Pain Relief During Labour

Every woman's labour is different and no woman knows how they will feel until their labour actually starts. For some women, the labour is painful, yet bearable and no pain relief is needed. For others, pain relief is needed from the beginning. Whatever a woman decides, there is always the option of pain relief to help them through their journey to motherhood. Here are some tips to help relieve pain yourself, and also information on the types of pain relief available.

Self help tips:

• Be prepared, read as much as you can on the labour process before your labour and talk to midwives and other mothers to find out what worked for them. Ask questions and if possible, attend antenatal classes.
• Try to stay as calm and relaxed as possible and breathe deeply.
• If possible, try to stay active. You could walk around or sit on a birthing ball. Bouncing gently or rocking backwards and forwards helps the baby to stay down and move into position. It also gives you something to focus on other than the pain.
• Remember the importance of gravity when choosing your birthing position. Kneeling or standing will increase the pull of gravity on your baby.
• Ask your partner, friend or relative to support you and help you to keep your fluids up by offering you drinks regularly.
• You may wish to ask your birthing partner to massage you during labour. This can keep you relaxed and make them feel useful. However, some women don't like to be touched during labour, so you'll have to see how you feel.
• Take a bath.

Hydrotherapy (the use of a bath or birthing pool)

Being immersed in water can help you to feel more relaxed and reduce the pain of contractions. The water needs to be monitored and kept at a comfortable temperature. It must not be above 37.5C. If this is a method of pain relief you wish to pursue, talk to your midwife or doctor.

TENS machine

TENS stands for transcutaneous electrical nerve stimulation. Some hospitals have TENS machines available, but it is worth checking in advance just in case they do not. If they don't have a machine available, you can hire your own machine from midwives, GP surgeries and even some major high street stores. TENS machines can be effective during the early stages of labour or if you plan to give birth at home. They have not been proved to be effective during the active phase of labour.

How it works

With a TENS machine, electrodes are taped onto your back and connected by wires to the small battery-powered machine which you control yourself. During labour you give yourself small but safe amounts of electrical currents through the electrodes. It works by stimulating the body to produce endorphins (the body's natural painkiller) and by reducing the pain signals sent to the brain by the spinal cord.

Side effects

With a TENS machine you are free to move around and there are no known side effects to you or your baby.

Gas and air (Entonox)

Entonox is a mixture of oxygen and nitrous oxide gas, also known as laughing gas. It has a calming effect which will not remove all the pain but should make it more bearable. Women like gas and air because it is easy to use and they control the amount themselves. It is available in most birth centres and is also available to use at home if you so wish.

How it works

When using gas and air you are given a mask to place over your face or a mouthpiece which you hold between your teeth. As soon as you feel a contraction coming you need to begin breathing in the gas deeply and evenly. The face mask/mouthpiece has a two-way valve which releases the entonox for you to breathe in and takes away the carbon dioxide as you breathe out.

You will need to continue the deep breathing until you begin to feel a little light-headed and then stop. Within a few seconds you should feel normal again because the gas does not stay in your system.

Side effects

It is safe for your baby and you don't require additional monitoring whilst you are using it.

Pethidine or Diamorphine

An intramuscular injection is given into the muscle of the thigh or buttock.

How it works

Both pethidine and diamorphine help you to relax which can ease the pain of labour. The injection takes about 20 minutes to work and the effects last between 2 and 4 hours.

Your midwife can prescribe and give injections of pethidine or diamorphine without the necessity to consult a Doctor. Pethidine often causes sickness so you will be given an anti-sickness drug at the same time to combat nausea.

Side effects

Some women will experience no side effects whatsoever, however there are some possible side effects to be aware of.

• It can make you feel light-headed, nauseous and forgetful.
• If the effects haven't worn off towards the end of your labour, it can make pushing difficult. It is possible to ask for a half dose of pethidine or diamorphine at the beginning of your labour and then judge the need for any more.
• If the injection is given too close to the baby's delivery, it can affect the baby's breathing; if this happens an antidote will be given.
• The drugs can make breastfeeding difficult.

Epidural

An epidural is a type of local anaesthetic injection. The injection numbs the nerves which carry pain signals from the birth canal to the brain. Most women will experience complete pain relief from an epidural and it can be particularly effective for women who are having prolonged or an extremely painful labour. It also helps in situations where the mother has become very distressed.

Epidurals can only be administered by an anaesthetist so it may be worth checking whether an anaesthetist will be available at the hospital when you give birth. If you are planning a home birth an epidural is not an option.

How it works

• When you have an epidural a drip is placed in your arm. Fluid will run through this and into your blood stream.
• While you lie on your side or sit up in a curled position the anaesthetist will clean your back with antiseptic and numb a small area with some anaesthetic. Using a needle, a small tube will be placed in your back near the nerves which carry pain signals from the uterus. Once the tube is in place, a mixture of drugs (usually anaesthetic and an opioid) will be administered through the tube.
• An epidural takes approximately 20 minutes to set up and then a further 10-15 minutes for the drugs to take effect and provide pain relief. It doesn't always work perfectly first time and adjustments may need to be made.
• Once the epidural is set up, the drugs can be topped up by your midwife when needed. Sometimes you are able to top it up yourself if the epidural is attached to a machine.
• After an epidural, your contractions and also the baby's heartbeat will need to be continuously monitored. This is done by placing a belt around your abdomen and in some cases, a clip is attached to the baby's head.

Side effects

• An epidural can make your legs feel heavy so you will be unable to get up and move around.
• You should not feel drowsy or sick with an epidural.
• Epidurals can cause your blood pressure to drop; however, the drip in your arm should prevent this.
• The second stage (the pushing stage) of labour can take longer with an epidural as you may not be able to feel your contractions. The midwife will tell you when you need to push.
• An assisted delivery by means or forceps or ventouse is more likely with an epidural. Sometimes you will receive a lower dose of the drugs towards the end of your labour to prevent the need for an assisted delivery
• You may find it difficult to urinate following an epidural, in which case you may need to be fitted with a catheter.
• 1% of women can suffer from a headache as a result of an epidural.
• You may have a sore back for a few days afterwards, but there will be no permanent damage.
• A very small percentage of women suffer with pins and needles in one leg; however, this can be as a result of childbirth itself, not necessarily the epidural.

Alternative therapies

Some women choose not to use any of the pain relief methods listed above and instead try alternative therapies to ease their labour pains. Such therapies can include acupuncture, hypnosis, reflexology, massage, homeopathy and aromatherapy. Most of these will not provide effective pain relief but can help you to feel calm and relaxed.

If you wish to use alternative therapy then you need to discuss this with your doctor or midwife before the birth. Most hospitals do not offer this kind of pain relief during labour. If you decide to use alternative therapy please ensure that the practitioner is properly trained and experienced.