Thinking about pain relief beforehand will give you a chance to find out what is available and how it will affect you and your baby. Your midwife will tell you what’s available and will be happy to discuss all the options with you. You’ll be able to talk about your choices in antenatal classes, too.
You may wish to use self-help forms of pain relief or to have pain-relieving drugs of some type.
There are different options and, depending where you will give birth, different choices may be available to you. Most women use breathing and relaxation techniques whether or not they choose to have pain-relieving drugs.
Non-chemical pain relief
There are different forms of pain relief aside from pain-relieving drugs. The primary one is breathing and relaxation techniques but birthing pools and lying in water are also considered non-chemical ways of helping you cope with the pain.
Other methods of non-drug pain relief are things like TENS-machine, homeopathy, hypnosis, acupuncture or acupressure. You will need to see a specialised practitioner if you are interested in these methods – they are not covered by your midwife.
Most antenatal classes teach breathing awareness as a way of coping with the pain of contractions. The emphasis is on breathing as a way of relaxation, which helps you cope with the pain.
Relaxation doesn’t take away pain, but it can prevent pain becoming stronger, because tension increases pain levels. The main aim is to help you cope with the pain and not be overwhelmed by it. Then you will be fully conscious and in as much control of your labour as you want to be. Research shows that when women are relaxed they release the body’s own, hormone-like, pain relievers – endorphins.
Some women want to avoid drugs in labour, as all drug-based pain relief has some disadvantages to mother or baby or both. You may want to rely on yourself, with the support and encouragement of those around you. There are no disadvantages to breathing and relaxation, but sometimes it may not work if your labour is very long or complicated or is just too painful for you.
An epidural refers to a pain-relieving technique where local anaesthetic is injected into the epidural space around your spine.
How it works
You may be asked to curl up on your side while the anaesthetist inserts the epidural, or you may be able to sit up while leaning forward over a pillow. While it is being inserted it is important to keep still and let the anaesthetists know if you are having a contraction. It usually takes 20 minutes to do and 20 minutes to work. Some epidurals do not work and need to be adjusted or replaced.
A fine plastic tube – an epidural catheter – will remain in your back so that more pain-relieving drugs can be given as needed, usually every hour or so. You will also need a cannula in your hand so that fluids and intravenous medicines can be given if needed (low blood pressure can be a side-effect of the epidural). It is likely that your baby’s heartbeat will need to be continually monitored.
The aim of the epidural is to relieve the pain of labour. Your legs might feel numb or heavy but the dose of the epidural can be altered to allow you to move around the bed. The epidural may make it more difficult to push and may also slow down the second stage of labour slightly. You may need help with the delivery with forceps or ventouse. The heavy legs and numbness can last up to a few hours after the delivery.
Anaesthetic drugs can be delivered through the epidural catheter so you are pain free for a forceps delivery or a Caesarean section if needed.
One percent of patients may have a bad headache for some days after the birth. As you will be seen the day after delivery by one of the anaesthetists, treatment can be given for this. Mild itching, nausea or fever are also possible with some epidural drugs but this will only last for a few hours. You may also experience some tenderness around the epidural insertion site but epidurals have been shown not to cause long-term backache. About 1 in 1000 women who have epidurals may have a numb patch on their leg lasting a few days but permanent numbness is extremely rare.
In general epidurals do not affect the baby.
Check with your midwife as epidurals may not be available at every unit.
Gas and air
Entonox and Equanox are brand names for a mix of gas and air (50% nitrous oxide and 50% oxygen) that can be used to help you through the pain of contractions. This is usually referred to simply as ‘gas’ or ‘gas and air’. This form of pain relief is available in hospital and at home births
How it works
The gas comes with a tube and a mask or mouthpiece that you can breathe through when you need it – usually at the start of a contraction. It starts to work within about 15-20 seconds after first breathing in. You can keep breathing in and as you start to feel light-headed and drowsy your hand holding the mouthpiece will drop away. It can take the ‘edge’ off the peak of pain and the relief should last to the end of the contraction.
The pain relief does not last very long and for it to work effectively you need to begin breathing it at the very start of the contraction so it builds up by the time you are at the peak of it.
Because you become drowsy when inhaling the gas and you naturally stop breathing it in there is no danger of taking too much. Your body expels the gas quickly. It can make some people nauseous. Using gas does not prevent you from using other pain relief. Babies do not appear to be affected as very little gas reaches them.
Morphine and opiate drugs
Drugs that are related to morphine are commonly given in labour and can be used at home too. The use of opiates at a home birth is strongly discouraged because they may cause breathing difficulties for the baby and these can be dealt with better at hospital. They are given by injection and the dose can be varied.
Most morphine and opiate drugs take around 15 minutes to work and last for two to four hours. You may feel sleepy and slightly ‘out of it’, as if the pain is there but you’re not experiencing it. Some women feel this distancing effect as being out of control. Some feel sick with these drugs and an anti-sickness medicine is usually given at the same time.
All opiates can affect the baby’s breathing at birth. The baby may be sleepier and less interested in feeding for two or three days afterwards. If your baby’s breathing is poor because of the opiates, a drug can be given to treat this. This effect on breathing is more likely if the injection is given too close to the birth, and you may be advised not to have it for this reason. If opiates are given four or more hours before birth, the effects have a better chance of wearing off in the mother. The effects will remain in the baby for longer, say up to 48 hours, after birth.
TENS (transcutaneous electrical nerve stimulation)
TENS is a form of pain relief provided by a small box wired to electrodes which fix on your skin, and which give out a slight electrical charge. It can be effective in relieving pain, and it is safe for you and does not affect your baby. If you want to use this, ask your midwife where you can hire or borrow a TENS machine so that you can start to use it as soon as labour begins.