What pain relief options are there during labour?

I have photographed a lot of newborn babies, and during the session, I’m always chatting away to the mum about the birth and how she is doing. Most often or not, we talk about the birth and the experience for her. All births are certainly different, and labour can be painful, so, with such a range of pain relief available during labour, I thought I would run through the options for any pregnant mum, who is in the process of thinking about.

It’s definitely a good idea to have a talk with your midwife or doctor to discuss your options so you can decide what’s best for you.

Write down your wishes in your birth plan, but remember you need to keep an open mind. You may find you want more pain relief than you’d planned, or your doctor or midwife may suggest more effective pain relief to help the delivery.

Gas and air (Entonox) for labour

This is something I used during my second labor. It’s a mixture of oxygen and nitrous oxide gas. Gas and air won’t remove all the pain, but it can help reduce it and make it more bearable. It can also make you feel light-headed & giggly. Many women like it because it’s easy to use and they control it themselves. Around 80% of women use gas and air during labour, so its the most popular choice. It can also be used when labouring in a birthing pool or when having your baby at home.

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.

Side effects

  • there are no harmful side effects for you or the baby
  • it can make you feel light-headed
  • some women find that it makes them feel sick, sleepy or unable to concentrate – if this happens, you can stop using it
  • It can dry your mouth out

If gas and air doesn’t give you enough pain relief, you can ask for a painkilling injection as well.

Pethidine injections in labour

This is an injection of the drug pethidine into your thigh or buttock to relieve pain. It can also help you to relax. Sometimes, less commonly, a drug called diamorphine is used. It takes about 20 minutes to work after the injection. It blocks the pain receptors to your brain. so tends to be used in the first part of labour, as it can last up to 4 hours.

Side effects

There are some side effects to be aware of:

  • it can make some women 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 drug to reverse the effect will be given
  • the drugs can interfere with the baby’s first feed

Epidural

An epidural is a special type of local anaesthetic. It numbs the nerves that carry the pain impulses from the birth canal to the brain. It shouldn’t make you sick or drowsy.

Your anaesthetist injects the drugs around the nerves that carry pain signals from your womb (uterus) and cervix to your brain during labour. An epidural numbs your belly and usually gives very effective pain relief.

An epidural and a similar painkilling treatment called a spinal must be given by an anaesthetist. About 30 per cent of women have an epidural or spinal during labour or after the birth. Due to having to be administered by an anaesthetist, it is only available if giving birth at hospital.

A low-dose epidural should allow you to retain some sensation in your legs and feet. You should have enough strength in your legs to move around in bed and change position when you want.

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 8 women who have an epidural during labour need to use other methods of pain relief.

How does an epidural work?

To have an epidural:

  • a drip will run fluid through a needle into a vein in your arm
  • while you lie on your side or sit up in a curled position, 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. Drugs (usually a mixture of local anaesthetic and opioid) are administered through this tube. It takes about 10 minutes to set up the epidural, and another 10-15 minutes for it to work. It doesn’t always work perfectly at first and may need adjusting
  • the epidural can be topped up by your midwife, or you may be able to top up the epidural yourself through a machine
  • your contractions and the baby’s heart rate will need to be continuously monitored. This means having a belt around your abdomen and possibly a clip attached to the baby’s head

Side effects of epidurals in labour

There are some side effects to be aware of:

An epidural may make your legs feel heavy, depending on the local anaesthetic used.

Your blood pressure can drop (hypotension), but this is rare because the fluid given through the drip in your arm helps to maintain good blood pressure.

Epidurals can prolong the second stage of labour. If you can no longer feel your contractions, the midwife will have to tell you when to push. This means that forceps or a ventouse may be needed to help deliver the baby’s head. When you have an epidural, your midwife or doctor will wait longer for the baby’s head to come down (before you start pushing), as long as the baby is showing no signs of distress. This reduces the chance you’ll need an instrumental delivery. Sometimes less anaesthetic is given towards the end, so the effect wears off and you can feel to push the baby out naturally.

You may find it difficult to pee as a result of the epidural. If so, a small tube called a catheter may be put into your bladder to help you.

About 1 in 100 women gets a headache after an epidural. If this happens, it can be treated.

Your back might be a bit sore for a day or two, but epidurals don’t cause long-term backache.

About 1 in 2,000 women feels tingles or pins and needles down one leg after having a baby. This is more likely to be the result of childbirth itself rather than the epidural. You’ll be advised by the doctor or midwife when you can get out of bed.

Using water in labour (water birth)

Being in water can help you relax and make the contractions seem less painful, so water births are becoming more popular. However, you can only choose this option if you have had a low risk pregnancy. The water will be kept at a comfortable temperature, but not above 37.5C, and your temperature will be monitored.

You may not be able to have a water birth if:

TENS machines

This stands for transcutaneous electrical nerve stimulation. Some hospitals have TENS machines. If not, you can hire 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 many women experience 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. Ask your midwife to show you how it works.

How TENS machines work

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.

Side effects of TENS machines

There are no known side effects for either you or the baby.

Alternative methods of labour pain relief

Some women may choose alternative treatments such as acupuncture, aromatherapy, homeopathy, hypnosis, massage and reflexology. Most of these techniques aren’t proven to provide effective pain relief.

If you’d like to use any of these methods, it’s important to discuss them with your midwife or doctor and let the hospital know beforehand. Most hospitals don’t offer them for pain relief during labour.

So, hopefully, this has given you a good overview of what methods of pain relief are available during labour. Keep in mind that things may change during your labour.

Once your little one has arrived, why not cherish this special time with some newborn photos. You can view details of what a newborn session entails by visiting here

Tianna Williams, a friend who is a newborn baby photographer in Birmingham, has written a great blog post about a recent session, so definitely worth a look.

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