Choices in Childbirth

It’s more than 160 years since doctors first experimented with pain relief for women during childbirth.

Dr James Simpson from Edinburgh was the UK’s first pioneer of the use of ether and chloroform in labour during the 1840s.

But it wasn’t until Queen Victoria was administered chloroform for the birth of her seventh and eighth children – Arthur and Leopold – in the 1850s that the practice became medically and ethically acceptable.

Today, such is the standard and quality of obstetric pain relief that most women could safely expect to endure the process of childbirth largely pain-free, should they choose to.

Choice is crucial in childbirth.

Some women may be so stressed by the prospect of labour pain that it has a powerful psychological impact and detracts from what is supposed to be a joyous occasion.

Others may feel some level of pain helps them ‘connect’ more with the birthing experience.

Certainly, there is good evidence that epidural analgesia – where anaesthetic is injected into the back to numb the body from the waist down – adds to the delivery time for most births.

But for many women the associated, small increase in risk of an emergency Caesarean-section is worth it to be free of discomfort.

‘Gone are the days when women in labour were simply told what was going to happen to them,’ says Ginina Houghton, a former nurse and clinical lead at CME Medical.

‘They now have more input than ever before and a choice over what’s going to happen, including the choice of what type of pain relief.

‘I would say the objective with any pain management these days would be to have the patient pain-free as much as possible.’

Technology has advanced to the point where obstetric anaesthetic pain control is probably more effective and safer than ever before.

CME Medical, for example, supplies an infusion product called the Programmed Interval Auto Bolus, or PiAB.

It aims to improve obstetric pain relief by delivering of up to 1,000 millilitres of pain-relieving medicine an hour, ‘ensuring a better spread of medication and resulting in improved pain relief’.

Epidurals provide total pain relief in around 90 per cent of patients and partial pain relief in the rest.

Most are given while the patient is sitting down and leaning forwards, or lying on their side with their knees drawn up.

This opens up the spaces between the bones of the spine (the vertebrae) and allows the epidural needle easier access.

A sterilising solution is rubbed on the back and an injection of local anaesthetic into the skin helps to reduce any discomfort.

Then, the anaesthetist inserts a hollow needle and passes through the middle of it a thin, plastic tube (called an epidural catheter), through which the anaesthetic can be injected.

The drug works by numbing pain nerves as they enter the spine and the extent of the numbness will depend on the type of drug used and the amount injected. As the medication wears off, feeling in the affected areas returns.

Once in place, they can usually be topped up by an experience midwife, rather than waiting for an anaesthetist.

Their great advantage is that they enable the patient to still feel the contractions but retain a clear mind and feel no pain.

But they do require increased monitoring and often, due to the lack of sensation, a catheter needs to be inserted to empty the bladder.


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