Heinz - Tinytums

Pain relief

In the run-up to your baby's birth you may feel very anxious about the pain of labour and how you will cope. Labour does involve pain but you can build up your confidence by understanding your own limits of pain tolerance and by learning about different methods of pain relief. Try to think of pain as positive, each contraction bringing you closer to the birth of your baby.

Most people like the idea of a birth without the need for drugs but it is as well to be prepared. When it comes to the reality of labour, you cannot predict how you will react.

How will I cope?
Everyone's pain threshold is different and the kind of pain experienced during contractions varies from woman to woman. Often it feels like a thick band being tightened around your abdomen as the uterine muscles tense and harden before relaxing. Some women describe it as being like a severe menstrual cramp, others feel intense backache. There may be a combination of sensations as the contraction reaches its peak, culminating in a wave of discomfort which then subsides.

You may prefer not to use drugs during labour as they can dim your awareness and because of the potential effects on your baby. But it is very difficult to know your own pain threshold, particularly with a first baby. Some women are surprised by the overwhelming intensity of their contractions.

Drugs in labour can offer either complete relief (as in an epidural) or reduction of pain to bearable levels (as with gas and air and pethidine). Most people decide not to have any drugs in the early part of the first stage of labour then to have a low dose of gas and air towards transition.

Remember, labour isn't a test, so don't be self-critical if you opt for pain relief from drugs. Their use may even be essential for you to deliver your baby. But there are alternatives to drugs for pain relief if you want your baby's birth to be as natural as possible.

Endorphins are the body's own brand of painkillers. If you've opted for a natural birth, your body will produce these painkilling hormones more quickly, so your pain threshold should increase.

What preparations can I make?
Many doctors and midwives try to make labour and delivery as pain-free as possible with the help of drugs and unless you state your preferences you may find that certain analgesics are used automatically.

Talk to your midwife, doctor and birth partner and then outline your choices in your birth plan, with an alternative version available in case any complications arise. Do not hesitate to question their use if you are unhappy or to request a smaller dosage.

You should always find out as much as possible about the types of pain relief available at your chosen hospital or at home.

Types of pain relieving drugs

Caudal anaesthesia
This is used for short-term relief if the birth involves a vacuum extraction or forceps delivery. It's administered by an injection into your spinal area to numb your vagina and perineum.

A pudendal block
This involves an injection into your vagina near the pelvic region and blocks the pudendal nerve. It may be used if you have an episiotomy, although is not used often.

Epidural block
This is the most widely used form of this type of anaesthesia and prevents pain spreading from your uterus by acting as a nerve block in your spine.

An anaesthetist injects anaesthetic into the spinal column through a catheter via a hollow needle called a canula. It numbs your uterus, vagina and vulva completely. A tube is attached to the needle and taped to your back so that the anaesthetic can be topped up.

If you have a difficult labour, have pre-eclampsia or asthma or if you have a forceps delivery then an epidural may be recommended.

Mobile epidurals
About a quarter of hospitals now offer a low-dose 'mobile' epidural. This will leave you with enough sensation to walk around, and so help the progress of your labour.

You will be able to push during the second stage. You may want to check whether hospitals provide this when you're choosing where to have your baby.

Inhaled analgesics - (gas and air/Entonox)
This is a mixture of gas and air that is breathed through a mask or mouthpiece during a contraction so that it deadens the pain at its height.

You administer this yourself, inhaling deeply as the contraction starts and then breathing in until the contraction peaks or until you have had enough.

You can then put the mask aside and breathe normally. The gas numbs the pain centre in the brain and makes you feel as if you are floating.

Pethidine/narcotics
These are now considered rather old fashioned. The most commonly used drug is pethidine, which is derived from morphine.  Although more effective as a sedative than a pain reliever, it can be useful in the first stage of a long, slow  labour to help the mother relax and prevent exhaustion.

It is given by injection in the thigh or buttocks during the first stage. It dulls the sensation of pain by acting on the nerve cells of the brain and spine and can make you feel sick or woozy. It can also make the baby drowsy so it's not given late in labour.

Tips for drug-free pain relief

• If you can, walk around, lean against your partner or the wall or rock your pelvis. You'll feel much more comfortable than lying on your back.
• Massage can relieve discomfort and provide reassurance from your partner, whether you are lying, standing or squatting. It's of particular help if you have backache.
• TENS (Transcutaneous electrical nerve stimulation) involves having electrodes taped to your back that are connected to a battery-powered stimulator. Pain impulses from the nerves are blocked by an electric current, which also stimulates the production of endorphins. You use a handset to give yourself small amounts of stimulation. This also enables you to control the amount of pain relief that you receive. If your hospital does not provide TENS machines then you may be able to hire one and take it to the hospital with you.
• Many hospitals now have pools available for use during labour. Buoyancy helps to reduce pressure on your abdomen, makes your contractions more efficient and being in water is relaxing and soothing and enables you to move easily into different positions. If no birthing pool is available you may want to hire one for use, either in hospital or at home. It is important that these are used under supervision.
• Sighing, moaning, groaning and grunting will all help you to release tension. Don't be inhibited. Do what comes naturally. Listening to music may also help.
• Acupuncture can reduce pain and stop nausea but it must be carried out by an acupuncturist who is familiar with labour and delivery. It is advisable to opt for this only if you know that it can relieve your pain through your own experience or on the advice of a trusted healthcare professional. 

How will drugs affect me?

Drugs can affect your experience of childbirth so you should make sure that you opt for one that will enhance rather than detract from the pleasure of your baby's birth.

Drowsiness
A common side effect of gas and air, tranquillisers and narcotics. You may enjoy the sensation of drifting or you might feel out of control.

Dizziness
Pethidine and other narcotics can sometimes induce a feeling of confusion or disorientation and some mothers have even had hallucinations.

Nausea
This is usually slight with gas and air but common after using pethidine.

If you go into labour feeling very anxious this may affect the uterus, slow down labour and adversely affect your baby.

If you believe the use of drugs will make you less anxious then make sure you discuss the best options for you with your midwife and include them in your birth plan

How will drugs affect my baby?

Most drugs will cross the placenta to affect your baby once they are in your bloodstream.

This can cause:

Drowsiness
Pethidine can make your baby drowsy after the birth and affect his ability to suckle and respond to you

Breathing difficulties
Narcotics, such as pethidine, can also affect your baby's breathing and so it is not given late in labour as it will remain longer in your baby's bloodstream.

Drugs used in epidural anaesthesia, however, do not enter your baby's blood so a baby born after epidural anaesthesia stands a very good chance of being alert and of breathing well.