WOMEN’S BODIES: CHILDBIRTH. LABOUR AND DELIVERY
Labour pains are different from other pain
we experience. They mean the right things are happening: other pain usually means that something is wrong.
Pain relief during labour and delivery
Contractions of the uterus in labour are painful. Some people have played down me force of labour pains and given the impression that if you know what to expect and are armed with the right attitude plus breathing and relaxation techniques that can help to distract you from the pain, you’ll be able to cope with them and shouldn’t need pain relief. This is called psychoprophylaxis (meaning ‘prevention by the mind’), and works wonderfully for some women, but not for all. It’s impossible to predict how much pain any woman will feel during labour: it can be different for the same woman from one deliver to the next.
Nine out of ten women having their list delivery need more than psycho-prophylaxis and minor pain relief. More women manage well without drug relief in subsequent deliveries. The drugs used today include self-administered nitrous oxide/oxygen gas anaesthesia (with which you can’t put yourself too far under because you drop the mask), pethidine (a synthetic narcotic) and epidural block, which anaesthetises the body from the waist down. Methods of pain relief will be explained to you in your antenatal classes and by your doctor. During labour you can ask for pain relief if you need it, and refuse if it’s offered to you and you don’t want it.
There has always been some concern about the effects of drugs on the foetus and on the course of labour, though when administered and monitored with care, all the above methods have proved safe. There has been controversy about the increasing use of epidural anaesthetic, especially in first deliveries (six out of ten in one study in New South Wales). A 1983 review by the NHMRC of potential benefits and hazards of epidural block in labour concluded that in experienced hands epidural is safe, but recommended that its possible effects on delivery (mainly that forceps delivery is more likely to be needed) should be discussed with the pregnant woman before the onset of labour.
Delivery sitting or lying down?
It’s only during the twentieth century that women have been encouraged to lie down during labour and delivery. It’s been suggested that the main reason for this position is that it is easier on the backs of the birth attendants!
Advocates for more active roles for women in childbirth encourage walking around and a variety of positions during the first stage of labour. You’ll learn about these in your antenatal classes. It’s been suggested that uterine contractions may be more effective when the mother’s body is upright, resulting in a shorter labour.
Delivery may be in whatever position you find easiest: sitting semi-reclined; crouching holding someone or something; squatting; kneeling; on ‘all fours’; lying on your back. Delivery-room staff say that the majority of women feel most comfortable lying on their backs, and this position is certainly easier for birth attendants. If you need some help with delivery (for example forceps), you may have to lie on your back so that procedures can be performed safely.
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