Pain Management
There are several ways of helping you cope with pain in labour.
Relaxation and breathing techniques and walking are some of the self-help techniques. Some women find gentle massage, using warm water in the shower or bath helpful. It is difficult to know before labour what will work best for you.
The midwife will be able to provide you with additional information to help you choose what suits you. Here are some facts about the main methods of pain management available in the Rotunda.
Natural methods of pain relief
Anti-burst gym ball
Sitting on a gym ball encourages a natural swaying and rotating motion of the pelvis and can help to move the baby down through the birth canal. Sitting on the ball can help to take pressure off your bottom. The way you sit on the ball is similar to a squat, which helps to open the pelvis and speeds up labour. Gentle moving on the ball reduces the pain of the contractions and it also means your partner can rub your back if you would like it massaged. If you are considering using a gym ball, please purchase an anti-burst one and make sure that it is inflated to the recommended level.
Massage
The sense of touch has been associated with the power of healing since the beginning of time. Touch has the power to soothe pain. Some women like a light, stroking massage or a long stroke massage, while others like firm, circular massage particularly if they are tense or are having back pain. Massage oils can be used and we recommend you talk about and practise the different types of massage with your birth partner before labour.
Breathing techniques
These relaxation techniques work by making you aware of your breathing patterns. Focusing on how you are breathing helps you to breathe slowly and deeply. It helps you to avoid holding your breath – holding your breath tenses up your muscles and reduces the level of oxygen. Some women develop techniques to help them concentrate on their breathing such as chanting a word or poem, or focusing on just one element of the breathing cycle.
Imagery
Thinking about or imagining something pleasant can encourage relaxation and help women manage their pain in labour.
Warm or cold pack
Warm or cold packs are simple ways of easing pain and helping you to relax in labour. You can buy heat and cold packs in your local pharmacy. An ice pack or heat pack on the lower back can help to ease backache.
Music
Music can help you to relax and reduce stress and tension. It might also help you to focus on your breathing and take your mind off the contractions.
Gas and air (entonox)
This is a mixture of oxygen and another gas called nitrous oxide. You breathe it in through a mouthpiece when you have a contraction. It acts quickly and wears off quickly once you stop using it. While it won’t take the pain away completely, it makes the contractions easier to cope with. It doesn’t cause any harm to the baby and it can be used at any time during labour. It can also be used with the TENS machine or pethidine.
TENS stands for ‘transcutaneous electrical nerve stimulation’. Four electrodes are placed on your back, which are connected to a small hand-held device that is battery operated. TENS has been used for back pain for many years. It works by stimulating the nerve near your womb and your body responds by producing natural ‘morphine like’ substances called endorphins. These are the body’s natural painkillers. The TENS machine helps to ease the pain for some women. There are no known side effects for either you or your baby and you can continue to move around while using it.
It is recommended that you start using the TENS machine as soon as your contractions become regular. As this often happens when you are at home, you may consider renting or buying one. If you start to use it at home, you can continue to use it throughout your labour. Some TENS machines are also available in the delivery suite.
Analgesia in labour
Pethidine
Pethidine is a drug that is injected into the muscle in your buttock (bottom). A second drug is given at the same time to stop you feeling sick. It takes about 20 minutes to work and the effects last between two and four hours. It works by easing the pain and it helps you to relax. Pethidine can make some women feel a bit light-headed and forgetful. Pethidine slows your digestion so eating and drinking in labour is restricted. The drug passes through the placenta to the baby so if it is given too close to birth, it may temporarily affect your baby’s breathing at birth and the initiation of breastfeeding. If this happens, the midwife will give the baby a drug to undo the effects of the pethidine.
Epidural
An epidural is the most effective form of pain relief during labour. The word ‘epidural’ refers to a space in your back where pain messages from your womb and birth canal pass to the brain. An epidural involves injecting local anaesthetic and pain relieving drugs into this space to block the sensation of pain. If you decide you want an epidural, the anaesthetist will tell you how the procedure works and explain the advantages and possible side effects. You will need to sign a consent form before you can have an epidural.
It takes about 20 minutes to set up the epidural. You will need a drip in your arm to give you extra fluids so that your blood pressure does not fall. The midwife will help you into a sitting position or you can lie on your side. This makes it easier to get the epidural tube inserted. You will be asked to stay very still while the tube is being inserted.
The epidural can be very helpful for women who are having a long and painful labour. It takes the pain away for most women. Some of the disadvantages of having an epidural include having difficulty passing urine so a catheter (tube) is placed into your bladder to keep it empty. Your legs may feel heavy so you must stay in bed. Your baby’s heartbeat will be monitored continuously. If you have an epidural for pain relief, only sips of water are recommended, as the drugs cause the stomach to empty at a slower rate.
Some of the known side effects of an epidural are:
- the second stage of your labour may take longer;
- you are more likely to have an assisted birth with forceps or vacuum (but it doesn’t increase the chance of needing a caesarean section);
- you might have some backache for a few days after an epidural. (Long-termback pain after birth can happen with or without an epidural.);
- 1 in 100 people can develop severe headaches in the days following birth. This can be treated but it involves having another epidural procedure.
The risk of injury to the nerves in the epidural space is very small. This side effect is thought to occur 1 in 10,000 times. Numbness, tingling, or weakness in one or other leg can also rarely occur (1 in 2,000 times) following births where epidurals have not been used.
For further information on anaesthesia please follow this link to the Obstetric Anaesthetists’ Association website www.oaa-anaes.ac.uk.