Evidence Express: Laughing all the way!!

By Aneesh Thomas George

Aneesh, in his own words, is "a Research Scientist at the South Asian Cochrane Centre, who found how to relate with a consumer's perspective, through one of the most eventful incidents in his life...entry into parenthood."

I least expected it, when the doctor asked “You guys ready for labour?” Yes, Blessy was around 37 weeks pregnant and we did not want to wait anymore, but my reaction was that of a timid child who did not know how to respond, especially to the first two words. Compare that to my wife’s reaction, gleefully nodding, as though our child had already won its first…science quiz (geeky)!

The next thing I recall is, her being wheeled to room 11 A of the labour ward after the vitals were recorded and my in-laws running home to get the maternity bag. Nothing like what I had imagined …say Hugh Grant’s ordeal in Nine Months AND thank you Lord for that! Contractions were initiated at around 6:30pm. In a few hours, we were in the labour room. Blessy actually slept for the first fifteen to twenty minutes (she always does that when under stress, which I find enviable).

My job was to constantly monitor the FHR (fetal heart rate) and keep an eye on the “distance between the peaks” in the continuously generated graph from the electronic fetal monitor, give her an occasional glucose drink for hydration and keep talking (all the time not knowing when I would get slapped). The contractions began to gain strength and so did her yells of pain. The head nurse brought in the Nitrous Oxide cylinder and I questioned her on the safety, the date of expiry, blah blah and blah. I even reasoned that the gas would cause my wife to lose consciousness when the labour was at its peak and then all hell would break loose.

Ultimately, I succumbed to woman power (my wife and the head nurse) and was entrusted with the task of administering the gas between contractions. I thought it best to give the mask to her, as she could judge and inhale in a controlled manner (later realised that it was not a wise decision), while I searched the Cochrane library for Nitrous Oxide AND labour (the Boolean AND that I teach people to use in my training sessions on “How to search the Cochrane Library”). Blessy shot me an irritated look and with that, I gave up the virtual world for the real one.

When the pain started to become more ‘tolerable’, I had my hypothesis ready - “Nitrous Oxide has a placebo effect during labour.” But being a Cochranite used to looking for the evidence, I glanced at the graph and saw that the pain had stopped because the contractions had subsided and it was 4am. IV was started with the ‘pit’ and she kept on taking in more of that gas. 10 am, and cervical dilation still not adequate, but the contractions had become more rapid and the doctor said we might need to wait for one more hour. What annoyed me was not the lack of sleep or my constant running around the bed, it was her obsession with the gas, even when it was proving to be ineffective.

10:30 am: the first push and she finally realised the gas was a nuisance. Exhausted to the core, because of all the pushing and screaming (and probably the N₂O), she finally threw the mask aside. Amidst all the prayers and admiration for wifey, baby Efrem finally arrived on August 11^th 2012 at 10:40am and the Cochrane review “Inhaled analgesia for pain management in labour” came around a month later.

Blessy’s one line verdict: “was somewhat useful in the beginning only, but it did give some psychological support.” (I admire her even more today).