Fear of childbirth (FOC) is a serious problem for women, since it leads to avoidance of pregnancy, maternal and foetal stress, and an increase in maternal requests for caesarean section. Normal vaginal birth for women is a painful experience due to uterine contractions, recurrent vaginal examinations, and vaginal lacerations. Widely used in other parts of the world, a pain relief method known as ‘epidural anaesthesia’ was officially introduced in Rwanda, launched on September 17, at King Faisal Hospital Kigali. How it works During the launch, Dr Samuel Muhumuza, a senior consultant anaesthesiologist at King Faisal Hospital, explained that epidural, also known as labour anaesthesia, is the best method that can be applied for any woman planning to give birth, even though there are other ways to relieve pain like morphine, nitrous oxide, and pethidine. Senior Consultant Anaesthesiologist at King Faisal hospital, Dr Samuel Muhumuza discussing with Media about Epidural anesthesia, the method of pain relief during labor at Kacyiru on Thursday (Craish Bahizi) He said that this is a procedure whereby an injection is given in the back of the expectant mother through the catheters (medical devices that can be inserted in the body to treat diseases or perform a surgical procedure) and the medication can be given by infusion (this is the delivery of liquid medicine or treatment through a vein). Once the catheter is inserted, it is left in the back, which enables the doctors to keep adding medication. “When the drug gets into the potential space, it will work on the nerves that are supplying the uterus. The contracting uterus which is the cause of the labour pain, therefore, will continue contracting but the mother won’t be able to feel the pain because the nerves are convened. The pain from the uterus is being numbed by the drugs that are given,” he said. He said that after giving the first dose within the first five minutes, the mother has already started feeling relief from pain. Every woman in labour is entitled to labour anaesthesia. According to Dr Adeyemi J. Olufolabi, an anaesthesiologist at Duke Global Health Institute in Durham, women have options, and doctors have to give them all the available choices. He explained that the problem in Rwanda is that there was no general pain relief which caused many women to suffer due to pain, thus inciting decisions that were not good for themselves. For example, many women opted for C-section to avoid the pain of natural birth. A Professor of Anesthesiology, Adeyemi J. Olufolabi Olufolabi pointed out that apart from epidural anaesthesia, there are other ways that have been used to reduce labour pain, with the use of medicine or without. For instance, without medicine includes, rubbing the backs of women, rolling on the ball for expectant mothers, walking around, among others. He, however, noted that spinal and epidural methods are being given by professionals that are trained. The whole process is referred to as neuraxial; this is medicine inside the spine but there are different areas it goes into. Olufolabi added that the spinal method is one shot injection and it lasts for a certain time, while an epidural is a way to deliver an anaesthetic so that it stops pain signals traveling from the spine to the brain. It involves injecting a small amount of anaesthetic into the epidural space of the spine. The epidural space is filled with fluid and surrounds the spinal cord. If it’s a 12-hour labour, epidural is good, but if it’s a two-hour labour, spinal type is better. He said that the long term effect is nil, unless one has a complication. Sometimes the epidural may result in complications such as severe headaches that start after two days and go on for days, but can be treated. Olufolabi also that the labour anaesthesia doesn’t affect the duration of labour. When the pain is reduced, some women’s labour even becomes shorter. So far, the cost of this procedure has not yet been communicated, however, it is known that it won’t be covered by health insurance. “We did a survey and realised that not all women want pain relief, and they can’t be forced to accept the pain relief procedure. However, some women were asked about the nature of their labour pain, and almost all of them said severe pain. When asked if they would have liked pain relief, they were in support of it,” the visiting Dr stated. He further noted that epidural anaesthesia doesn’t affect the labour, baby, or the psychology of a woman. In Rwanda, this service can be found at King Faisal Hospital Kigali and University Teaching Hospital of Kigali (CHUK). According to Muhumuza, there is more need for manpower as King Faisal Hospital Kigali has only three permanent anaesthesiologists but also uses other part time anaesthesiologists from different hospitals. The doctors’ expectations are that this method is going to grow, almost all women will be extremely delighted, it will add to the willingness to have more children, there won’t be trauma caused by painful labour, and it will reduce the incidences of C-section.
