Pain Relief - Giving Birth - Knowledge Area

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GIVING BIRTH - PAIN RELIEF IN LABOUR

You will have had an opportunity to discuss pain relief with your midwife before labour and here are basic notes about some of your options. For more information about pain relief, please talk to your midwife or ante-natal teacher.

What works for you will be personal to you - both with the medicinal and more natural options - and you don't have to stick with one method, either. See the bottom of the page for Personal Experiences (ie, a quick survey round the Naturebotts office!).

What is clear from our experiences of labour is that it is different for everyone and even different for you in subsequent pregnancies. If you've got a birth plan, be prepared for it to change, whether it's up to you or the circumstances. Try not to get too determined for labour to happen in a particular way - you will only be more disappointed if that can't happen. The midwives and doctors are looking out for the safety & health of you and your baby.

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Drug Free Pain Relief

Some pain relief involves using your own coping mechanisms, such as relaxation and breathing to encourage production of endorphins (your body's natural painkillers which are released in response to pain).

Relaxation can be encouraged by using a bath or birthing pool (both the warmth and buoyancy help), effective breathing techniques, massage, visualisation techniques (this involves focusing on pictures or calming thoughts during contractions) or complementary therapies such as aromatherapy or homeopathy.

Your position will make a difference - keep moving and walk around - whatever you find comfortable. Try to think of the pain as positive - you are getting closer to meeting your baby all the time.

Not knowing what is going to happen and the subsequent fear can also make pain feel worse than it is. Make sure you've found out as much as you can, talk to your midwife, learn to relax and feel in control.

Homeopathic remedies - contact a homeopath to discuss your needs and expectations during labour. There are many remedies available for different stages and reactions during labour. Rescue remedy is definitely worth having in your bag - useful for your birth companion, too!

TENS (Transcutaneous Electrical Nerve System) machine

How do you use it? You control the unit yourself so you can adjust the pulse frequency and strength and give yourself an extra boost when needed.
What is it? A small, hand-held device send electrical impulses to four pads on your back.
How does it work? The electrical pulses prevent the pain signals from your womb and cervix from reaching your brain and stimulates the release of endorphins.
Downsides? Makes it difficult for your birth partner to massage your back as the pads are in the way; can take about an hour for your endorphins to first release; may need to remove the pads if your baby is being electrically monitored; may only help with milder early contractions and not be strong enough for the big time ones.
Upsides? Portable; drug-free; non-invasive; you are in control; easy to use; no lasting side effects; not thought to have any effect on the baby; can practice at home with it beforehand; can also be used for muscular/sports injuries.
Easily available? If your hospital or maternity unit doesn't have one available, you need to pay to hire one yourself (about £20-30 a month) or you can buy them online & from Boots.
Home Birth? If you've got one in advance, yes. Easy to use at home but you need help placing the pads on your back.
Water Birth? You can use one beforehand, but not once you are in the pool.

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Medicinal Pain Relief

Here are the main methods of pain relief that use medicines to stop or reduce pain messages before they reach the brain.

Entonox (gas and air)

How do you use it? Inhaled through a moutpiece or mask during each contraction
What is it? Made up of 50% oxygen and 50% gas (nitrous oxide)
How does it work? Dulls the peak of each contraction without making you sleepy. Inhale as soon as contraction starts - takes about 20 seconds to build up in the blood stream and about 45-50 seconds to reach maximum effectiveness.
Downsides? Can make you feel sick, dries out your mouth and is only a mild painkiller.
Upsides? The oxygen is good for your baby; it doesn't stay in your system; you can't overdose on it and it doesn't prevent you from using other pain relief drugs.
Easily available? Just about all maternity units will have it available, sometimes from a central supply so it never runs out.
Home birth? Yes, your midwife can bring it to you.
Water birth? Yes, can be used while you're in a pool.

Pethidine

How do you use it? Administered by your midwife (no need for a doctor) either by injection or intravenously (via a fine tube inserted into your vein). Often combined with an anti-emetic to control sickness which it often causes.
What is it? An analgesic - pain killer and also an anti-spasmodic which is a drug that helps you to relax. It is a synthetic version of morphine.
How does it work? Takes the edge off your contractions for up to 3 hours.
Downsides? Quite a lot of these, unfortunately. Can make you very sleepy; can make you feel sick or be sick; can make you feel dizzy; you may be sleepy between contractions but wake up as they reach their peak; may slow down labour; can affect your baby's breathing (once born, may need to have an injection to reverse the effects); baby may be sleepy for a few days & could affect breastfeeding; cannot be used late in labour due to effects on baby.
Upsides? If given intravenously you can control the dose (PCA - patient controlled analgesia); helps you to relax; no need for a doctor
Easily available? All maternity units & midwives should have pethidine available
Home birth? Can be used at home (if administered by midwife) but not all midwives are happy giving it at home
Water birth? Probably not a good idea as it can make you sleepy. Check with your midwife.

Spinal

How do you use it? A single injection into your lower back near your spinal cord, carried out by an anaesthetist. Often used for caesarean, forceps or ventouse deliveries if an epidural (see below) isn't in place already.
What is it? Local anaesthetic that lasts about two hours- ie, numbs a specific area unlike a general anaesthetic when you are completely knocked out.
How does it work? Numbs the nerves supplying your womb and cervix so you can't feel contractions.
Downsides? Also numbs your legs so you can't move around; can't be given more than once; you might feel shivery, itchy or sick; possibility of a headache.
Upsides? Very effective and quick acting; no tube left in your back (unlike epidural).
Easily available? You'll need to be in hospital for this, with anaesthetists available, not a midwife led maternity unit.
Home birth? No.
Water birth? No.

Epidural

How do you use it? Injected into your lower back near your spinal cord using a fine, hollow tube (catheter), carried out by an anaesthetist.
What is it? Local anaesthetic that lasts about 2-4 hours - ie, numbs a specific area unlike a general anaesthetic when you are completely knocked out.
How does it work? Numbs the nerves supplying your womb and cervix so you can't feel contractions. Caesarean section can be carried out under epidural. You will either lie on your side with your knees drawn up, or sit on a bed or chair and lean forward.
Downsides? Also numbs your legs so you can't move around; may experience a drop in blood pressure; may suffer from a headache between one day and one week afterwards.
Upsides? Very effective and quick acting - works in 5-10 minutes; can be topped up through the catheter; should still be able to feel the pushing sensations during the final stage of active labour.
Easily available? You'll need to be in hospital for this, with anaesthetists available, not a midwife led maternity unit.
Home birth? No.
Water birth? No.

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Personal Experiences

Here are some experiences of pain relief from the Naturebotts office (please do let us know of your experiences, too):

Jess - I worked through just about everything in my first labour - starting with paracetamol (I thought that was pretty ridiculous but apparently they often start with it), then a warm bath (lovely, cosy and well timed), then a TENS machine (ok for the early contractions that I could have coped with anyway), then gas and air (couldn't get the hang of it at all and then it ran out), pethidine (made me dozy between contractions but I woke up during the peak of them) and onto an epidural - ending with a Caesarean 44 hours after my waters broke.
Personally, only the epidural really worked for me. With my second I was told the day before that I would need a Caesarean again as he was sideways, and that will be happening again this summer with number 3.

Elena - With my first baby, I was in labour on and off for over 36 hours with contractions starting and stopping.
For early labour I used a TENS Machine, but for the rest of the time it was gas and air. Had Pethidine, but that didn't work for me. It made my son sleepy when he was born. Gas and air didn't do much good and I screamed my way through! Had 3rd degree tears and was given a epidural after all that to be sewn up. Not much fun!
With my second baby I had gas and air and it worked really well. Completely different experience but the same mother!

Nikki - WIth my first I stayed at home as long as I could using the TENS machine right from the start (in the morning) as you need to build this up during your labour. I walked around as much as I could and leant my back on the hot radiators from time to time. If you do stop all of a sudden using the TENS machine, then the build up will disappear and all your efforts up to that point will be wasted.
Once in the labour ward, I used gas & air whilst using the TENS machine right up until the end. I gave birth to both my babies in the upright position, on my knees leaning onto a beanbag on the bed.
With my second, she came in 1 hour and 20mins, nearly in the hospital toilet. I used the TENS machine again and sat on those active birth bouncing balls. Obviously gently bobbed up and down. I didn't get the chance for any gas & air - 3 pushes and she popped out!

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