjing Medical University, Nanjing - 210 004, China

Correspondence Address:
Dr. Fuzhou Wang
No. 123, Tianfei Xiang, Mochou Road, Nanjing 210004
China
Login to access the Email id

Source of Support: This work was supported in part by the National Natural Scientific Foundation of China (NSFC, 81271242, and 81371248); Nanjing Municipal Outstanding Young Scientist Grant in Medical Science, Development (JQX12009); and Nanjing Municipal Developmental Young Grant of Medical Science(QYK11139),, Conflict of Interest: None


PMID: 25558189

Rights and PermissionsRights and Permissions
Date of Web Publication6-Nov-2014
 


How to cite this article:
Wang X, Wang F. Labor pain relief for parturients: We can do better. Saudi J Anaesth 2014;8, Suppl S1:4-5

How to cite this URL:
Wang X, Wang F. Labor pain relief for parturients: We can do better. Saudi J Anaesth [serial online] 2014 [cited 2022 Jun 30];8, Suppl S1:4-5. Available from: https://www.saudija.org/text.asp?2014/8/5/4/143920

"Do you know labor analgesia"? We ask parturients this question every day, and they answered "Yes." In our Institute, approximately, 95% obstetric patients know, at least in part, the labor analgesia technique. [1] However, this is not the situation as the others are. In this issue, a group from Nigeria addressed the need of education for parturients as well as training of caregivers in labor pain control. They suggested in their study that women should be encouraged to request various pain-relieving methods, and the care providers should be helped to enhance their ability to provide labor analgesia and think critically about the practice.

Women undergoing labor delivery without effective pain relief often experience incredible or unbelievable pain, and it was often described as the most excruciating event in their lifetime. Acute severe labor pain may induce many physical disorders on mothers and neonates such as maternal hyperventilation, respiratory alkalosis, increased cardiovascular load, fetal hypoxemia, and/or metabolic acidosis. [2] Furthermore, adverse psychological events such as poor maternal-neonatal bonding, traumatic stress disorder or even postpartum depression may also occur. [3] Relief of labor pain has been considered one of the fundamental human rights issues addressed by some declaration such as "The Universal Declaration of Human Rights." [4] Nonetheless, the situation might not be that good in low-income countries owing to inadequate awareness, limited resources and insufficient financial support. Besides, the management of labor pain is inadequately addressed due to the limited knowledge of caregivers concerning the types, benefits, and adverse effects of various analgesic means, even though it was well-known for the conception that the attitudes and behaviors of caregivers with regard to labor analgesia significantly affect the level of pain perception and satisfaction with the birth experience of parturients. [5] Hence, not merely new mothers, but also antenatal caregivers including midwives, obstetricians, and anesthetists need be educated to have more positive attitudes as emphasized by others. [6]

The methods listed for labor pain control in the abovementioned article, including "inhalational analgesia, intravenous pethidine or morphine, spinal anesthesia, and transcutaneous electrical nerve stimulation" were incomplete. In fact, more nonpharmacological interventions such as water immersion, relaxation, massage, and acupuncture as well as pharmacological ones like combined spinal epidural, nerve blocks or sole anesthetics have been demonstrated to be effective in relieving labor pain. [7] It is essential to note that the indications and contraindications, and the maternal and fetal benefits and risks for each method provided in labor pain control need to be fully explained to the parturient. [8] For those who fear of side-effects on baby and self, some nonpharmaceutical pain managements can be recommended due to the properties of noninvasive, low cost, and easy to implement, especially for women from low-resource countries because neuraxial analgesia is not readily available in such countries, even though it is the most effective way in controlling labor pain. [9] Therefore, labor pain-relieving regimen should be tailored to the individual woman's wishes, needs, and corresponding circumstances. Furthermore, postpartum perineal pain as one part of labor pain is usually neglected and not reported by caregivers. [10] Especially for women with low-income, young pregnancy age, high pregnancy rate, and short inter-pregnancy interval, postpartum perineal trauma may be prevalent and may induce many adverse physical and psychological outcomes. Alleviation of postpartum perineal pain is of particular importance for caregivers and new mothers. As thus, it possesses particular value if attention was paid to postpartum perineal pain with respect to its morbidity, prevention, and treatment in low-resource regions.

Labor pain relief has been in existence since 1847, when Dr. Simpon first used ether as an analgesic for one woman in delivering. Many effective analgesia methods have been developed for labor pain control since 1943 including neuraxial blockade, whereas it is a reality that plenty of women today still experience pain during labor for a variety of social, cultural, attitudinal, financial, and religious reasons. Therefore, it is urgent for caregivers including midwives, obstetricians, and anesthesiologists teaming up to run educational programs for spreading corresponding knowledge. It is time to offer each parturient safe and effective pain-relieving method.

 
  References Top

1.
Wang X. Adhere to the principle "primum non nocere": A documentary of the pioneer scientist in labor pain control in China. Sci Insights 2014;6:112-4.  Back to cited text no. 1
    
2.
Reynolds F. The effects of maternal labour analgesia on the fetus. Best Pract Res Clin Obstet Gynaecol 2010;24:289-302.  Back to cited text no. 2
[PUBMED]    
3.
Eisenach JC, Pan PH, Smiley R, Lavand'homme P, Landau R, Houle TT. Severity of acute pain after childbirth, but not type of delivery, predicts persistent pain and postpartum depression. Pain 2008;140:87-94.  Back to cited text no. 3
    
4.
Pillay N. Right to health and the universal declaration of human rights. Lancet 2008;372:2005-6.  Back to cited text no. 4
[PUBMED]    
5.
Lally JE, Murtagh MJ, Macphail S, Thomson R. More in hope than expectation: A systematic review of women's expectations and experience of pain relief in labour. BMC Med 2008;6:7.  Back to cited text no. 5
    
6.
Boama V. Overcoming barriers to pain relief in labor through education. Int J Gynaecol Obstet 2011;114:207-8.  Back to cited text no. 6
[PUBMED]    
7.
Wong CA. Advances in labor analgesia. Int J Womens Health 2010;1:139-54.  Back to cited text no. 7
[PUBMED]    
8.
Broaddus BM, Chandrasekhar S. Informed consent in obstetric anesthesia. Anesth Analg 2011;112:912-5.  Back to cited text no. 8
    
9.
Ogboli-Nwasor E, Adaji S, Bature S, Shittu O. Pain relief in labor: A survey of awareness, attitude, and practice of health care providers in Zaria, Nigeria. J Pain Res 2011;4:227-32.  Back to cited text no. 9
    
10.
Wang X, Xu S, Feng S. Postpartum perineal pain in the absence of obstetric anal sphincter injuries: A prospective observational study. Sci Insights 2013;4:69-74.  Back to cited text no. 10
    




 

Top
 
Previous article    Next article
 
  Search
 
    Similar in PUBMED
   Search Pubmed for
   Search in Google Scholar for
    Access Statistics
    Email Alert *
    Add to My List *
* Registration required (free)  

 
  IN THIS Article
   References

 Article Access Statistics
    Viewed1714    
    Printed35    
    Emailed0    
    PDF Downloaded188    
    Comments [Add]    

Recommend this journal