Epidural anaesthesia has revolutionized
the labor process. It involves insertion of
catheter (very slim tube) in a certain space
called the epidural space that surrounds
the spinal column. This allows for the
women to have adequate pain relief but
still maintain movement unlike spinal
anaesthesia where the limbs can’t move for
the duration of the anaesthesia.
Augmentation of labor is when the woman
is given additional drugs (uterotonics e.g.
oxytocin) to help contractions to come
better and aid progress of labor. Induction
is done when the woman has not started
labor and the same medication can be
used.
In 75% of cases labor will progress well
with or without augmentation and the
mother will reach second stage of labor.
This is the period from full dilatation to
delivery of the baby. In most women it is
relatively short but can be up to 1 hour and
even longer with epidural anaesthesia.
We normally request women to push and
just to aid we explain that she imagines she
is constipated and stool refusing to come
out and to try to push stool out. When the
head crowns we breathe in and out and
not exert as much force and usually in a
few seconds or minutes the baby’s head is
delivered.
The person conducting will feel to see if
there is any cord impeding delivery of the
rest of the body and with following push
plus assistance of midwife/doctor the baby
is delivered with a huge sigh of relief from
everyone. Big congratulations to the new
parents!!
If the baby has no issues we practice
delayed cord clamping to help minimize
anaemia in the newborn. If it is only one
baby oxytocin is administered to help
prevent bleeding post-delivery. After
cutting the cord, continuous traction on
it delivers the placenta. The period from
delivery of the baby to delivery of the
placenta is called third stage of labor.
The first hour after delivery of the placenta
is known as the fourth stage and here the
biggest worry is bleeding or post-partum
haemorrhage (PPH). Clots will be expelled
with uterine massage to help the uterus
contract and minimize bleeding. During
this period the mother is examined for
tears and these or the episiotomy shall be
prepared.
Once the mother is ready she is encouraged
to breast feed as this helps with milk let
down which also releases natural oxytocin
from the body again reducing bleeding.
Bleeding during pregnancy accounts for
30% of deaths hence we are very anal
about interventions to minimize bleeding.
I hope I have given you an overview of
labor and what to expect. May I take
this opportunity to wish you a Merry
Christmas and fruitful 2020!
Dr. Maureen Owiti is a practicing
Obstetrician Gynaecologist and
fertility consultant based in Nairobi.
You can commune with her on this
or related matters via email at:
Drmaureenowiti@gmail.com.
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