What pain relief options are available?

Labour is a painful experience but there are ways to manage the pain and help you to cope more effectively. It is advisable to attend antenatal classes during your pregnancy so that you can learn about breathing, exercises and techniques to help you during labour; it is also beneficial for your birthing partner to attend these classes so that can be more helpful during your labour.

There are many methods and techniques, which can help you to manage pain more effectively during labour; these include both medical and natural treatments and remedies. Popular pain relief methods are outlined below:

Self-help techniques

During your pregnancy you will be invited to attend antenatal classes, where you can learn about a variety of different topics related to pregnancy and childbirth, as well as getting tips for dealing with pain and breathing correctly during labour. As well as going to antenatal classes, there is a vast range of books on offer, which talk you through labour and childbirth and offer information and advice; you can also talk to other women on chat sites and forums on pregnancy websites.

Most women prefer to have someone with them during labour, whether it be their partner, a relative or a friend. It is beneficial for them to attend the antenatal classes with you if they don’t have previous experience of childbirth or labour (some people, like your Mum, will already have experience of labour and will be able to offer you the support and advice you need). Try to take someone who is clam under pressure and will not cause you any stress; the chances are that you will already feel stressed and a calming, supportive presence will be much more beneficial. If you don’t have anyone you want to bring with you, you will get all the support and advice you need from your midwife.

Try to relax as much as possible; this might seem obvious but staying clam will help you to manage the pain more effectively. Try to breathe slowly and deeply and do things which you find relaxing; for example have a bath or ask your partner to massage you.

Try to move around; you may find a position that is more comfortable and this will reduce the pain.

Gas and air (also known as entonox)

Gas and air is one of the most popular methods of pain relief; women are able to control it themselves and it does not cause any unpleasant side-effects for the mother or the baby.

Gas and air is a mixture of nitrous oxide and oxygen; this is breathed in using a mask, which is held over the mouth and nose. During your antenatal classes, you will probably be given the opportunity to practice using the mask so that you know how to do it when the time comes; if you haven’t practised, don’t worry as the apparatus is easy to use and your midwife can show you how it works.

The gas and air has a very quick effect and you will start to notice the effects after around 15 seconds; it is advisable to breathe in slowly and deeply just as a contraction is starting, as this will reduce pain when the contraction gets stronger.

Gas and air is very safe; there is no risk of complications and it does not harm the baby; it may make you feel slightly dizzy and light-headed for a while and some women feel slightly nauseous; if you don’t find it effective, you can simply stop using it.

Injections

If gas and air do not provide enough pain relief, you may choose to have an injection. The injection usually contains diamorphine or pethidine, which reduce pain. The injections are intramuscular, meaning they go deep into the muscle and they take around twenty minutes to take effect. The effects can last for up to four hours.

The injection is an effective method of controlling pain but it does have some negative side effects (these do not affect everyone); possible effects include:

• Nausea
• Forgetfulness
• Light-headedness
• Confusion

In some cases, if the effects haven’t worn off it can make it more difficult for the woman to push; sometimes midwives will recommend having half a dose to prevent this from happening. If the drugs are administered a short time before delivery, the baby’s breathing may be affected; in the event that this happens you will be given an antidote.

There is some evidence to suggest that having an injection can delay the ability to breastfeed; however things should start to function normally after a short period of time.

TENS (transcutaneous electrical nerve stimulation)

Some hospitals have TENS machines and some women choose to hire their own and take it into hospital with them. TENS is a system which is commonly used to treat musculoskeletal injuries and conditions because it stimulates the production of endorphins; these are the body’s painkillers, which are produced to combat pain. TENS also reduces the amount of pain signals that are sent to and from the brain via the central nervous system, meaning you won’t feel pain to the same extent as you usually would.

TENS machines are most effective during the earlier stages of labour; they are particularly beneficial for reducing pain in the lower back, which is very common during the early stages of labour.

If you want to use a TENS machine, you should learn how to use it during your pregnancy; this method may be particularly attractive for people who want to have a home birth.

If you choose to use TENS as a pain relief method, you will have electrodes taped to certain areas of your body; if you have back pain, they will be taped to the areas on your back where you are experiencing pain. A gentle electric current is then passed through the skin and you can control the current using a hand-held remote control.

TENS is a very safe method, which does not have any harmful side-effects.

Epidural

An epidural is a form of anaesthetic; the epidural desensitises the nerves which run from the pelvic area to the brain.

Having an epidural involves having a very fine tube inserted into your back; the tube will be placed near the nerves that carry pain signals from the uterus. The epidural is carried out by an anaesthetist; the anaesthetist will clean the area on your back thoroughly to reduce the risk of infection and then insert the tube. Medication to control pain and numb the nerves will then be administered through the tube.

It usually takes around twenty minutes to carry out the epidural and then another ten minutes for the medication to take effect. The midwife will top up the epidural if needs be and the contractions will be monitored closely throughout; your baby’s heart rate will also be monitored.

Epidurals are usually only recommended for women who are having a particularly difficult or long labour; the epidural provides complete pain relief but it does present some risks. Possible risks include:

• Soreness and tenderness in the back (this should wear off after a short period of time)
• Heavy legs
• Low blood pressure (this will be monitored carefully and will be treated very quickly)

Epidurals may lengthen the second stage of labour and you may lose the feeling of contractions; if this is the case, the midwife will advise you when to push. If you are struggling to deliver the baby, the midwife may choose to use instruments, like forceps, to pull the baby out.

Occasionally, epidurals cause headaches, tingling sensations and problems urinating; usually these problems wear off fairly quickly; if you are having trouble urinating, you may be given a catheter.