As Her Majesty The Gyaltsuen’s gift to the people

Health: The health ministry will introduce epidural labour analgesia to ensure painless childbirth that would also come free of cost.

Epidural analgesia is a medical technique of relieving pain administered to pregnant mothers during delivery.

Epidural anesthesia is injected on the spine after placing a catheter into the epidural space before the woman goes into labour. Epidurals block the nerve impulses from the lower spinal segments and results in decreased sensation in the lower half of the body.

Thimphu national referral hospital’s medical superintendent Dr Gosar Pemba said the epidural analgesia is a gift from Her Majesty The Gyaltsuen to the people of Bhutan. Epidural could be introduced coinciding with the birth of The Gyalsey or following it.

“It will be free for all pregnant women who opt for it or are suitable for it like a normal service,” Dr Gosar Pemba said.

However, there are certain criteria based on which epidural would be administered. Dr Gosar Pemba said women with deformity on the backbone, bleeding tendencies, low blood pressure and spinal abnormalities, among others, will not be eligible.

“Besides if a pregnant woman visit the hospital, fully dilated, there is no point giving them epidural,” he said.

Dr Gosar Pemba said that pregnant women with rheumatic heart would be given the preference, as it will reduce stress during labour without affecting her heart. “It’s not like all 100 women who turn up for deliveries would be administered epidural,” he said.

Epidural analgesia is not a new concept in Bhutan. Health officials said that few pregnant women were administered epidural based on request during which the process was found to be labour intensive.

Currently, two doctors and two nurses have been trained on administering epidural from Bangkok, Thailand. Some more are expected to follow suit.

While the cost implication would not be much, workload among the hospital staff especially of the birthing centre is expected to increase with the introduction of epidural. Each dose of epidural analgesia would otherwise cost about Nu 3,000 including the cost of the catheter set.

Dr Gosar Pemba said that the same epidural analgesia administered in Bangkok would be given here.

“Once a pregnant woman is given epidural, it requires constant monitoring of both the mother and child,” Dr Gosar Pemba said. “While one anesthesiologist can give the epidural on three to four women, each woman would require a nurse each.”

Currently, 19 nurses are deployed at the Thimphu referral hospital’s birthing centre working on an eight-hour shift.

Complications during the process like post-dural puncture headache, wrong placement of catheter, allergy and cardiac shock can be expected.

Views are divided among women for now. Some said it was timely while others emphasized the need to develop expertise and technique in the hospital accordingly along with the introduction.

A private employee, Kesang who is expecting her second child said that she would rather go for normal delivery, as there could be side effects.  “But it’s a good initiative as women now have a choice considering women who opt for painless deliveries abroad,” she said.

Some Bhutanese women who have the means opt to deliver abroad especially in Bangkok, Thailand, where it costs about Nu 100,000 to Nu 300,000 depending on the packages.

According to the 2015 health bulletin, health personnel in 2014 attended about 10,873 deliveries in the country of which 3,122 were in Thimphu. The maternal mortality rate stands at 86 per 100,000 while infant mortality rate is 30 per 1,000 live births.

Kinga Dema