Important: This is intended as general information only. It may not apply to your specific situation. It is not a substitute for medical advice. If you have a question or concern, please raise it with me at your next appointment or contact me sooner if it's urgent.
Pain Relief in Labour
One of the (many) things that you’ll receive a lot of unsolicited advice about is pain relief in labour. It seems everyone has an opinion and everyone is convinced that their opinion is the only one worth considering. Keep these two things in mind:
- No two labours are the same: you can’t compare your experience of pain to someone else’s or even to the experience you may have had in a previous labour. It’s not as simple as how tough you are or what your pain tolerance is.
- It’s your labour: don’t concern yourself with the pain relief (or lack thereof) used by your mum/sister/neighbour/random busybody expressing an opinion. You’re the person in pain and you get to decide how you wish to approach this. Whether you have absolutely no pain relief or an epidural with your first contraction – it’s nobody’s business but yours.
It’s a good idea to have a plan in your head (or in writing if you like) for how you wish to approach pain relief in labour. It’s also a good idea to remember that that labour is unpredictable and you never really know what it is going to be like, even if you’ve laboured before. It may turn out to be much better or worse than you were expecting - keep your plans flexible. All the options available (including no pain relief) have their benefits and their downsides. Your task is to weigh up the various pros and cons and make the decision that is right for you.
With that in mind, these are your options:
Relaxation strategies/Meditation/Self hypnosis
There are lots of different strategies available including ‘hypnobirthing’ and ‘calmbirth’. They all involve learning to relax and moving your mental focus away from pain. Some women find these techniques extremely helpful, feeling that have more of a sense of ‘control’ over what is happening to them. All of these techniques require practice.
Hot packs/warm showers
The application of heat can be very soothing, particularly in the early stages of labour.
Massage/positioning
Simple physical therapies like massage, movement and positioning can also be very helpful. The particular position that feels best or body part requiring massage may change as the labour progresses.
TENS (Transcutaneous Electrical Nerve Stimulation)
The sensation of pain (and everything else for that matter) is carried from your body though your nerves to your spinal cord and then to your brain as an electrical impulse along specific nerve pathways. A TENS machine acts by applying a safe electrical current to these pathways. There is a bit of controversy as to exactly how TENS machines work but it is thought that they bombard the nerve pathways with stimulation, thereby ‘distracting’ them from transmitting other stimuli. Some women find TENS machines extremely effective and some find they have almost no effect. I suspect that this is because everyone is ‘wired up’ slightly differently – perhaps some people’s nerve pathways are more susceptible to this kind of distraction than others. The units can be hired reasonably cheaply so many women feel that it is worth a try, even it turns out not to be effective for them.
Nitrous oxide
This is an inhaled pain reliever that has been used in labour for a long time and is known to be safe. Like the TENS machine, some women find it extremely effective while others feel it doesn’t do much. It may have some side effects including nausea and a feeling of light-headedness. The drug acts quickly and wears off quickly. This means you have to inhale it with each contraction but, if you don’t like the way it makes you feel, it’s out of your system very quickly.
Pethidine/morphine
These are strong opioid pain killers given by injection. They don’t take away the pain of labour altogether but they certainly take the edge off and may make you relaxed and drowsy. There has been concern in the past that these drugs affect the baby. This is now thought to have been overrated – the risk to the baby is minimal and, in the rare event that it affects a baby’s breathing, easily treated. These drugs are particularly useful early in labour – you can use then to give yourself a coupe of hours ‘break’ and save your strength for later on. They tend to be much less effective later in labour.
Epidurals
An epidural (or, less commonly a spinal or combined spinal epidural) anaesthetic involves inserting a very fine needle into a particular space around your spinal nerves (below the level of the spinal cord) and injecting some pain killers and local anaesthetic. This results in extremely effective pain relief from the level of the upper abdomen downwards. Epidurals are usually extremely effective in relieving the pain of contractions and significantly reduce the pain of delivery. Like all procedures, there are risks involved although these are very small. If you chose to have an epidural, your anaesthetist will discuss this with you in more detail.
The sensory nerves that carry pain are different from those that carry other sensations such as pressure and movement and different from the motor nerves that control movement. With epidurals, we’re aiming to preferentially block these nerves to remove the sensation of pain without losing too much other sensation or movement. With the ideal epidural, you’ll be aware that you’re having a contraction (due to a sensation of pressure or tightness) but the contractions wont be painful and you’ll still have a reasonable amount of movement. That way, when it comes time to push your baby out, you can still feel and move enough to be able to push effectively. It’s not always easy to get this balance right as everyone responds slightly differently to the medications. Some women lose more sensation and movement than others and it can be harder to push effectively if that occurs. If you’re having difficulty pushing, you may need an assisted vaginal delivery (forceps or vacuum). Contrary to popular myth, epidurals don’t make you more likely to have a caesarean and they don’t make it harder to breastfeed.
