Birth doesn’t have to be a scary prospect. We have TV programmes (think Rachel in friends) to thank for the common perception of labour and birth; feet in stirrups, lying on your back, screaming…
The good news is, it doesn’t have to be this way. Labour can be a calm, beautiful and truly empowering experience.
Preparation is key; knowledge is power.
In this week’s blog we’re looking at all the pain relief options available to you in labour and birth.
Water
Being in water can help you to relax and make the contractions/surges feel less painful. Discuss the options for labouring and birthing in water with your midwife before you go into labour. Birthing pools in the hospital may be limited so make sure you have a back up plan if one isn’t available so that you don’t feel too disappointed on the day if you can’t have one.
If you are able to get into the water it will be kept at a comfortable temperature but not above 37.5C and your temperature will be monitored.
You may choose to spend time in the pool to help with contractions during labour and get out to deliver your baby or you may wish to birth your baby in the birthing pool. If you do birth your baby in the water you don’t need to worry as they won’t try to breath until they’ve reached the air. They’ll be brought gently to the surface by your midwife.
TENS Machine
TENS stands for transcutaneous electrical nerve stimulation. Some hospitals have TENS machines. If not, you can hire or buy your own machine.
TENS has not been shown to be effective during the active phase of labour, when contractions get longer, stronger and more frequent. It’s probably most effective during the early stages, when you may have lower back pain.
TENS may also be useful while you’re at home in the early stages of labour or if you plan to give birth at home. If you’re interested in TENS, learn how to use it in the later months of your pregnancy.
How it works:
Electrodes are taped on to your back and connected by wires to a small battery-powered stimulator. Holding this, you give yourself small, safe amounts of current through the electrodes. You can move around while you use TENS.
TENS is believed to work by stimulating the body to produce more of its own natural painkillers, called endorphins. It also reduces the number of pain signals sent to the brain by the spinal cord.
There are no known side effects for either you or your baby.
Gas & Air
Gas and air (Entonox) is a mixture of oxygen and nitrous oxide gas.
Gas and air will not remove all the pain, but it can help reduce it and make it more bearable. It’s easy to use and you control it yourself.
You breathe in the gas and air through a mask or mouthpiece, which you hold yourself. The gas takes about 15-20 seconds to work, so you breathe it in just as a contraction begins.
It works best if you take slow, deep breaths and it’s a good idea to practise before the contractions get too intense so you know what to do in the moment.
Side effects
- there are no harmful side effects for you or the baby
- it can make you feel lightheaded, sick, sleepy or unable to concentrate, but if this happens you can stop using it
If gas and air does not give you enough pain relief, there are other options you can use alongside it.
Pethidine
We are continuing with our series on pain relief in labour and today we’re looking at pethidine.
Pethidine is a medicine that is injected into your thigh or buttock to relieve pain. It can also help you to relax. Sometimes, less commonly, a medicine called diamorphine can be used.
It takes about 20 minutes to work after the injection. The effects last between 2 and 4 hours, so would not be recommended if you’re getting close to the pushing (second) stage of labour.
There are some side effects to be aware of:
– it can make you feel woozy, sick and forgetful
– if pethidine or diamorphine are given too close to the time of delivery, they may affect the baby’s breathing – if this happens, another medicine to reverse the effect will be given
– these medicines can interfere with the baby’s first feeds because it can make baby drowsy,
Remifentanil
Remifentanil is a powerful morphine-type drug used regularly in anaesthetics and labour.
A drip is inserted into a vein in your arm or hand and attached to a patient-controlled analgesia (PCA) pump. You press the button on the pump and a small dose of remifentanil is given directly into your vein providing pain relief on demand, reducing the severity of labour pain. This starts working within five minutes of the drip being connected. You need to press the button every time you have a contraction because each dose of remifentanil wears off within a few minutes.
Remifentanil will make you feel sleepy and relaxed. Although it will not provide you with complete pain relief, remifentanil has been shown to enable women to feel ‘in control of’ and able to cope better with their contractions.
You can continue to use ‘gas and air’ (entonox) as an additional form of pain relief, if required.
Remifentanil is quickly removed from your body, with the effects wearing off within ten minutes. Your baby will remove the drug from their body just as quickly as you do.
Remifentanil will pass across the placenta to your unborn baby and can cause your baby to be drowsy at birth therefore you may be advised to limit the number of times you self-administer remifentanil when your baby’s birth is fast-approaching.
Common side effects:
- nausea, vomiting and itching
- drowsiness and dizziness
- slow, shallow breathing (one in two women will need extra oxygen to breathe)
Uncommon side effects:
Having to stop using remifentanil altogether due to persistently low oxygen levels or excessive sleepiness (sedation) despite oxygen support (one in 300 women).
Rare side effects:
stopping breathing or very slow heart rate needing emergency resuscitation (less than one in every 2200 women).
Epidural
An epidural is a type of local anaesthetic. It numbs the nerves that carry the pain impulses from the birth canal to the brain.
In most cases, an epidural gives complete pain relief. It can be helpful if you are having a long or particularly painful labour.
An anaesthetist is the only person who can give an epidural, so it won’t be available at home. If you think you might want one, check whether anaesthetists are always available at your hospital.
How much you can move your legs after an epidural depends on the local anaesthetic used. Some hospitals offer “mobile” epidurals, which means you can walk around.
However, this also requires the baby’s heart rate to be monitored remotely (by telemetry) and some hospitals do not have the equipment to do this. Ask your midwife if mobile epidural is available in your local hospital.
An epidural can provide very good pain relief, but it’s not always 100% effective in labour. The Obstetric Anaesthetists Association estimates that 1 in 10 who have an epidural during labour need to use other methods of pain relief.
To have an epidural:
– a drip will run fluid through a needle into a vein in your arm
– an anaesthetist will clean your back with antiseptic, numb a small area with some local anaesthetic, and then introduce a needle into your back
– a very thin tube will be passed through the needle into your back near the nerves that carry pain impulses from the uterus. It takes about 10 minutes to set up the epidural, and another 10-15 minutes for it to work.
– the epidural can be topped up by your midwife, or you may be able to top up the epidural yourself
– your contractions and the baby’s heart rate will need to be continuously monitored.
There are some possible side effects to be aware of so it’s a good idea to do your research before you’re in labour so you are fully informed at the time you need to make the decision.
More information
Check out this page of the NHS website for more information on all of the pain relief methods mentioned above. Chat through the options with your birth partner so that you are both clear on what your preferences are.
Share this article with any mums to be who might find it helpful.