Unfortunately, ‘no pain no gain’ is apt in the case of labour. You will have to go through some pain in delivering your baby. The amount of pain women experience varies greatly, some women have little or mild pain while others have strong pain. To help you understand what is happening and what pain relief is available we have outlined the causes of pain and the pain relief available during labour.
In a normal labour the level of pain builds up as contractions become stronger, longer and closer together. This gradual increase in intensity allows your body to respond by releasing endorphins (natural painkillers). If you have an epidural you stop releasing endorphins.
Giving birth is painful but you will be offered help if you want it. The main options are explained below with some facts about each type of pain relief to help you make an informed choice of what is right for you.
An epidural is an anaesthetic injected into the space around your spine to numb sensation so you don’t feel the contractions. This may be used if you have a caesarean delivery so you are still able to hold your baby straight after the birth.
With an epidural, an injection of local anaesthetic is given to numb the lower back. The anaesthetic is then fed continuously via a thin plastic tube into the epidural space, which lies between the spinal cord and the vertebrae in the spine. It must be done by a qualified anaesthetist. Depending on where on the spine the injection is made, you can have either total loss of feeling from the breasts downwards or loss of feeling in the abdomen only. With a mobile epidural, you can still move around, which helps your labour to progress more naturally.
Points to remember
- An epidural may be particularly recommended if you have a difficult labour; pre-eclampsia or severe asthma or if you need a forceps delivery.
- If you want to push your baby out yourself you will need to allow the effects of the epidural to wear off before the second stage of labour.
- With an epidural you must have electronic fetal monitoring to check for distress. This is because the drug crosses the placenta within minutes of being given.
- You may find it difficult to move and change positions so ask your midwife or partner for help.
- It difficult to know when your feet are flat on the ground. Ask for support if you’re walking around.
- An epidural is the most effective way to completely eradicate any sensations of pain. There can however, be some discomfort associated with inability to move and an area of stitch which is intense in the side.
This is a mixture of gas and air that you administer yourself through a mask or mouthpiece to take the edge off contractions. Gas and air (Entinox) is a mixture of laughing gas and oxygen. The effect lasts about 60 seconds, which should help you get through the peak of a contraction. It works by numbing the pain centre in your brain. It can make you feel as though you are floating.
Points to remember
- The best time to use gas and air is at the end of the first stage during strong contractions of transition.
- Inhaling gas and air can make you feel a bit nauseous, but has few side effects.
- If gas and air is used during the second stage, the deep breaths you take to inhale may interfere with the bearing down needed to push your baby out.
- To be most effective, you should place the mask over your mouth. Take three full breaths, slowly inhaling through your mouth and exhaling through your nose.As the contraction gets stronger, remove your mask and concentrate on quick breathing movements until the contraction has passed
Pethidine is derived from morphine. It is injected into the thigh or bottom and acts on the nerve cells in the brain and spinal cord. It’s not really a pain reliever, but alters your state of consciousness and your perception of pain.
Points to remember
- Many women find it ineffective as a pain reliever and it can leave you feeling very disoriented.
- It can make your baby drowsy and slow to feed after birth.
- Nausea can be a side effect, so pethidine is sometimes given with tranquillisers to stop this. However it’s best (for you and your baby) if it’s taken, without the tranquillisers, before you’re 7cm dilated.
- Pethidine can slow down the second stage of labour and cause your baby distress if given too early (before you are 7cm dilated).
Breathing and relaxation techniques to help you through contractions are taught at classes run by your local health board. You could ask your local doctor for more information on classes.
Lying in warm water can be very relaxing and soothing. It can also make you feel weightless. The benefits of a water birth include freedom of movement, acceleration of labour, lowered blood pressure, less interventions of most kinds, and a gentler entry into the world for baby. Research shows that for first-time mothers, labouring in water reduces the need for pain-relieving drugs.
Points to remember
- Some birth experts believe that the best time to get into your birthing water pool is when you’re around 5cm dilated (that is, when you’re actually in ‘established’ labour) this is when the water is thought to be the most effective.
- Many women also enjoy being in the pool before this time. The best guide is to follow your instincts.
- You will have to check that your hospital has a birthing pool and book it. Even when you have booked, there is no guarantee that one will be available on the day.