The Bhutanese Leading the way.
Of the 4,000 babies delivery in JDWNRH in the last couple of years, only 2.2 percent or 238 of the mothers took epidural analgesia or anesthesia. This comes despite the fact that an epidural is provided for free of cost and is given as an option to every expectant mother.
Medical Superintendent of JDWNRH, Dr Gosar Pemba, said mothers fear the side effects of medicated births and epidural. He said while the pain is reduced significantly, it also possess some risks of back pain and soreness, headaches, persistent bleeding, fever, breathing difficulties, drop in BP which can slowdown the newborn’s heart rate.
“Also, most believe in the family tradition of giving a natural birth,” Dr Gosar said.
The other factor leading to less number of women opting for an epidural is that most of the women prefer to remain in their homes until the last moment of their labour contractions. There are examinations to be done before administering the mother with the epidural analgesia.
While making a recommendation, Dr Gosar said, the overall the health of a mother, size of mother’s pelvis, mothers pain tolerance level, intensity level of contractions and size or position of baby needs to be considered. “Those with bleeding disorder, low blood pressure and spinal abnormalities are not eligible.”
Anesthesiologist, Dr Jampel Tshering, said the number of women opting for an epidural is increasing as compared to the past two years where 51 women went through the epidural labour analgesia in 2016 , followed by 101 in 2017, and 86 mothers this year till date.
However, he said even when the options to deliver babies are made aware in hospital through patient information leaflet and explanation through nurses with pros and cons, most mothers preferred the natural birth so far.
Other factors that leads to women taking less interest in epidural birth, he said, could also be due to limited number of anesthesiologists in the hospital. The epidural process needs constant monitoring where at least one nurse is required for each delivery.
He said though the process assures reduction in labour pain and comfortable birth, the complications like headache, wrong placement of catheter, allergy and cardiac shock can be expected.
He said some Bhutanese women prefer to give birth in other countries, especially in Bangkok, Thailand, which costs between Nu 100,000 to Nu 300,000.
Pema Deki, 29, was amongst the first batch to opt for an epidural analgesia for labour in 2016. She said that she felt a major side effect of back pain after birth which lasted for several months. She said, “The process requires more work compared to natural birth but the pain during delivery was very less.”
A 27- year-old expectant mother, Tshering Dema, who is due to give birth in the next month, says that an epidural would just prolong the birth and might come in with side effects harmful to the baby.
“I would always prefer a natural birth as long as I can sustain the pain since every mother has been delivering through the natural process so far.”
There are currently six anesthesiologists in the hospital of which three are hired expatriate and one is hired from the military hospital. Currently, around 20 nurses are deployed at the birthing center. Dr Jampel said the workload among the staff are tasking, especially for the epidural labour. The hospital has allotted ten beds in the epidural ward.
