New Vision (Kampala)

6 February 2013

Uganda: Why You Need to Steer Clear of Labour-Inducing Herbs

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.

Company

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.

Massage

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.

Desired position

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.

Breathing technique

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.

Water

Submerging in warm water will reduce pressure and pain, as well as relaxing labouring mothers.

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