Labour pain meets modern care as MNH introduces epidural analgesia

DODOMA: FOR many women, the excitement of meeting a newborn is accompanied by another thought: The pain of labour. As contractions intensify and the baby moves through the birth canal, discomfort can become severe.

Medical advances are giving women options for managing labour pain. One is epidural analgesia, which reduces pain while allowing a mother to remain awake, feel pressure and participate actively in childbirth.

At Benjamin Mkapa Hospital (BMH) in Dodoma, epidural analgesia is being introduced as an option for women having vaginal births. Specialist anaesthesiologist Dr Lugano Wilson said the procedure does not stop labour. Instead, it blocks pain signals from reaching the brain.

“The mother continues to experience the contractions. She can feel the pressure and she can feel that the baby is coming down, but the pain information that normally reaches the brain is blocked,” he said.

Woman can therefore respond when health workers instruct her to push, while the baby continues descending normally. The procedure is generally started after labour has begun and the cervix has reached about four centimetres of dilation. Its effect usually begins within 10 to 20 minutes after medication is administered.

The World Health Organisation (WHO) recommends epidural analgesia for healthy pregnant women requesting pain relief, according to their preferences. Women should also receive information about available pain-relief options as part of womancentred care.

Yet access remains uneven. A WHO Multicountry Survey on Maternal and Newborn Health examined 359 health facilities in 29 countries across Africa, Asia, Latin America and the Middle East. Among 221,345 women who had vaginal births, only four per cent received labour analgesia, with epidural being the main form recorded.

Use was higher in countries with higher Human Development Index levels and lower in lower-HDI settings. WHO does not provide a reliable figure for the number of African countries currently offering epidural analgesia or a global count of countries using it.

Dr Wilson said epidural services are more available where resources and specialist anaesthesia services are accessible. He cited the United States, Finland, France and the United Kingdom, while noting that use remains less widespread in Africa.

For him, expanding access is not about changing the natural process of childbirth but reducing unnecessary suffering. Severe pain can cause psychological distress and make it harder for a woman to concentrate on instructions from health workers.

“When the pain is very severe, the mother may concentrate more on the pain than on what the health workers are telling her to do,” Dr Wilson said. “But when the pain is controlled, she can concentrate on the instructions, including when to push and how to position herself.”

Pain relief may also reduce exhaustion during prolonged labour. Some women experience labour for many hours, sometimes approaching 20 hours, leaving them physically exhausted and distressed. Severe pain and fatigue can become overwhelming, and some women may begin asking for Caesarean delivery.

WHO’s evidence review identifies epidural analgesia as an effective option for labour pain relief. It found moderate-certainty evidence that epidural probably results in fewer Caesarean births than no epidural in the trials reviewed. However, WHO notes uncertainty around some other outcomes and says epidural requires more resources and monitoring than opioid analgesia.

Despite its benefits, epidural is not suitable for every woman. At BMH, women are assessed before the procedure. The hospital has established a specialised clinic where expectant mothers can receive information, ask questions and undergo assessment.

Dr Wilson encourages women to attend from around 32 weeks of pregnancy so they can understand the service, discuss concerns and make plans before labour begins.

Women expected to undergo Caesarean delivery are not candidates for epidural as a method of pain control for vaginal childbirth, although epidural techniques can also be used for anaesthesia and pain management associated with surgery.

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Blood-clotting problems are another consideration. Doctors check platelet levels and clotting status because inserting an epidural needle when clotting is severely impaired can present serious risks. If a correctable problem is identified, specialists can provide appropriate treatment. If it cannot be safely corrected, the woman may not be considered suitable.

An infection at the procedure site and some medicines affecting blood clotting can also influence eligibility. WHO notes that epidural requires additional resources and monitoring for possible adverse effects. It recommends using the lowest effective concentration of local anaesthetic to reduce complications while preserving motor function as much as possible.

Childbirth carries cultural and religious meanings, and attitudes towards labour pain differ among individuals and communities. Dr Wilson said medical decisions should be guided by scientific evidence and patient needs, while beliefs about childbirth remain personal.

He cautioned against presenting any medical procedure as completely riskfree. Possible adverse effects of epidural analgesia include itching and nausea, although he said none of the patients receiving the service at BMH had experienced these effects.

For Dr Wilson, reducing labour pain should not diminish the value attached to pregnancy, childbirth or motherhood. Pregnancy involves months of physical and emotional changes, including nausea, vomiting, changes in blood levels, hospital visits and other challenges.

“The value of the child should not be measured by the pain of the 18 or 20 hours of labour,” he said.

He also urged men to abandon the idea that women must suffer during childbirth for motherhood to have meaning. In his view, technology that reduces suffering does not reduce the value of a child or diminish the importance of motherhood.

At BMH, the hospital has set a target of having 100 mothers deliver using epidural pain control during the planned period for the service, Dr Wilson said.

For him, the central issue is informed choice. Women should understand that labour pain can be managed through different approaches and should be able to discuss available options with qualified health professionals.

“The important thing is for a woman to know that there are options for managing labour pain,” he said.

WHO evidence highlights a wider challenge: Access to labour pain relief remains unequal. Although epidural analgesia is an established option recommended for women who request it, many women in lower-resource settings continue to have limited access to pharmacological pain relief during childbirth.

For Tanzania, BMH’s experience represents more than the introduction of a specialised procedure. It forms part of a broader conversation about what women can expect from modern maternity care and how health systems can respond to needs.

Childbirth remains a natural physiological process, but the way a woman experiences it can increasingly include informed choices about pain management. For eligible women who choose it, epidural analgesia offers another way to manage labour pain while remaining conscious, responsive and involved in bringing a child into the world.