Rwanda: Painless Birth for Rwanda Women, but Only 'The Rich'

(file photo).
24 September 2020

Pregnant women in Rwanda can now have epidural painless and normal (vaginal) delivery without going through a surgical procedure.

Pregnant women worry about going through painful natural delivery most of the time. Some have opted for Caesarean section (C-section) a surgical procedure that involves incisions in the abdomen to avoid the pain.

C-section comes with side effects including longer hospital stay and surgical-associated risks. There is now a painless way for normal delivery - the use of epidural anaesthesia.

Though this comes as a relief, women who spoke to Rwanda Today said the painless normal delivery is for the rich people since it is expensive and insurance in the country does not cover it.

Labour pains

Ms Ester Katushabe a mother of three had been experiencing terrible labour pains during delivery to the extent that she underwent C-section during her second delivery.

During the third trimester of her last pregnancy, however, she visited a doctor at the University Teaching Hospital of Kigali (Chuk) who introduced her to an anaesthetic drug that helped her deliver with no constraints.

"Everything was a miracle to me; immediately after the doctors introduced the drugs, I never felt any labour pain and after two hours, I delivered my son," said Ms Katushabe.

She, however, said the procedure was very expensive. It cost her Rwf400,000 (Ksh45,000), a price only affordable to a few.

Provide subsidy

Rwanda Today has learnt that the new procedure is currently at the University Teaching Hospital of Kigali (CHUK) and King Faisal Hospital.

Marie Clair Uwamwiza, a mother of four, said she once wanted to have an epidural but because of the cost, she opted to endure the pain instead of a surgical operation.

"The government should find a way of either negotiating with health insurers to consider it or provide a subsidy so that even the poor mothers wishing to deliver without pain can access it," she said.

Officials from King Faisal Hospital said they had not yet set the cost for an epidural pain relief procedure but hoped that when it's out, it won't be more than Rwf300,000 (Ksh35,000).

Painless birth

An epidural labour pain relief procedure in Kenya and South Africa cost $450 (Ksh49,000) and $500 (Ksh54,000) respectively.

"It is possible to have a normal and painless delivery. When you are in labour, we identify a spot on your back, sterilise it and inject you painlessly to numb the area. After that we put a catheter on your back to deliver drugs to numb the labour pains, giving you a normal (vaginal), but painless birth," said Dr Samuel Muhumuza, a senior anesthesiologist at King Faisal Hospital.

"The epidural is the gold procedure among many other pain relief methods used in childbirth management and also reduces the length of hospital stay associated with Caesarean sections," said Dr Muhumuza.

"The drugs and technique we use ensure labour progresses normally. They do not interfere with the process. Pain is not necessary, so we take it away," he added, and urged expectant mothers to ask for options during childbirth, including prevention of pain while in labour," he said.

Longer labour

Dr Adeyemi J. Olufolabi, an anesthesiologist in Durham, North Carolina and currently a visiting doctor at King Faisal Hospital told Rwanda Today that an epidural involves injecting a local anaesthetic and sometimes other pain-relieving medicines into your lower back, just above your waist.

He said epidurals are usually very effective, but take about 30 minutes to work. If you have an epidural, your second stage of labour may take longer because you won't feel the urge to push. It may also make moving around more difficult because you will have less feeling in your back and legs.

He, however, said there is an option of a mobile epidural that uses a lower dose of local anaesthetic plus an opioid painkiller. It allows you to walk about and use different positions that may make your labour easier.

Severe headache

Rwanda Today has learnt that the epidural pain relief procedure has many side effects but the most common ones included a drop in blood pressure, loss of strength or control of your leg muscles and itchy skin.

It can also lead to difficulty in passing urine, requiring one to have a catheter fitted to drain it from the bladder into a bag until the effects of the epidural wear off.

Likely complications during and after an epidural according to Dr Olufolabi include severe headache that can last up to a week, or sometimes longer, assisted birth after failing to push, and infection in the back, though rare since it happens to two in 100,000 women.

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