Is pain during childbirth unavoidable?

The pain experienced during childbirth is one of the most intense forms of pain. It follows a certain rhythm and can be divided into three phases that correspond with the birth:

• the dilation of the cervix
• the dilation of the pelvic floor
• and the dilation of the perineum

These various stimuli trigger different painful sensations.

Reducing fear

Labour pains are more than simply the transmission of stimuli through the pain receptors. The stimuli are also interpreted in the brain and influenced by emotional, cultural, social and motivational factors. Fear for instance, which is an emotional factor, can influence the intensity of the labour pains. Fear causes tension, which heightens the pain by reducing the level of endorphins (the pain relievers produced by the body). This in turn makes the labouring woman more afraid and creates a vicious circle. Uncertainty can also fuel fear, so individual preparation for the birth plays a major role in the reduction of pain during labour. Various different relaxation and breathing techniques can be learnt as part of these preparations.

Conversely, positive emotions can alleviate pain, dispel fear and aid relaxation. It is assumed that this effect is caused by another circuit in the brain, which is controlled by the happy hormone dopamine.

The importance of a familiar and trustworthy birthing partner

If a woman feels like she is on her own during the birth, this can lead to emotions such as panic, distress and fear. Medical professionals can reduce the feeling of insecurity by ensuring the birth follows a professional procedure, as well as making the mother-to-be feel confident about her ability to give birth. The spouse or trusted birthing partner provides emotional support. A good atmosphere in the delivery room and the inclusion of the woman and her partner in all decisions prevents any feelings of powerlessness.

Pain relievers

Of course in addition to emotional support, various pain relievers are also used during childbirth:

- Patient-operated analgesia
This method enables the women in labour to administer herself a pain relieving infusion at the push of a button. The medication is called Remifentanil (Ultiva) and it’s a potent morphine derivative with an ultra-short effect. The infusion apparatus can be attached in a few minutes and does not hinder the women’s mobility. The medication takes effect very quickly and is also broken down by the body incredibly fast. That means it is safe for both mother and child. Salem-Spital was the first hospital in Switzerland to use Remifentanil in obstetrics. As a result, it has gathered the most data in this area. The technique is now also offered by 16 other Swiss hospitals.

- Local anaesthesia
Peridural anaesthesia (PDA) and spinal anaesthesia are used in obstetrics, as well as a combination of both methods.

- Peridural anaesthesia
PDA is performed under local anaesthetic and involves the insertion of a very thin plastic tube between two vertebrae in the lower part segment of the spine near the spinal meninges. A local anaesthetic can then be administered via this tube as required. The anaesthetic surrounds the nerves leading from the uterus to the spinal cord and numbs the labour pains during the birth.

- Spinal anaesthesia
Spinal anaesthesia is similar to PDA. A very thin needle is inserted in between the vertebrae under local anaesthetic, however, in this instance the needle is inserted all the way through to the spinal meninges, which it then pierces. This means that the pain relief is inserted directly into the fluid surrounding the spinal cord.

- Combined approach
Both techniques can be used for natural births and caesarians. They are usually combined to ensure the pain relief quickly takes effect and can be applied for as long as required.

Experienced Team

The complex processes that produce the associated with the production of hormones oxytocin, endorphin, adrenaline and dopamine during childbirth have not yet been comprehensively studied. However, unlike in the past, there is a lot we can do to reduce pain and support the patient so that they feel safe and can look forward to a healthy and happy start to motherhood. That’s why the maternity ward team is available around the clock for the mother-to-be and her partner.

Alternative pain relief

Natural pain relief techniques are designed to aid relaxation during childbirth by appealing to the mother’s various senses. Thesey include, for example:
• Breathing techniques and relaxation exercises
• Therapeutic exercises, alternative birthing positions
• Physical measures (water birth, compress, massage)
• Acupuncture
• Homoeopathy
• Aromatherapy
• Music

Article from Dr. med. Metascha Stierli, specialist in gynaecology and obstetrics