Labour is one of the most painful experiences women go through. To quicken the process, many mothers take herbs without considering their side-effects, Agnes Kyotalengerire writes
Twenty-six-year-old Olive Mumbere (not real name), a first-time mother, lies in the maternity ward staring at her newborn baby. Suddenly, she gnashes her teeth and writhes in pain as she struggles to reach for her crying baby. The nursing officer moves quickly to assist her.
“Her blood pressure is low and her skin is pale because she lost a lot of blood. She was brought in bleeding profusely,” the nurse explains.
Mumbere was given a blood transfusion to save her life.
At the time Mumbere was brought to hospital, her waters had broken much earlier and the risk of infection was high, so she was given treatment to avert it. Upon examination, it was discovered that Mumbere had obstructed labour.
The baby was too big to go through her pelvis. This made it difficult for Mumbere, whose cervix had dilated fully, to deliver normally.
According to the nursing officer, Mumbere’s baby was getting distressed because its oxygen supply was interrupted. She was rushed to the theatre, where the doctors delivered her by caesarean section. Luckily, both mother and baby survived.
While in the theatre, the doctors discovered that Mumbere’s uterus had ruptured beyond repair. Her uterus was removed, meaning that Mumbere will never conceive again.
Mumbere revealed that she had taken herbs to stimulate contractions and quicken delivery so that she would deliver from home. Realising that she had failed to deliver after almost 10 hours, her neighbour rushed her to the hospital.
Mumbere is not alone. Sylvia Kalegere, the in-charge of the labour ward at Mbale Referral Hospital, says the number of expectant mothers using herbs to speed up labour is cause for worry. “Everyday, we receive expectant mothers experiencing abnormal labour pains caused by the use of local herbs.”
According to hospital statistics, during December 2012, nine expectant mothers, who had ruptured uteri as a result of using herbs were registered at the hospital.
Dangers of using herbs during labour
Dr. Daniel Murokora, a consultant gynaecologist and medical director of Uganda Women Health Initiative, says traditionally, women use the herbs to widen the birth canal and speed up labour.
“Usually, we suspect that a mother used herbs when she presents with a short history of labour and strong uterine contractions. A few fortunate ones get away with it and deliver, while others get complications,” Murokora explains.
He notes that there is no knowledge of medical properties in herbs and clay capsules (emumbwa) used by some women in labour, but there is a risk of a mother taking overdose, causing complications.
Dr. Evelyn Nabunya, a gynaecologist/obstetrician at the maternal and foetal health clinic, Mulago Hospital, says under normal circumstances, labour is supposed to be progressive, with the cervix becoming thinner and wider (dilating) gradually.
However, the herbs cause hyper-uterine stimulation, where by contractions occur frequently and do not allow the baby to rest, Nabunya explains. The frequent contractions put the baby at risk of distress because there is no time for the uterus to recover. The mother may also end up distressed. Under normal circumstances, a mother should not exceed five contractions in 10 minutes, she affirms.
The mother is also prone to suffering a uterine rupture because of hyper stimulation, which may lead to severe bleeding, warns Murokora.
He explains that uterine rupture is the tear on the walls of the uterus.
“The uterus can tear as a result of prolonged labour if the baby is too big for the mother’s pelvis or from contractions that are too frequent or forceful,” he explains.
In addition, Nabunya says some mothers may present with cervical dystocia, a condition where the cervix fails to dilate even with normal contractions.
If a mother is unlucky, she may end up with a tear of the cervix extending down to the vagina. Usually when such a condition presents, operation is done to deliver the baby, Nabunya says.
How to make labour less painful
Each woman’s experience during child labour is different. Some mothers labour for hours, while others will take two to three days. Whatever the case, labour is painful. It is for this reason that many mothers will do anything to quicken the process and make it less painful. Below, medical experts give tips on how to make labour less painful.
Distraction and visualising
Dr. Daniel Murokora, a consultant gynaecologist and medical director of Uganda Women Health Initiative, advises caretakers to help a labouring mother get distracted by watching television, listening to music or talking to her.
Having the company of the person they trust like a spouse makes a woman in labour know that they are not alone.
“A woman who is in the company of her mother is likely to do better as opposed to having a stranger around her,” Murokora says.
An attendant massaging the back of a mother amidst a strong contraction helps to relieve the pain.
Stay active; walk around
Walking helps the baby’s head to press down with more force, enabling the cervix to dilate quicker.
However, a mother should walk within a distance where medical personnel can monitor her so that they can help should there be need.
Allowing a woman to deliver in a position of their choice quickens labour. “A woman who is squatting is likely to deliver faster because her pelvic bone tends to widen to make it easy for her to push,” explains Murokora.
He adds that lying on the side is also a good delivering position.
Controlled deep breathing helps a mother in labour to stay calm and stop the uterus from being starved of the oxygen it needs to contract and push a baby out. The deeper the mother breathes, the more oxygen circulates around the body, helping her muscles to relax. When a mother is calm, her body tends to relax and is less likely to suffer pain.
Get on the ball
One of the greatest comfort tools you can rely on during labour is a birthing ball. The ball gets women into positions that help labour progress. For instance, rocking hips back and forth on the ball can help the baby descend into the pelvis during early labour.
Submerging in warm water will reduce pressure and pain, as well as relaxing labouring mothers.
Despite a widespread belief that sex during the later stages of pregnancy can jumpstart labour, a recent study from Malaysia found no differences in the timing of delivery between women who had sex near term and those who abstained.
Dr. Tan Peng Chiong, an obstetrics and gynaecology professor at the University of Malaya, and one of the authors of the study, said many women believe intercourse can induce labour and scientists have proposed plausible biological explanations for why it might help.
For one, semen contains a hormone-like substance called prostaglandin, which is used in synthetic form to induce labour. Breast stimulation is also thought to hasten labour and orgasm can trigger uterine contractions.
Tan said the belief also probably came from “the deep seated folk perception that intercourse in pregnancy may be unsafe and may cause pregnancy expulsion or miscarriage despite fairly replete evidence to the contrary”.
But few studies have ever investigated whether sex really can initiate labour and the small amount of existing evidence was inconclusive, Tan and his colleagues write in the obstetrics and gynaecology journal BJOG.
So they set out to see whether advising women to have sex during the final weeks of pregnancy could help them avoid an induction.
“Labour induction for prolonged pregnancy is common and many women are also tempted for a variety of personal reasons to trigger labour off in the very latter stages of pregnancy,” he said.
The researchers invited more than 1,100 women to participate, all of whom were 35 to 38 weeks pregnant (the typical pregnancy lasts 40 weeks) and none of whom had had sex in the previous six weeks.
Roughly half of the women were advised by a physician to have sex frequently as a means of safely expediting labour.
The other half were told that sex was safe during pregnancy, but that its effects on labour were unknown.
The researchers then tracked the women to determine how long their pregnancies lasted and whether they required any medical intervention to start labour.
They found that about 85% of the women who were encouraged to have sex did follow the doctor’s advice, while 80% of women in the other group also had sex.
Women in the group advised to have sex also had it more frequently for the remaining duration of their pregnancies — three times versus two.
But the rates of induced labour were similar in both groups: 22% of those advised to have sex and 20.8% of the other group had inductions, a difference so small it is likely to have been driven by chance.
Pregnancy also lasted an average of 39 weeks for both groups.
Dr. Jonathan Schaffir, an associate professor of obstetrics and gynaecology at The Ohio State University College of Medicine, who has studied obstetrical folklore, said the findings offer good support for the idea that sex won’t induce labour.
Earlier research had relied primarily on surveys of women about their sexual experiences during pregnancy, but this study was “the first attempt to really randomise the experience, for some to have sex and some to not, which is a hard thing to do,” Schaffir said.
Schaffir would not advise his patients to have sex for the express purpose of going into labour, he added, but the study did indicate that there aren’t any hazards to it.