Pain Relief in Labour and Childbirth
Although every woman copes with pain differently, preparing for birth and understanding pain relief can help most women to reduce discomfort and lower their anxiety. Your first labour is usually the longest and hardest, but there is nothing to fear as midwives and doctors are highly skilled in relieving your pain and keeping you and your baby healthy.
It is recommended that you speak with your midwife or doctor about the pain relief options available to you at your planned place of birth. Some women like to make a delivery plan, but remember that no firm decisions need to be made before the day and your doctors will respond to your pain relief needs during labour.
Relaxation – The best environment
Being relaxed in labour has many benefits as your body functions much more effectively in a calm state. When you feel out of control, or you are not sure what to expect, next nerves and tension are a normal response. However, it is important to try to lower anxiety, as when you are fearful your body produces stress hormones such as adrenaline which can inhibit pain relief and make the birth more difficult. On the other hand, relaxing and trusting that your body knows what to do will help you manage your pain.
Your body will release natural hormones that help you as your labour progresses. Oxytocin affects the frequency, duration and intensity of your contractions, while Endorphins help you cope with labour, being released more readily when contractions become more intense. Both work most effectively when you feel calm and relaxed.
Each relaxation technique affects people differently, but there are a number ways to aid relaxation:
Create a calming atmosphere that works for you such as music, meditation or incense.
Learn how to relax and stay calm through breathing deeply. Rhythmic breathing techniques may help you to ‘ride the waves’ of each contraction.
Keep hydrated to ensure your body is in its best condition.
Have a supportive partner or someone close who can offer reassurances and encouragement.
Lower the lights and avoid harsh lighting to limit unnecessary stimulation.
Remember that a relaxed mind is a relaxed cervix. If your face is relaxed, the muscles through your pelvis are too.
Touch and massage
Massage can reduce muscle tension and warm the skin, producing endorphins and reducing the feeling of stress and anxiousness which make pain seem worse. Having your neck or back rubbed can provide a welcome distraction between and during contractions. However, remember that at different stages during labour, massage and touch will feel good, and at other times it may be distracting or annoying. Practise with your partner during your pregnancy and find out what massage techniques work for you.
Heat and water
Applying warmth has been proven to help to ease tension and discomfort in labour. Both hot and cold packs are useful for neck and back pain, as is being immersed in water in either a shower or a bath. Having a bath or shower to reduce pain during labour is very different to a water birth, and not all hospitals are equipped for a water birth. A warm bath and heat packs increase relaxation by producing natural painkilling endorphins as well as reducing the pain of contractions and the pressure on your pelvis and achy muscles.
In early labour, alternative therapies such as acupuncture, acupressure, homeopathy or hypnosis can also provide effective pain relief, although the degree of relief is unproven. These supplementary pain relief methods should only be used in consultation with a trained and experienced practitioner.
The transcutaneous electrical nerve stimulation (TENS) machine is a small, portable, battery-operated device that delivers gentle electric currents via sticky pads on your back. The mother can adjust and control the frequency and strength of the small electrical pulses which stimulate your body to release endorphins. This helps with lower back pain that is associated with the early part of labour, but additional pain relief is usually required for the later, active phase of labour. TENS has no proven side effects for you or your child.
Nitrous oxide/gas and air
This mixture of oxygen and nitrous oxide gas, often known as ‘laughing gas’, is delivered through a mouthpiece or mask. It acts quickly as partial pain relief and wears off in minutes with no after-effects for you or your baby. Many women in labour choose this option because they can control the amount of gas they receive and it gives them something to focus on to help them through each contraction. The gas is best inhaled when a contraction is coming to get the maximum benefit when the pain is at its strongest.
Pethidine is a strong painkiller given by injection often in the thigh or buttock that replicates the effects of endorphins. The painkiller reduces the severity of the pain, but does not take it away completely. Women have varying responses to pethidine with some feeling no effect at all on their pain level.
The injection can take up to 30 minutes to be effective and anti-nausea injections are usually given with pethidine to help the mother. The effects last for between 2-4 hours and therefore it is more beneficial during the early stage of labour.
Sometimes pethidine may contribute to breathing problems in your baby or drowsiness after birth if given within two hours of birth. Therefore, it is not common in the more advanced phase of delivery.
An epidural is a procedure where an anaesthetic is given that numbs the nerves that send pain impulses from the birth canal, taking away the pain of contractions. They are considered to provide the most complete pain relief and have a very high success rate.
The benefits of epidurals
An epidural may be given during any phase of the labour and can be increased in strength if an emergency caesarean is needed. The anaesthetic can be effective for hours and is especially beneficial for women having a long or uncomfortable delivery when the pain relief allows them to sleep and recover their strength.
How Epidurals Work
As epidurals can cause a fall in blood pressure, women in labour are given an intravenous drip that sends fluid via a needle into a vein in your arm or the back of your hand and your blood pressure will be monitored more closely. Then in a curled position on your side or sitting up leaning forward, a thin plastic tube will be gently inserted near your spinal cord by a specialist anaesthetist to administer pain relief. This tube will stay in your back so that anaesthetic can be added when you need it.
How Epidurals Affect Your Body
After an epidural, you will have an altered sensation from the waist down and your legs will feel warm. The extent to which you can move your legs and the degree of feeling in them after an epidural will depend on the type and dose of anaesthetic used. If you lose the sensation to pass urine, you will be given a catheter tube to help drain your urine.
Potential Side Effects of Epidurals
The chance of you needing assistance with the birth of your baby increases once you have had an epidural, but they are considered very safe. Around 50% of first mothers and many second and third-time mothers have one. Women rarely feel drowsy or sick and occasional epidural headaches are easily treated.
Due to the potential side effects such as low blood pressure following an epidural, the baby’s heart rate will be continuously monitored by a CTG machine. In the push stage of delivery, the pain relief is usually reduced to aid pushing and to avoid prolonging the final part of the labour.