Labor pain relief for parturients: We can do better.

“Do you know labor analgesia”? We ask parturients this question every day, and they answered “Yes”. In our institute, approximately 95 present 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.[2]

Women undergoing labor delivery without effective pain relief often experience incredible or unbelievable pain, and it was often describes 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.[3] Furthermore, adverse psychological events such as poor maternal-neonatal bonding, traumatic stress disorder or even postpartum depression may also occur.[4] 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.”[5] 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 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.[6] Hence, not merely new mothers, but also antenatal caregivers including midwives, obstetricians, and anesthetists need educate to have more positive attitudes as emphasized by others.[7]

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 non-pharmacological 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.[8] 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.[9] For those who fear of side-effects on baby and self, some non-pharmaceutical pain managements can be recommended due to the properties of non-invasive, 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.[10] Therefore, labor pain-relieving regimen should be tailored to 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.[11] 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 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.