Pain Relief in Labour

Although labour is different for every woman and every birth, it is more than likely going to be painful. Therefore, it is vital that you understand and learn about the different types of pain relief that are available to you. It is also very important that your birthing partner(s) are also aware of the different types of pain relief available.

Your midwife will be able to explain to you the types of pain relief available and answer any questions that you may have regarding pain relief or labour. If you attend ante-natal classes these options will also be discussed in detail.

Once you have researched into different types of pain relief and decided which you would like to use, write them into your birth-plan and make sure you discuss your wants with your birthing partner. It is also a good idea to make your midwife and birthing partner aware of which, if any, you would like to avoid if possible, although, it is important that you are flexible with your decisions as when the time comes you may find that you need more or less pain relief than you planned.

The main types of pain relief used in labour include:

  • Gas and Air – Entonox
  • Epidural
  • Pethidine
  • TENS
  • Natural aids


Entonox

Often referred to as ‘Gas and air’, Entonox is a mixture of oxygen and nitrous oxide. It is a clear and odour-free gas which is sometimes nicknamed laughing gas. Entonox will not remove the pain or block it out but it can help to calm you and make labour easier to bear as well as help you to take control of the situation.

Entonox is widely available in hospitals and birthing centres and it can also be used during homebirths as it can be transported in portable cylinders by your midwife.

You can use Entonox at any stage during your labour. You breathe it in through a mouthpiece: it might take a little practise to get your breathing right in order to get the most benefit. It is important to remember that it may take up to a minute of breathing the Entonox for it to take effect as you need to get the gas into your bloodstream. Whilst breathing the Entonox, you may begin to feel light-headed and almost ‘drunk’ but this side-effect will disappear immediately once you stop breathing in the gas.

Your midwife will help you to breathe properly and will tell you when to take breaths of Entonox. Although in general it is best to start using the Entonox when each contraction begins.

Advantages Disadvantages
Easy to use May make you feel light-headed and sick
Can be used anywhere even in water and for homebirths Only a mild painkiller
You are in full control of your body, actions and the amount you take If used for a long time you can become very thirsty and dry in the mouth
Fast acting Can take a few contractions to get the timing right
Takes the edge of contractions If used with pethidine, it can make you drowsy
Does not affect your baby May be difficult to hold the mouth piece and get comfortable
Your baby does not need any extra monitoring
Quickly leaves your system through your lungs causing no side effects

Epidural
This is when an anaesthetic is inserted into the back near the lower spine through a needle. The anaesthetic numbs the nerves in thelower back which in turn blocks the pain messages being sent to the brain from your uterus and cervix.

In most pregnancies, an epidural gives complete pain relief and is normally used in labours that are very long or painful or if the patient is becoming distressed although any woman can request one in labour. It is common for an epidural to be used when a labour is induced.

An epidural can only be given by an anaesthetist which means that this type of pain relief is only available in hospital and only if an anaesthetist is available.

What will happen?

  1. You will have a drip put into a vein in your arm to run fluid into your body. You will be asked to lie on your side or sit in a curled position.
  2. The anaesthetist will clean your back with antiseptic and will then numb a small area with some local anaesthetic.
  3. A tiny tube will be put into your back very close to the nerves that carry the pain from your uterus/cervix to your brain.
  4. You must remain very still during this procedure. Concentrate on your breathing to help you.
  5. The drug, usually a mixture of local anaesthetic and opioid, is then administered through this tube. It may take 20 minutes to set the epidural up and it may then take another 15 minutes for it to start working.
  6. Once it has been set up, the epidural can be topped up as and when needed.
  7. Throughout the process your baby’s heart and your contractions are monitored closely and continuously.
  8. The epidural will stay in place until after the baby and placenta has been delivered.

Advantages Disadvantages
An epidural should not make you feel drowsy You have less control over the delivery of the baby
In 90% of women it offers complete pain relief It is more likely that your baby will need help during delivery, such as forceps or ventouse
Can help to lower your blood pressure Blood pressure can fall too low and need treating
Your mind will remain clear, although you may be aware of contractions-you will not feel them It may prolong the second stage of labour and make it difficult to push
It can be topped up easily once it is set up You may find it hard to pass water and will need a catheter fitted
It does not normally affect the baby unless you require a very high dose About 1% of women have a severe headache during and after the birth.
 It may make you feel shivery
Can make you feel sick, though less so than a general anaesthetic would.
Increases the chance of having to have an emergency Caesarean section
As you will need monitoring, you will be unable to move around during labour
You cannot have an Epidural during a home birth or in midwife-led units
You may feel feverish
There is a very small risk of nerve damage and a numb patch on your leg or foot.  The risk is minor with one in 1,000 for temporary nerve damage.

Pethidine 
Pethadine is a painkiller which is related to morphine. It is given to you via an injection. Pethidine (or similar products such as Metpid or diamorphine) will help you to relax and lessen the pain. It may take up to 20 minutes to work and will last for up to 3 or4 hours. You should be able to receive pethidine in hospital, in a birthing centre or during a homebirth.

Advantages Disadvantages
Will help you to relax May make you drowsy and can make you feel as if you have lost control
Can be given by the midwife so you do not need to wait for a doctor One in three women find opiate drugs, including pethidine unpleasant
Can be used during a homebirth It can make you feel sick
If you are in established labour it will not slow the process Can make you feel weepy or depressed
Can make baby sluggish and drowsy, can affect their breathing, feeding and bonding and can take up to 5 days for it to leave the baby’s system
Cannot be used towards the end of labour
May make breastfeeding difficult for baby
You may not remember the birth accurately

TENS
TENS stands for Transcutaneous Electrical Nerve Stimulation. A TENS machine has electrodes which are taped onto your back and connected by wires to a battery-powered stimulator. It is important that you read and follow all guidelines and instructions that come with your TENS machine, although with most you will need to hold the pulsar and you will be able to send yourself small, safe amounts of electric current to your back.

It is thought that a TENS machine helps during labour as it stimulates your body to make more endorphins.  Endorphins are your body’s natural painkillers. It is also thought that is reduces the number of pain signals that are sent to your brain from the spinal cord.

Advantages Disadvantages
Easy to use You may need some help to put the pads on in the correct places
You can move around as you wish You cannot use it in water
Ideal for the early stages, especially when you are still at home Your partner will be unable to massage your back easily
It is under your control Less effective later in labour
No known side effects Can take up to an hour to work effectively
Safe for your baby
Can be used anywhere
Easy to buy from most large chemists/supermarkets. Can also be hired.

Natural Aids
There are many different ways that you can help yourself through labour without needing the aid of drugs or medical intervention.  These include:

  • Breathing and relaxation exercises: For some women slow, rhythmic breathing can help them achieve a more relaxed state which can help them to cope better. You will need to attend classes that will teach you the various techniques.
  • Self-hypnosis: This can help the body to reach a deeper state of relaxation. A qualified practitioner will be able to help teach you how to do this.  Allow plenty of time before the birth to learn this technique.
  • Complimentary therapies: These include aromatherapy, reflexology and homeopathy. These therapies all work in a similar way as they all use stimulating agents to help you reach a more relaxed state and help make you more able to cope with labour. It is vital that you ask a qualified practitioner for more advice as some remedies are not suitable for use in pregnancy or labour. It is also important that you discuss these methods with your midwife as some techniques such as candles or oils may not be allowed in hospital or a birthing centre.
  • Water: This can help you at both the first and second stage of labour. A warm bath in the early stages can help you to relax and labouring in water can help make contractions more bearable. Most hospitals and birthing centres have a birthing pool although it is important to remember that it may not be available when you need it. Inflatable birthing pools can be bought if you are having a home birth.
  • Warmth: Applying warmth is an easy way of relaxing aching or tense muscles. However, it is important that you never overheat or burn yourself on hot items. A heated wheat bag or a covered hot water bottle are good ways to warm your back, groin or tummy.
  • Massage: By having your birthing partner gently massage your back, your muscles will warm and will create endorphins to help with the pain.  It is important that you ensure that any massage oils that you use are safe to use in pregnancy.
  • Changing positions: It is best not to give birth whilst lying on your back as this can make your contractions slower and more painful. Try lying on your side or asking your midwife for help. Try different positions, such as:
    • Stand up and lean forward on to the bed
    • Kneel on the floor (on a mat or pillow) and lean onto the seat of a chair
    • Kneel with one leg raised. This makes lots of room in your pelvis for your baby to slide through.
    • Getting on all fours helps with backache. This position also helps baby to turn and is thought to be the least painful position for labouring.
    • Sit and bounce on a birthing ball
    • Stand or sit and rock your hips
    • Go for a short walk
  • Taking advice: Your midwife and birthing partner are there to help you through labour. They may have advice and tips that will help to ease labour for you. It is important that you listen to your midwife as she has experience of different labours and will be able to support you.

If you have any questions or want more advice regarding pain relief in labour, you should arrange to speak to your midwife or attendante-natal classes. It is important that you understand all the options before labour begins so that you can choose the right pain-relief for you and be able to make decisions during labour if needed.

 

by Jenny, mum to William and James

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