At most hospitals in low-resource settings it is very unlikely that women would receive pain medication during labor. This is a problem, however, when women must receive emergency C-sections. While some administer general (inhaled) anesthesia, the spinal anesthesia poses more risks when there is no adequate training. However, doctors and researchers have shown that spinal anesthesia can be successfully given in low -resource settings with proper training.
Doctors and researchers from the non-profit, Kybele, Inc, have worked at Ridge Regional Hospital in Accra, Ghana, a regional referral hospital that has an estimated 8,000 births per year, many high-risk deliveries. Kybele, Inc began the MOMS (Making Obstetric Management Safer) program at Ridge Regional Hospital where they teach nurses practical skills for spinal or epidural anesthesia.
“We demonstrated that spinal labor analgesia can be provided in a low-resource setting with the development of appropriate protocols, staff education, and the availability of a few basic drugs,” write Dr. Adeyami J. Olufolabi of Duke University Hospital and colleagues in Teaching Neuraxial Anesthesia Techniques for Obstetric Care in a Ghanaian Referral Hospital: Achievements and Obstacles (June 2015). They describe their “achievements and obstacles” in working to implement an effective labor analgesia service at a busy hospital in Accra, Ghana.
Anesthesia training by Dr. Olufolabi and his colleagues included the development of the single-shot spinal labor analgesia technique using “pencil-point” needles—a simpler and safer alternative to more complex epidural analgesia techniques. Hospital health workers were also trained on monitoring patients who are given analgesia as well as patient assessment and evaluation. Over the past five years, the maternal mortality rate at Ridge Regional Hospital has decreased by 23 percent.
“Anesthesia providers bring a unique set of skills to the care of high-risk obstetric patients, well-recognized in high-resource countries,” Dr. Olufolabi and coauthors of study. “We must work to overcome barriers that prevent broader roles for involvement of anesthesia providers in maternal and neonatal care in low-resource countries.”
Photo: United Nations