Pain Relief

Pain Relief for labour

Labour can often be an uncomfortable process and most women choose to use some form of pain management. We have therefore put together this guide so you are aware of the options for pain relief. The reason that labour can be painful is that the uterus (or womb) where the baby has been growing is made up of a criss cross of muscles. Running in between and through these muscles are blood vessels and when you get a contraction the blood supply to the muscle is temporarily interrupted. This causes muscle cramping and is very similar to cramp that runners can suffer from due to a lack of blood supply to the muscle.

As labour is split into different stages there are different pain relief methods that can be offered as you progress through labour.

Latent phase of labour

The latent stage of labour is where your uterus is getting ready to go into active labour. During this stage your baby is slowly moving into the best position to be born and your cervix is moving forwards so that the stronger and more regular contractions of active labour can begin dilating. This stage can be really very uncomfortable and tiring but the best place to be at this point is at home. The latent stage of labour can sometimes continue on and off for days and this is the stage where women may complain they were in labour for days and days. You will not be in active labour for days.

Breathing

When you are getting tightening’ or contractions it is important to keep breathing through the contractions as it is the natural reaction to hold your breath when you are in pain. By breathing deeply through the contraction you are supplying more oxygen to the muscles in your uterus and therefore the cramp will be less painful. Some women find hypnobirthing helpful with regulating breathing and remaining relaxed during labour.

Paracetamol

Taking regular paracetamol is very good for backache and can take the edge off the tightening’s and allow you to rest. It is a good idea to keep taking paracetamol up to 8g in 24 hours. This will not affect your baby.

Bathing

A bath is also very helpful for many women. Making sure your bump is under the water interferes with the nerve signals which carry the pain signals to your brain.  You can also have a bath if your waters have broken too. This will not affect your baby.

TENS machine

You may also have heard of a TENS machine. TENS stands for Transcutaneous Electrical Nerve Stimulation. This works in a similar way to a bath by interfering with the painful nerve signals caused by the contractions. TENS block or reduce the pain signals going to the spinal cord and brain and this can help reduce or relieve pain. The device is battery operated and four electrodes are attached to your skin on your back. When the device is turned on it administers small electrical impulses which can be felt as a tingling sensation and you are completely in control of the settings. You should have a TENS machine that is designed for labour, they have settings which can be increased as the labour progresses. They also have a ‘boost’ button that should be clicked as the contraction starts, this will increase the electrical signal and provides more pain relief during the contraction. Following the contraction the button should be unclicked. TENS pain relief stimulates the body’s natural pain killer known as endorphins. This will not affect your baby.

Active phase of labour

Entonox (Gas & Air)

Once you have gotten through the latent phase of labour and are progressing into the active phase you would usually be in hospital or may have called your midwife if you are planning on having a home birth. At this point you might decide to use entonox, which is also known as gas and air. Entonox is a mixture of nitrogen and oxygen, called nitrous oxide, and it is breathed in and out during the contraction. It can also make you laugh which is why it is also known as laughing gas. Entonox helps to increase the amount of oxygen going around the body and to the muscles which can act as pain relief. The gas begins to take effect 15 to 20 seconds after inhalation and also lasts for 15 to 20 seconds after you have stopped inhaling it. Entonox does not cross your placenta and will not affect your baby. It can make you feel disorientated and some women feel sick but these effects tend to wear off after using it for a few contractions.

Birthing Pools

Some hospitals can offer a birthing pool as a method of pain relief. This works in a similar way to TENS and a bath as it interferes with the nerve pain signals. The birthing pools are usually within a relaxing environment and as the water is much deeper you will be weightless and therefore more supported. You can use Entonox when you are in the pool. Water can be a very effective method of pain relief and will not affect your baby.

Pethidine

If you feel you would like something more for pain relief then you could consider an injection of pethidine. This goes into the muscle at the top of your leg or in your buttock. It is an opioid like morphine and therefore has the same side effects of morphine such as sickness, feeling ‘woozy’ and sleepy. Most labour wards routinely give an anti-sickness drug in with the pethidine which can be helpful as labour can also make you feel nauseous. The injection takes about 20-30 minutes to begin working and will last 2-4 hours. You can have more than one dose in labour. Pethidine does cross the placenta to your baby and if you have the pethidine close to the time that the baby is born it can make the baby sleepy and not want to make much effort to breathe initially. Although rare, if this does happen the midwives will be able to help the baby with the first breaths as required, but most babies are absolutely fine and need no extra help. You can continue to use entonox when you have pethidine.

Epidural

Some women choose to have an epidural and these can be very useful in long and painful labours. An epidural will numb the nerves that provide the pain signal to the brain by using local anaesthetic and an opiate pain killer. An epidural has to be inserted by an anaesthetist who is a specialist. The anaesthetist will insert a large needle into a space between the bones of the spine and when it is in the correct space a fine plastic tube is threaded through. Position is very important and you will need to get into a slumped over sitting position on the side of the bed but you will be supported throughout so don’t worry. The anaesthetist or midwife will put up a drip prior to siting the epidural, they will then clean the skin on the back prior to beginning the procedure. Most epidural sitings are very straight forward and take around 15-20 minutes from starting the procedure to the pain relief beginning to take effect. Some procedures can take longer as it can occasionally be difficult to locate the correct space. The fine plastic tube is held in place securely by a dressing and local anaesthetic is administered as a continuous infusion via the tube. Epidurals can have side effects which will all be explained to you before the procedure, an example would be a bad headache which is rare. The most common side effect is a drop in blood pressure, but fluids can be given via the drip if required and is quickly rectified. As the epidural will also block the nerves to the bladder it can be difficult to pass urine whilst the epidural is effective and the midwife may have to empty your bladder by inserting a catheter to release the urine. Epidurals can prolong the second stage of labour which is the pushing stage as the sensation to push can be less strong and you may need support to know when the contractions are happening. . If you can no longer feel your contractions, the midwife will have to tell you when to push. If you have an epidural, your midwife will usually wait until the baby’s head is very low and this will decrease the chance of an instrumental delivery. A forceps or ventouse (instrumental delivery) may be used to deliver the baby’s head if you do need any assistance but the epidural would be “topped up” for this to happen. Occasionally it is possible that the epidural will not work completely and may need to be adjusted or re-inserted if required.

Be Empowered:

The following website discusses options in more detail, and is available in many different languages:

http://www.labourpains.com/ui/content/content.aspx?ID=332

References

Gizzo, S et al (2014) Update on best available options in obstetrics anaesthesia: perinatal outcomes, side effects and maternal satisfaction. Fifteen years systematic literature review. Arch Gynecol Obstet 290:21–34

Intrapartum care; NICE Clinical Guideline (2007)

Immersion in Water During Labour and Birth; Royal College of Midwives and Royal College of Obstetricians and Gynaecologists (2006)

Jones L, Othman M, Dowswell T, et al; Pain management for women in labour: an overview of systematic reviews. Cochrane Database Syst Rev. 2012 Mar 14;3:CD009234. doi: 0.1002/14651858.CD009234.pub2.

Klomp T, van Poppel M, Jones L, et al; Inhaled analgesia for pain management in labour. Cochrane Database Syst Rev. 2012 Sep 12;9:CD009351. doi: 10.1002/14651858.CD009351.pub2.

Lally, JE (08/01/2014). “Pain relief in labour: a qualitative study to determine how to support women to make decisions about pain relief in labour.”. BMC pregnancy and childbirth (1471-2393), 14, p. 6.

Ullman R, Smith LA, Burns E, et al; Parenteral opioids for maternal pain relief in labour. Cochrane Database Syst Rev. 2010 Sep 8;(9):CD007396. doi: 10.1002/14651858.CD007396.pub2.