Pain relief in birth

Pain relief is at the foremost of most women’s minds in pregnancy. This article outlines the main options for pain relief in labour in New Zealand today.

Everyone’s tolerance to pain is different, and we all have different needs for pain relief.

Let’s start by looking at how we respond to a headache, or period pain –

• Some would reach straight for paracetamol
• Some would lie down in a quiet room
• Some would continue with life and presume it would go away…

We all respond differently to pain and we all treat pain in different ways. This is no different in labour. No two labours are ever alike, no two births are ever the same and nothing is more unpredictable than birthing!

There is a whole range of pain relief during labour and birth available to women in New Zealand – some is widely available, some you may need to seek out in advance. Here are the main options:

Water as pain relief in labour

Many already know of the healing power of water – we reach for it to clean a wound, we dampen the flannel that will soothe a child, we run a bath for warmth and comfort, and we jump in the shower to cleanse and revitalize.

Women use water in labour for all of these reasons; it calms and soothes, it lightens the load, it eases the pain, it distracts us and supports our bodies when tired.

• A shower in labour – particularly with the spray directed onto the lower back – can give enormous pain relief.
• A bath will sooth, calm and comfort you.
• Some women achieve a “water birth” —using a birthing pool which also enables them to move around freely

Water in a birthing pool should be at the temperature of 36-37ºc, to ensure safety for you and your baby. It is advisable to get out every 1-2 hours, walk around, cool down, and have a change of environment for a short while. Remember to drink a lot of water too, to remain well hydrated.

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Massage in labour

Massage can also have great soothing powers and also helps to distract from the pain. A suitable oil or any rich moisturizing lotion could be used – try it out prior to labour.

A lot of women experience back ache in labour (because of the way baby is laying, or from referred pain) and massage of the lower back may help this. Other women prefer massage to be a distraction, so having their hands or feet massaged is helpful.

Some people do not like to be touched when they are pain, so for these people massage is unhelpful.

Breathing to ease pain in labour

There are some schools of thought that suggest you must learn how to breathe for labour! However, we are all breathing all the time… but consider this – if you stub your toe as you walk out the room what is your first reaction? Most people have a sharp intake of breath and hold it. This is most unhelpful and something we definitely need to overcome in labour. Mums and babies need oxygen in labour – and lots of it. Your midwife and your birthing support people may need to remind you to breathe slowly in and out to ensure that you and your baby are healthy in labour – holding your breath will actually make the pain feel worse!

Entonox (Gas & Air)

This is a mixture of 50% nitrous oxide (laughing gas) and 50% oxygen.

How is it taken?

It is mixed together in cylinders or can be piped out of outlets in the walls of hospitals. The woman breathes in entonox via a tube and mouth piece / mask and therefore it is fully controlled by her only. Basically, the more you breathe, the more you get!

• It takes 15-20 seconds to become effective, so women are advised by their midwife to start breathing ‘the gas’ as soon as the contraction begins
• By the time the contraction reaches its peak the entonox will be effective.
• Once the contraction is easing off, stop breathing the gas and carry on breathing fresh air, slowly.

How does it work in labour?

It makes you feel a bit lightheaded and giggly to begin with- but stick with it and you will soon get used to it. It will not take the pain away, but has some great benefits:-

• It keeps you breathing slowly and regularly (if you hold your breath you will not get any!)
• It takes ‘the edge’ off the pain.
• Entonox can be combined safely with any other pain relief and there are no side effects, as it wears off within 30 seconds.

Pethidine in labour

This narcotic drug is used widely throughout the world, for pain relief in labour.

How is it given as pain relief in labour?

If the mother chooses this pain relief it is given by injection, usually into the leg, or occasionally directly into the vein via a luer. Different doses will be used depending upon the mother’s weight and how far through labour she is when she receives the drug. Anywhere between 50 -150 mg of pethidine may be given.

How does it work?

Pethidine does not change the physiological process of labour, but it does change your perception of the pain. It usually makes people feel sleepy and relaxed, but also sometimes confused or disorientated.

It has side effects:

• Nausea – which can be prevented by giving an anti-nausea drug (such as prochlorperazine) at the same time as the pethidine
• If given in large doses, close to the birth, it may affect the infant’s breathing rate. This is unlikely if used carefully and can be reversed by giving the infant a drug called naloxone, which reverses the effects of pethidine in the baby.

The advantage of pethidine, however, is that it provides relaxation and pain relief without affecting the physiological process of birth. Realistically, it will help you to cope with the pain but will not take the pain away. It is particularly useful if your early labour is dragging out and you are tired, but unable to sleep.

Some hospitals/ health professionals may offer different alternatives to pethidine, such as morphine.

Epidural as pain relief in labour

This is a form of pain relief used commonly in labour, which involves injecting drugs (local anaesthetic and opiate analgesic) into the epidural space, in order to block the impulses of the spinal nerves and to relieve pain.

How is it given?

Only an anaesthetist can administer an epidural, so these will only be offered in hospitals where anaesthetists offer this service.

After a woman in labour has requested an epidural, her midwife and the anaesthetist will discuss the procedure with her and usually they will have to sign consent for the procedure:

• An intravenous luer will need to be inserted into a vein in the arm, in order to give fluid directly into the vein if your blood pressure drops as a result of the epidural.
• The woman is asked to curl up into a position that opens up the spaces between the vertebrae in the back.
• The anaesthiatist will give a small injection of local anaesthetic under the skin half way down your back – this stings a bit.
• After this the anaesthetist will work between contractions to insert a thin tube into the epidural space, through which the drugs will be given. During this time you will feel prodding in your back.
• A test dose of the drug will be given – this may cause a strange sensation down your back and in your legs.
• Within approximately 10 minutes you should begin to feel the benefits of the epidural, with the contractions becoming less painful.
• The midwife will monitor your blood pressure to ensure that it does not fall too low. She will also monitor baby’s well-being through continuous heart beat monitoring.
• Following a successful test dose you will either be given a further epidural injection or a continuous drip will commence into the epidural.
• The epidural remains in until you have given birth, then can be removed by the midwife or doctor.

How does it work in labour?

Local anaesthetic drugs given directly into the epidural space bathe the nerves and block impulses from the womb to the spinal cord – and hence the brain.

The disadvantage is that other motor functions are also affected – such as moving around and passing urine. Some women also lose the urge to push in the second stage of labour.

Sympathetic nerves (which raise blood pressure) are also blocked, resulting in the veins in the legs widening and the blood pressure falling. This can result in reduced oxygen supply to the baby.

Most epidural infusions now contain analgesic drugs also, such as fentanyl, to reduce the amount of local anaesthetic drugs that are needed – and hopefully to reduce these side effects.

The aim is to be pain free, but to remain mobile, able to pass urine and to push your baby out in the second stage of labour.

As you can see from the above there are many options for pain relief in labour and many more than are explained here. Many natural therapies offer support for women in labour, such as acupuncture and aromatherapy – if you are interested in these options seek advice from a fully qualified, registered natural therapist.

Helpful Articles

For information on the Labour: The 3 Stages and  how they feel, click here

Normal Birth outlines the process of a straightforward vaginal birth

See here for information on HypnoBirthing