As soon as you find out your pregnant, the planning begins and you have 9 months to plan, but one of the big items that need some thought will be your options for pain management, it's a really hot topic! Some will plan for non-medical pain management whilst in labour, or whether you plan other methods of pain relief, it's still important to know all the options, and to way up the benefits and risks of the decisions you may be faced with. Your midwife will be able to help you decide on the best options for you.
Depending on your hospital or birth centre, the options for pain management can vary. At my local hospital, the options you’ll typically be offered are: Nitrous Oxide (gas & air), Pethidine injections, Epidural, Water as in a water birth or a TENS Machine.
Each of these are very different, and all of them have their pros and cons. Each labouring person will react and respond differently to each of these methods of pain management, and it’s important to realize that what you might have hoped would work, may or may not work for you and you may need to try an alternative.
Let’s take a closer look…
Nitrous oxide is delivered as a blend of nitrous oxide and oxygen, through a mask that the labouring woman holds and self-administers through contractions.
- Nitrous Oxide is fast acting and wears off quickly.
- It can be used at any point in labor right up until the pushing phase, and doesn’t effect the well being of baby.
- While you will still feel the pain, a lot of women find it helps them relax and reduce their perception of pain.
- Some women find that it makes them dizzy or nauseous.
- It doesn’t provide complete pain relief, and it isn’t always as effective as some hope for it to be.
Pethidine is a morphine-like opioid. It's synthetic, which means it's manufactured, rather than extracted from the opium plant (poppy).
- Peteidine can be easily accessed in labor, It can help you to relax and get some rest.
- Some women say that pethidine makes them feel less worried about the pain.
- It may help you to postpone or avoid having an epidural if you're finding your contractions hard to cope with.
- You can still use a birthing pool or bath during labour, but not within two hours of a dose of pethidine, or if you feel drowsy.
- Pethidine provides only limited relief from labour pain. It doesn't cut out pain altogether.
- It may make you feel spaced out and less in control of your labour.
- One woman in three finds opioid drugs such as pethidine unpleasant, and the side-effects may make it more difficult for you to cope with labour.
- It may make you feel drowsy and can make you feel sick or vomit, even if you have an anti-sickness drug.
- It crosses the placenta and may affect your baby's breathing, particularly if you take it when you're close to giving birth. Your doctor or midwife can give your newborn an injection to help reverse this side-effect of pethidine.
- Your baby may be drowsy for several days after the birth. This may mean that it's more difficult to get breastfeeding started.
The epidural: administered by an anaesthesiologist often described as a knight in shining armour bringing total relief. During an epidural, painkilling drugs are passed into the small of your back through a fine tube. An epidural is a regional anaesthetic, so not all of your body is affected.
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.
- It's the most effective form of pain relief during labour.
- Most women find that they are completely pain-free. An experienced midwife can usually provide top-ups once the epidural is in place, meaning no waiting for an anaesthetist.
- You'll still feel clear-headed, leaving you more in control of your birth experience. You may also still be aware of your contractions.
- It can be topped up with stronger local anaesthetic if you need an unplanned caesarean. Though having an epidural does not increase your chances of needing a caesarean.
- Although an epidural delivers pain relief quickly once it's working, the whole process can take up to about 40 minutes to take full effect. This is longer than most other types of pain relief.
- You may feel shivery or develop a fever. You may feel a bit itchy, particularly if you have a combined spinal epidural.
- It's most likely you'll need to stay in bed, as your legs will feel weak or heavy. Even if you are able to shuffle around on the bed, you won't be able to walk around.
- You will need more monitoring. Your midwife will monitor your baby's heartbeat continuously for at least 30 minutes at first, and then after each top-up. She will also take your blood pressure every five minutes for about 15 minutes as the epidural gets to work, and after each top-up.
The calming effect of warm water is in itself an effective method of pain relief. The hormones that help you cope with the pain of labour (endorphins) may increase when you’re in a birth pool.
- Pain relief Being in warm water can make it easier to deal with painful contractions.
- If you want strong pain relief such as an epidural then you will have to leave the pool but you can use gas & air to remove mild pain while still in the water.
- Women often say they feel an enhanced sense of privacy, once you are in the warmth of the pool you can focus solely on the labour. Some women like to dim the lights and have the room as quiet as possible to calm them throughout the process. Relaxation the motion and temperature of the water can help you to relax throughout labour.
- Contractions may lose their rhythm if you become tense, so by remaining calm contractions may become less stressful for you and your baby.
- Being relaxed will also help you to breathe more slowly and calmly, further helping pain relief.
- Less traumatic for the baby some believe that water births are more peaceful for your baby. The reason is that the warm waters of the pool will be similar to those of your uterus (womb). Babies who are born in water are often more relaxed and cry less than those born in air.
- Infection there may be a risk of infection in a birthing pool if you open your bowels - although midwives usually remove any debris quickly and efficiently, it does introduce the possibility. However, there is no evidence to suggest any difference in rates of infection between women who give birth in water or in air, and the NHS has strict guidelines about cleaning pools after each use, making sure the pool is left hygienic.
- Availability If you have your heart set on a water birth at hospital rather than at home there is a chance it will not be available when you need it.
- The pool/s may be out of order, in use by another woman, there might be a fault with the electrics or they might not have enough staff.
- Cost water births are one of the most expensive labour methods – hiring a pool can cost upwards of £400 or from £100 to buy a pool. Alternatively, you can use a birthing pool at hospital for free if your maternity ward has them.
- Not enough pain relief you may find that being in a birthing pool doesn’t make the contractions any less painful. Having to get in and out of the water for pain relief may just add more stress to the process.
TENS stands for Transcutaneous Electrical Nerve Stimulator, It stimulates the nerves for therapeutic purposes. It delivers small electrical pulses to the body via electrodes placed on the skin – it is thought to help ease the pain.
Non-invasive and safe nerve stimulation to reduce pain, both acute and chronic
Popular with people who have pain
Can provide effective and drug-free pain relief throughout labour
TENS is thought to have no effect on the baby
They are portable
Can be extremely effective for many women with no lasting side effects
Research evidence to support TENS is not strong
Takes an hour for body to start producing endorphins, so you should start using it earlier on in
your labour, even at home before visiting the labour ward.
Does not work for everyone
Provides no benefit for others
You cannot use the TENS in a birthing pool
Has to be removed for electric monitoring of baby’s heart. This will stop the release of endorphins
and therefore impact pain relief
For more information on pain relief in labour see the NHS GUIDE