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Gel application will relieve pain during labor

February 20, 2012

The percentage of Swedish women using pain relief during childbirth has continued to rise in recent years. More than 46 percent of first-time mothers and 17 percent of mothers of more than one child receive spinal or epidural anesthesia during labor.

Epidural anesthesia is currently the most effective way to relieve pain in childbirth, but it has its disadvantages. The method is complicated and the anesthesia must be administered by an anesthesiologist. It can also dampen contractions and prolong childbirth.

According to Gunvor Ekman-Ordeberg, professor of obstetrics and gynecology at Karolinska Institutet, there is currently no good alternative. But she and her research colleagues want to change that situation.

In her doctoral thesis a few years ago, Berith Karlsson Tingåker, obstetrician at Danderyd Hospital, showed that both the uterus and cervix have sensory nerves - but only those in the uterus are suppressed during pregnancy.

?This suggests that perhaps we should apply pain relief locally to the cervix, rather than injecting people in the spine,? says Gunvor Ekman-Ordeberg.

She and Lars Irestedt, anesthesiologist at Karolinska University Hospital, have developed a local anesthesia with the working name Shact that is vaginally administered as a gel.

?This spring we will start a study of women who are having an IUD inserted. If the drug works as it should, perhaps we can use it for legal abortions, curettage, miscarriages and uterine procedures. Ultimately, we hope it will find a use during childbirth,? says Gunvor Ekman-Ordeberg.

Two hundred women aged 18?33 will participate in the study. Half of the women will have the analgesic gel applied to their IUD. The other half will be a control group and will not receive active treatment. The effect of the drug will be evaluated when the study ends late this year.

Gunvor Ekman-Ordeberg and her research group are also working on another drug candidate, tafoxiparin, which has the effect of stimulating stronger contractions for women undergoing protracted labor. Weak contractions are a problem affecting as many as 60 percent of all women in labor.

In all, 46 percent of first-time mothers and 17 percent of mothers of more than one child use spinal or epidural anesthesia during labor.

?For 60 years we have only had oxytocin, which in excessive doses may jeopardize the health of the child. Back in the 1980s, I found that women who received the blood thinner heparin often had a good, quick delivery. Now, we?ve developed tafoxiparin, which has the same properties ? but without the anticoagulant effect - and we've tested it on women in labor with promising results.

For Gunvor Ekman- Ordeberg, researching better pain management techniques is an important women?s health issue - ?men would never accept having so much pain? - but the task has been challenging.

?We?ve worked with taking biopsies (tissue samples) during childbirth and that?s a pretty tough situation. It has also been a challenge to educate people to convince them of the need for research,? she says.

Drugs for use during delivery must also be carefully adapted with respect to the sensitive fetus.

?That's what?s difficult ? it may take 30 years to produce a drug. At the same time, it?s fantastic that we have come so far that we can see a little light at the end of the tunnel. But women need this.?

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