Barriers to effective painless labor in developing countries and the remedial measures

Childbirth has been the most controversial subject in the pain management since ages. While there are some proponents which argue that pain is pain, and it’s the physician’s responsibility to relieve it as he does for the kidney pain or even simple headache; while some argue that it is not a pathological process, and that pain associated with labor brings about a stronger and lasting bondage between mother and child. A religious argument has also been presented against it. The introduction of epidural anesthesia revitalized interest in offering pain relief in labor even for prolonged periods. In resource poor countries, it has been looked upon with guarded skepticism. The scarcity of resources and staff, coupled with lack of a nation-wide awareness campaign has been largely responsible for the low practice of this modality in SAARC countries. Apicare Journal has raised this issue at SAARC level with the association of representative bodies of the member countries. This editorial is an attempt to present some insight on the barriers to painless labor and remedial measures in our countries. Key words: Childbirth; Pain, labor; Pain relief; Epidural analgesia Citation: Ali L. Barriers to effective painless labor in developing countries and the remedial measures. Anaesth. pain intensive care 2020;24(6):__ Received: 22 November 2020, Reviewed: 22 November 2020, Accepted: 30 November 2020

Caesarean section on demand: a hospital-based study

Background: The aim of the study was to find out the reasons behind healthy women preferring cesarean section (CS) in the absence of obstetric and medical indications.Methods: This was a prospective study among women who came for delivery at ASCOMS, Jammu (Jammu and Kashmir), India a tertiary level teaching hospital. All women who underwent caesarean delivery for maternal request were included in this study.Results: The total number of deliveries during the study period (9 months) were 889. There were 636 (71.54%) vaginal deliveries and 253 (28.46%) CSs. Among 253 CSs, 25 (9.88%) had maternal request as their indication. Majority 13 (52%) of them were in the age group of 20 - 25 years. Multigravida opted for CS more than primigravida (17 versus 8). Most 10 (40%) of them were Graduates and 15 (60%) were working. Majority of them 13 (52%) were in class II socioeconomic status of Kuppuswamy’s scale. The various reasons for women requesting cesarean delivery were refusal of vaginal birth after cesarean section (VBAC), simultaneous tubectomy, painless delivery, prolonged infertility, afraid of neonatal outcome and astrological concerns.Conclusions: Most of the women who opted for cesarean delivery in our study was for preventable reasons like painless labor, previous negative birth experience and simultaneous tubectomy which would have been avoided by prior counseling starting from antenatal period and by providing labor analgesia. Proper education of the patient and personal involvement of the treating obstetrician in counselling the patient and her supporters can reduce cesarean delivery for maternal request.