Your Guide To Pain Relief During Labour

Using Pain Relief Doesn’t Make You A Bad Parent

“There are no prizes for giving birth without pain relief. It doesn’t make you a better person, and likewise, putting your hand up and saying that you want an epidural doesn’t mean you’ve failed at a natural birth. Your birth is such a small part of such a long journey. Drugs such as the epidural were invented to help women deal with the pain of labour. Think about it – you wouldn’t have a tooth pulled without drugs, so why not take the same philosophy for labour?” – Becca Maberly, pregnancy and postnatal expert and founder of A Mother Place

You’re Not Being Judged

“There’s so much sentiment that the ‘tough’ women don’t need an epidural – it’s total rubbish. As a mother of an 11-year-old, I can promise you no-one talks about, or probably cares, what pain relief they had when their babies were born. It’s what happens in their life that’s far more important. Statistically, it’s first-time mothers that are most likely to need an epidural and that’s because statistically, their labours are longer. Once your cervix has opened once, it’s easier to do it again. But that’s not true for everyone so keep your options open, and if you need medicalised pain relief, have it.” – Marina Fogle, co-founder of The Bump Class

Hours Are Often Wasted Making A Birth Plan

“By all means have a birth preference but I would discourage an expectant mum from having a birth plan, which gives the false idea that you can plan your birth; you can’t. All of us are different and all of us will cope with the pain, exhaustion, intensity, excitement and hormones in different ways. The key is to know about labour, however it turns out, so that you’re prepared for every eventuality. Whether it’s enabled with hypnosis, a birth pool, an epidural or a surgeon, it’s still just as special.” – Marina 

An Open Mind Is Key

“It isn’t possible to predict how painful or difficult your labour will be as it depends on so many factors that are out of your control. These include the position of the baby (the size of the baby is rarely a factor), the efficiency and frequency of your contractions, the way the soft tissue in your birth canal responds to the baby’s descent, the way in which your labour starts (e.g., if you have been induced), the length of the labour and how efficiently you push.” – Becca 

… As Is The Right Mindset

“To help you with contractions before you get to the hospital, one of the best things you can do is try and ignore the pain. This may sound like terrible advice, but if you can avoid not focusing on it until you have to, the whole early labour process which can last a frustratingly long time will feel shorter and more manageable.” – Marina 

There Are Different Options In Different Places

“Birth centres are midwife-led and have everything to help you have a natural birth. However, as soon as you need medicalised pain relief, you’ll need to go to a labour ward. A birth centre has gas and air, birthing pools, slings, balls and the wonderful expertise of midwives. Some birth centres will be able to give you pethidine, but for an epidural, you’ll need to be seen by an anaesthetist on a labour ward.” – Marina 

Here, Becca delves deeper into the main forms of pain relief…

TENS MACHINE

“TENS stands for Transcutaneous Electrical Nerve Stimulation. A TENS machine produces an electric current that stimulates the nerves that reduce pain. The machine usually has four electrodes with sticky patches at the ends, which are applied to the lower back.”

PROS: “TENS can provide a good form of distraction for you whilst you are in the early stages of labour. It can help pass time whilst applying the machine and testing out the different levels and strengths of currents. Many TENS machines come with timers or monitors to help you time your contractions, which can also be a helpful distraction. TENS is safe for both mother and baby and allows full mobility. You can also use TENS in conjunction with gas and air, perhaps whilst waiting for an epidural.”

CONS: “The jury’s out on whether TENS is any good at providing pain relief. Some women speak positively about their experience with it and say they couldn’t have coped without it, while others find the machine useless and, in some cases, just plain irritating. It’s best to start to use the machine in early labour before your contractions get more intense – if you wait until they are already painful and frequent, it’s unlikely you’ll feel the benefits.”

GAS AND AIR

“Also known as gas and air, or laughing gas, Entonox is made up of 50% each of nitrous oxide and oxygen. It’s usually available at every bedside in a labour ward and is self-administered through a mouthpiece or face mask. It has a two-way valve that lets you breathe in and out through the mouthpiece.”

PROS: “Gas and air has a calming effect and helps take the edge off the pain rather than eliminate it completely. It is very safe for mother and baby as it doesn’t pass over the placenta, and you can’t overdose on it. It can be useful if you are having a rapid labour and is also helpful towards the end of the first stage of labour just before you start pushing.”

CONS: “It takes up to 20 seconds to work, so in order for it to be effective in helping with pain you should start to take it at the very start of your contraction. It can be helpful for your partner to have their hand on your tummy – they may be able to feel when a contraction is starting before you do. Gas and air also has a cumulative effect and you may find (but not notice yourself) that you start to talk gibberish after you’ve been using it for a while. It can also make you feel sick and dizzy the first time you try it, which can be disorientating if this first time is during a painful contraction, and it isn’t good to use when pushing as you shouldn’t be breathing in and out when pushing.”

EPIDURAL

“When an epidural is used it provides the most effective form of pain relief possible. It works by blocking pain-transmitting nerves that supply the uterus without seriously affecting motor function. It’s a very safe procedure with less than a one in 10,000 risk of serious problems. An epidural is only given when you are in established labour, which is usually confirmed when your cervix is more than 3cm dilated. If you are being induced, you may be more likely to need or want an epidural.”

PROS: “If managed well, an epidural can be used as part of a very satisfying and painless delivery. In 90-95% of cases it is very effective. The epidural will be put in place in between contractions, so you won’t have to worry about staying still whilst you are contracting. To optimise your chances of a spontaneous delivery (i.e. without forceps or Ventouse) you need to listen to your midwife or doctor about the volume and timing of top-ups, especially in the second stage of labour before pushing. Generally, the more you can feel the better you can push. There is a window of opportunity that a good midwife will steer you towards – the idea is to try and let the epidural wear off enough so you have enough sensation to push but aren’t in uncontrollable pain.” 

CONS: “Having an epidural doubles the chances of needing an assisted delivery as you don’t feel the urge to push and therefore may not push as effectively. You will also have no awareness of your bladder filling up, meaning your bladder can stretch and become damaged, so you’ll need a catheter to drain your bladder whilst the epidural is in place. You’ll also need an intravenous drip to keep you hydrated and to correct your blood pressure if it drops or rises. 

• “If you have an emergency caesarean, it’s likely you’ll be offered a spinal block, which is administered in a similar way to an epidural. It is a very dense and even block of pain relief – it gets to work within five minutes and lasts for up to two hours.”

BIRTHING POOL

“For healthy women with uncomplicated pregnancies and labours there is good evidence to suggest that being in water during labour or whilst giving birth can provide some pain relief. When your midwife or doctor thinks you are ready to go into the water, the pool will be prepared – know this can take some time, often up to half an hour, as the pool must be freshly run for you and the temperature must be exactly right. It’s important the temperature of the water mimics blood temperature.”

PROS: “Studies have shown that many women find they experience less painful contractions, a shorter labour, less need for drugs and less need for augmentation (speeding up of contractions with Syntocinon) when they use water as a form of pain relief. There is, however, no evidence of any benefit to actually delivering underwater although many women who labour in a birthing pool will go on to give birth in the water. The baby’s heartbeat can be easily monitored whilst in the water, too.”

CONS: “When you get into the pool, you’ll realise quite quickly if it’s an experience you are going to enjoy or not. For some women, it’s relaxing and calming, while for others it may feel unpleasant. Be aware that your midwife will monitor your pulse and temperature and the heartbeat of your baby every 30 minutes, or if your contractions are more regular, after each contraction. You may have to stand for this. If your labour develops any complications, you may be advised to get out of the pool. You can use gas and air whilst you are in a birthing pool, but if you want anything stronger, you’ll need to get out.”

PETHIDINE

“Pethidine is an opiate-based, pain relieving drug given by injection into the thigh or bottom. It’s not 100% effective in eliminating pain, but it does dull the pain and helps you relax between contractions.”

PROS: “Although Pethidine isn’t so widely used these days – it doesn’t have a great reputation – it can be useful in certain circumstances when an epidural is inappropriate, perhaps where the early stages of labour are very painful and it’s too early for an epidural, or when an epidural isn’t advisable or delayed for some reason.”

CONS: “Pethidine travels across the placenta to the baby, and whilst it isn’t toxic to the baby, it can have an effect on the baby’s ability to breathe after delivery – for this reason, it isn’t advisable to have more than two doses of the drug. A lot of women complain of feeling nauseous or shaky using Pethidine, and is usually given alongside an anti-sickness drug to minimise this. Other women saying they feel ‘out of it’ and some report hallucinations.”
 

Nobody Tells You by Becca Maberly is available to buy now; Becca also runs online antenatal and postnatal courses with A Mother Place. For more information on The Bump Class, head to TheBumpClass.com. Marina’s podcast, The Parent Hood, is also worth a listen.

DISCLAIMER: Features published by SheerLuxe are not intended to treat, diagnose, cure or prevent any disease. Always seek the advice of your GP or another qualified healthcare provider for any questions you have regarding a medical condition, and before undertaking any diet, exercise or other health-related programme.