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Pain relief in labour

Pain relief in labour
The majority of women need some sort of pain relief during childbirth and various forms of pain relief are available providing different levels of respite. Methods vary from drugs, to more natural methods, such as acupuncture and hypnotherapy, and it is worth considering the various options available to you well in advance. Read on to discover what is to be had and its effects on you and your baby.

Gas and air
Gas and air is mix of 50% oxygen and 50% nitrous oxide (Entonox), which slows activity in the nervous system and is given through a mouth -piece or facemask, which you hold. As soon as you feel a contraction coming, you breathe the mixture quickly and deeply through your mouth. After an adequate number of breaths, you put the gas aside and breathe naturally for the rest of the contraction.

Gas and air are usually given if pethidine is wearing off, towards the end of the first stage of labour, or if you have not had pain relief until then and acts instantaneously. Some women find it useful for the second stage and delivery. You are in control of the amount you receive and you can move about in between doses.

Gas and air does not cause any side effects for the baby, however, some women have reported that they have experienced light-headedness, queasiness and disorientation. It is therefore not suitable as a pain relief for long periods.

Pethidine is a strong sedative injection, which is given into your thigh or buttock. It takes effect within 15 minutes but its effect lasts for a short time compared to other analgesics. This means that doses can be timed during labour to minimise adverse effects on the baby. You may require a repeat dose if it isn't giving ample relief in 45 minutes. However, it can cause side effects such as dizziness, nausea, vomiting, drowsiness, constipation and confusion. However, most women find that it helps them deal with their breathing and relaxation better. It doesn't stop the pain but does dull it. If you have had two doses in the eight hours preceding delivery, there is a possibility that the baby may be sleepy, not feed well or be slower to breathe.

This drug also passes into breast milk and may affect the baby. It is therefore important that you discuss any concerns with your doctor.

An epidural is a local anaesthetic injected into the tissues around the spine in the lower back. It operates on the nerves, blocking messages through the spinal cord to the brain, effectively numbing you below the waist. Given in the latter half of the first stage of labour, it takes 30 minutes to start working, but once it has taken effect, the pain ceases and you are much more able to relax.

An epidural has to be administered by an anaesthetist and needs to be set up before the pain becomes a real problem. You lie or sit curled up and a fine tube is threaded through a needle, which is passed between the bones of your lower back. The needle is removed and the tube left in so that the anaesthetic can be topped up as required at two or four hourly intervals. After about 15 minutes you will notice your legs going numb. You will probably lose most sensation in the lower part of your body. Once you have the epidural you have to remain on the bed, but there is no difficulty in getting comfortable as most, if not all, of the pain has gone.

Occasionally the epidural is not entirely effective and may only partially numb the area. If this should occur then it can be re-sited but it is possible that you still experience some pain. Sometimes the epidural can cause a fall in blood pressure, but turning you on your side, or tilting the bed so that your head is lower easily treats this.

An epidural can mean that you are not able to push so effectively in the second stage. This makes a forceps delivery a greater possibility. However, if there is time, the epidural can be allowed to wear off in the second stage so that you are more likely to be able push the baby out by yourself.

A mobile epidural blocks abdominal pain but leaves some feeling and mobility in the legs.

Epidurals are sometimes used instead of a general anaesthetic for Caesarean deliveries. One of the advantages of this is that you are conscious when your baby is born and you can participate in the excitement of his/her arrival.

Metip is a weak narcotic analgesic, drug similar to pethidine, used to reduce pain during childbirth. You are in control of the system, which delivers doses into your arm. It has less effect on the baby than pethidine but can make you feel sick. The safety of this drug during pregnancy has not yet been established, so it is important that you discuss its use with your doctor.

Paracervical block
The paracervical block involves two injections to each side of the cervix. It is simple to perform and is excellent for the pain in the early stages of labour. However, it does not really provide pain relief in the later stages. It does not block sensation from the perineum (pelvic area) and therefore pain from pelvic dilation and delivery can be significant.

The main advantage of a paracervical block is that it is quick and easy to administer, compared to an epidural, which is technically more difficult to perform and requires attention throughout to ensure that it is working properly.

Its major disadvantage is that there is a high incidence of slowing of the foetal heart rate. This is often associated with decreased oxygen delivery to the baby. This may be due to the high levels of local anaethesia around the blood vessels that supply the uterus and/or high levels of the medication in the foetal blood.

Pudendal Block
A pudendal block is a local anaesthetic injected in a similar fashion to the paracervical block, and deadens the nerves leading to the vulva. Given at the delivery stage, it acts quickly and is helpful for deliveries requiring the use of forceps or venthouse.

General anaesthetic
A general anaesthetic is administered via a needle in the back of the hand at delivery stage. It works fast and is used when it is necessary to perform invasive but life saving procedures, such as an emergency caesarean

Natural pain relief

Position and movement
Moving, rocking, rubbing, massaging and shifting pressure are the body's natural defences against all kinds of pain as they help to divert pain sensations away from the brain. Also, by moving around in an upright position, the forces of gravity make contractions more proficient and can cut down the time it takes for the cervix dilate.

Along with breathing exercises, antenatal classes teach various positions for labour, which can help to ease the pain of contractions. It may be that all that is required is for you to walk about, pausing for each contraction to lean against a wall or your partner for support.

The pressure created by massage can help to counteract pain signals and promote relaxation in the early stage of labour. It is drug free, non-invasive and comforting and has no unpleasant effects on either you or your baby. However, massage during labour is very much down to personal choice as some women cannot bear to be touched during a contraction, while others find that back rubbing helps.

Reflexology is a form of treatment that involves working 'reflex points', most often on the feet, although reflex points can be found all over the body. The reflexology method of application involves firm pressure using specific thumb and finger techniques. The main technique used in the treatment is applied by using the outer side of the thumb, which is moved along the foot in a slow caterpillar fashion - ensuring that all areas are covered. The index finger is used on the bonier surfaces of the foot in the same way.

As well as helping with all the normal effects of pregnancy, like morning sickness and dizziness, reflexology treatment is believed to promote a healthy uterus. It is also believed to encourage the pelvis to extend more easily and the cervix to dilate more rapidly.

It is normally recommended that if you have never received reflexology treatment, that you wait until week 18 of your pregnancy before starting treatment. However, if you have had treatment previously then it should be safe to have treatment from conception. It can be helpful if treatment is performed fortnightly up until week 38 although this can be increased if you have specific problems, such as backache or high blood pressure.

Reflexology will aid pregnancy by stimulating the liver, endocrine glands, and lymphatic drainage. Attention is of course paid to the pelvic and reproductive areas.

If all is going well, it is quite in order to have treatment during the early stages of labour and currently more hospitals have a policy of allowing access to complementary practitioners. This would of course need to be discussed with your medical team during pregnancy.

Transcutaneous electrical nerve stimulation involves attaching a portable unit to your lower back, which passes electrical impulses through electrodes directly into the main area of labour pain. The machine releases small electrical impulses that interrupt the pain signals to the brain, resulting in less discomfort.

It is also believed that TNS encourages the release of endorphins, the body's natural painkiller. Used in the first stages of labour, you are in control of the intensity of the impulses, which you can increase or decrease as required. This technique is appealing as it is non-invasive and has no reported side effects however, Tens does not guarantee pain relief for all users. Some hospitals have TENS machines, but they can also be hired out in advance.

Psychoprophylaxis (breathing and relaxation)
All women will benefit somewhat from breathing and relaxation exercises even if they know that they will be having a caesarean or epidural delivery. Breathing and relaxations techniques are taught at all antenatal classes and Psychoprophylaxis is a particular method of training for childbirth. Advocated by the Active Birth Movement and the Natural Childbirth Trust, it teaches women to manage and control the pain of labour. The theory behind this approach is twofold. The first is that fear generates pain as it causes women to tense up and fight the contractions rather than relax and ride with them. The second part is a way of distracting the brain from messages of pain by concentrating on another sensation. In this case a series of breathing exercises designed for all stages of labour and delivery.

Water births
Water encourages the release of endorphins, which, together with buoyancy, counteract pain signals and increases your ability to cope. Baths and showers are helpful but birthing pools are best and can be used throughout labour and even for the birth. Many hospitals now provide a purpose built pool, while for home births; several firms will hire out a pool that can be erected in the home.

The pool is filled with warm water and is kept at a constant temperature. The warmth and buoyancy effect of the water is believed to be helpful in coping with the pain of contractions. However, there is no scientific evidence that water births encourage a quicker or less painful labour
and not all women find it beneficial. Also, if complications arise it is very likely that it would be considered safer to deliver the baby in a more conventional way.

The main disadvantage with a water birth is that it is not as easy to monitor the birth, so water births are only recommended for women who have had no complications during their pregnancy.

Do not be concerned about your baby drowning if is born into the water as it is still receiving oxygen through the placenta and umbilical cord and does not take its first real breath until it is lifted from the water.

Acupuncture can be used quite successfully during childbirth to ease the pain of contractions and delivery. Ultra fine needles are inserted into the body, which encourages the release of endorphins. It is drug free with no side effects and can speed up labour while you remain mobile. However, not only can it be expensive with variable pain relief it is also most likely that you will have to make your own arrangements for a practitioner to attend the birth as very few hospitals will have one on staff. You will also need to obtain the agreement of your consultant.

Hypnosis is not, as many people imagine, a matter of going into a trance so that you do not know what is happening, instead, through hypnotic induction, the mind can be given what is commonly called a post hypnotic suggestion. While under hypnosis, the suggestion is made by the hypnotist that the body will not experience any pain. As a result, effective pain reduction/elimination can be achieved.

It is advisable that in the couple of months before your baby is due you attend two or three hypnotherapy sessions with a qualified practitioner. He will discuss your anxieties before testing your level of susceptibility, as not everyone can be hypnotised. Practitioners have various ways of treating their clients, however, you can probably expect to be taught self-hypnosis and will often be provided with a tape to listen to at home and during labour.

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