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February 12, 2019

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Childbirth pain endurable through epidural

Relief from labor pains through epidural anesthesia is common in developed countries, but only one in 10 new mothers in China have access to it.

The percentage is much higher in some maternity hospitals and in most major cities, but the nation still lags behind Western nations in taking the pain out of childbirth.

One reason is the current shortage of anesthesiologists.

To address the need, the National Health Commission unveiled a three-year-plan last November to introduce childbirth pain relief to more hospitals. Shanghai hospitals are ahead of the national initiative.

At the No. 6 People’s Hospital in Xuhui District, some 140 mothers have received epidurals since October, the hospital told Shanghai Daily. One of them is Yang, 26, who gave birth on January 22.

“My mother told me that labor pain is terrible, and when it started, I found it unendurable,” she said.

Yang’s water broke at 3am at home and she went to hospital immediately. By 8am, the pain was intense.

“Every three minutes, I felt as if needles were pricking my belly,” she said.

Yang asked for relief and was given an epidural that significantly reduced the pain. She gave birth to a boy that afternoon. Mother and son are doing well.

During an epidural, a local anesthetic is injected into the spine.

Zhang Xiaoli, director of the anesthesiology department at the hospital, said Chinese hospitals started to introduce the method of pain relief in the 1990s, but a lack of anesthesiologists has restricted its use.

By the end of 2016, there was only one anesthesiologist for every 20,000 Chinese people. The number in developed countries is often five to six.

“Anesthesiologists in China have taken up duties outside traditional operating rooms,” Zhang said. “For example, we now provide painless gastrointestinal endoscopy, brain stent placement and assisted reproduction.”

Further complicating the situation is the fact that an anesthesiologist has to stand by in delivery rooms even when there is nothing to do.

“Childbirth is not like surgery or a checkup that can be scheduled in advance,” Zhang said. “Obviously, it can’t be planned. On the other hand, it’s impossible for an anesthesiologist in theater to leave to attend to urgent needs in a maternity ward.”

From October, the hospital has assigned one anesthesiologist to work in obstetrics and gynecology.

Currently 40 percent of women undergoing natural childbirth have access to pain relief, and the percentage is expected to rise as the service is better staffed.

“Young women today have different expectations from their parents. Fear of pain drives many to choose Caesarean births, which is less desirable than natural birth,” said Huang Yajuan, director of the obstetrics and gynecology department. “They actively look for hospitals that offer pain relief.”

Huang said that more readily available pain relief might encourage more women to have a second child.

“Women who have had a Caesarean are more prone to hemorrhaging of the uterus during a second pregnancy and labor,” she said.

At Shanghai First Maternity and Infant Hospital, one of the earliest to provide epidural anesthesia, 78 percent of women undergoing natural labor last year received pain relief, up from around 50 percent in 2013. In the past year, an average of 30 epidurals were performed every day.

“We should help women when they need help the most,” said Liu Zhiqiang, director of the anesthesiology department at the hospital.

As epidurals become more common, misconceptions are being dispelled. For example, many people believe that the procedure is detrimental to mother and baby, Liu said.

“For those who still harbor doubts, the anesthesiologists tell them that even women doctors use it when giving birth,” he said.

Last year, 44 of 58 hospitals in Shanghai that account for 90 percent births were providing epidural anesthesia, and 37 percent of women undergoing natural birth used it, according to a survey of anesthesiologists.

In east China, the average rate of new mothers benefiting from epidurals is 30 percent, leading the whole country. In the northwest, by contrast, the rate is only 1 percent, the same survey showed.


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