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Pain Relief in Labour

If you’re an expectant mother you’re likely to be apprehensive about giving birth, especially if it’s your first time. When it comes to labour, stories are often split between mums who report it was a ‘good pain’ and friends who tell what seem to be horror stories of childbirth.

To make matters even more nerve-wracking, expectant mothers frequently encounter a kind of competitive chit-chat, or information overload on the subject. There is a lot of advice out there – people, books and other mums saying ‘you should do this and you shouldn’t do that’ – and the subject of pain relief in labour is no exception.

Here at Private Pregnancy UK, we want to inform you on your choices so we’ve laid out the various pain relief options to help you decide. We hope this best prepares you for future conversations with your doctor or midwife.

conversation-with-midwife

Self-Help Techniques
It definitely pays to know about all the ways in which you and your partner might be able to help make things go as smoothly as possible during the childbirth process, and that includes self-help techniques.

Learn as much as you can about giving birth, as the more prepared you are, the more relaxed you could be – and greater relaxation could make for less pain. Learning about the process of labour means you’ll be more confident when the big day comes.

So what does this mean in practical terms?

  • Read about labour and its different stages
    You can do this through books or helpful articles. Having awareness and being able to spot labour when it starts, as well as knowing what’s likely to be ahead of you in terms of everything from pain to pushing, will mean you’re less likely to panic. This in itself could help to alleviate your pain.
  • Attend antenatal classes
    Okay, so you’re tired with the pregnancy and probably have plenty keeping you busy but getting to an antenatal class can really make all the difference. In a class you can learn all sorts of practical techniques, such as how to breathe in a helpful way. Even if you’re planning to have pain relief injections it still helps to know good breathing, which can help you when it’s time to push.
  • Keep moving
    Your position in labour can make more of a difference than you think. For example, shifting onto your knees and elbows can help to alleviate pressure on your cervix, and lying on your side can be a good position too. It’s really worth experimenting.
  • Breathing techniques are essential for childbirthChoose your birth partner carefully
    Often women will bring someone other than their partner along with them but choose wisely. The wrong birth partner could make for extra stress at an already difficult time. Have a good think and try not to worry about other people’s feelings. At the end of the day, this is your birth. You’re undertaking one of the most wonderful and challenging things a human being can do, so your happiness is paramount.
  • Ask your birth partner to give you a massage
    This isn’t for everyone, some women find it really helps them to relax whereas others really don’t want to be touched during labour. (See our section on ‘Aromatherapy’ below for more details).
  • Have a warm (but not hot!) bath
    This may help your muscles to relax a bit, and ease the pain of contractions a little. See our Hydrotherapy section below for more information.

Water as Pain Relief
While water births are still very much in the minority, their popularity has increased over recent years, as many women have found water to be conducive to relaxation. Warm water can help to alleviate a sensation of pressure.

If you are having a private birth, it’s worth knowing that an increasing number of independent obstetricians and midwives are offering water births.

Hydrotherapy is becoming more popular but safety is paramount

How does a water birth work?
If you are considering this option it’s very important that it’s done in the proper way. Too much heat is potentially dangerous for your baby. A proper water birth will be supervised. The water will be at a comfortable temperature for you but not above 37.5C, and your body temperature will be continually checked.

You shouldn’t be in too much of a rush to get into the birthing pool. Experts tend to think that it will be more effective for you if you are 5cm or more dilated. Your birthing partner(s) can get into the pool with you, but everybody should shower first.

If you have risk factors or complications in your pregnancy, a water birth may not be medically advisable. Also, some doctors have argued that actually giving birth in water (as opposed to simply undergoing labour in water) may pose rare but clinically significant risks to the baby (see here).

With this in mind, many women who want to try water immersion opt for it in labour only, choosing to actually give birth out of water. For more information on birthing pools, go to www.nct.org.uk/birth/use-water-birth-pools-labour

Gas and Air (Entonox)
What’s known as Gas and Air is a combination of oxygen and nitrous oxide gas, which is used towards the end of labour. Gas and Air won’t take away all your pain but it can definitely help to make it more manageable in the later stages. You can easily control it yourself by hand, and many women like it for that reason.

How does Gar and Air in labour work?
You hold a mouthpiece to breathe in the Gas and Air (if you go to antenatal classes, you’ll probably have the chance to practice with a mouthpiece). Since the gas takes effect within about 15 to 20 seconds, you should breathe it in just as a contraction starts. It will be most effective if you take deep, slow breaths.

Are there any drawbacks?
There are no adverse health effects for you or baby but Gas and Air can make you feel light-headed. Sometimes women report that it makes them feel sleepy, sick or unable to concentrate. Should this occur, you can simply stop using it.

If Gas and Air doesn’t provide adequate pain relief for you, you can request a painkilling injection as well.

TENS Machines
TENS (Transcutaneous Electrical Nerve Stimulation) works by encouraging your body’s own ability to generate endorphins (natural painkillers). It can help to reduce the number of pain messages that your spinal cord sends to the brain, meaning greater comfort for you.

Evidence suggests that TENS is most helpful during the early stages of labour at home, when you will be experiencing lower back pain. There are no known side effects for either you or baby with TENS.

Many hospitals and independent health practitioners have access to TENS machines nowadays. In any case, it is also possible to hire one yourself. If you’re considering using TENS, it’s a good idea to learn how to operate the device before the big day. Ask a health professional to show you.

What is involved in using TENS for pain relief in labour?
Electrodes will be taped onto your back. These are connected by wires to a compact stimulator that you operate by hand. This design means you can control the stimulation – giving yourself safe amounts of current as you wish. You can move around whilst using TENS, which is another reason many women like it in early labour.

Epidural Anaesthesia

What is an Epidural?
An epidural is a kind of local anaesthetic. It numbs the nerves that carry the pain to the brain up from the birth canal. Most women find that an epidural offers total pain relief. It may be particularly helpful for women who are experiencing a long or especially painful labour, or who are becoming very upset. You should be a lot more physically comfortable with an epidural.

An anaesthetist is the only professional authorised to administer an epidural, so this will not be available in a home birth, obviously. If you think you may want to have an epidural, have a talk with your midwife or obstetrician in advance of the birth.

An epidural is likely to offer total pain relief in labour

What is involved in having an Epidural?
If you opt for an epidural, a fluid drip will be attached to you through a needle in a vein in your arm. You will be asked to lie on your side or sit in a curled position while an anaesthetist cleans your back with antiseptic and uses local anaesthetic to numb a small area.

A compact tube, usually carrying a combination of local anaesthetic and opioid, will then be positioned into your back near the nerves responsible for carrying pain from the womb. All in all, the process of setting up the epidural and waiting for it to kick in takes around half an hour. It may need to be adjusted, and will probably need to be topped up as the birth continues. Also, your contractions and your baby’s heart will need to be monitored continually throughout labour via a machine – so you will need to have a belt around your tummy and possibly also a clip attached to baby’s head.

Are there any side effects with an epidural?
An epidural could cause your legs to feel heavy, depending on the kind of epidural you have. Some women experience a drop in blood pressure – but this is rare because the drip in your arm should enable the maintenance of good blood pressure.

An epidural can prolong labour’s second stage (the point where you push and your little one is born). If you can’t feel contractions any more, then your midwife will need to tell you when to push and instruments such as forceps may be used to aid with the delivery. Having said that, obstetricians and doctors will wait longer before using instruments in cases of epidural, so long as your little one is doing okay. Sometimes less anaesthetic will be administered at the end so that the effect can wear off and your baby can be pushed out naturally.

There are a few other possible minor side effects. Some women find it difficult to urinate after an epidural: in such cases, you may be given a catheter to assist you. A small number of women (about 1%) get headache after an epidural, but this can easily be medicated. You may experience back soreness for a day or two after the birth but this won’t be long-term.

Around 1 woman in every 2,000 who gives birth experiences a pins and needles sensation down one leg afterwards. This is more likely to be down to childbirth itself rather than having had an epidural. Your midwife or doctor will tell you when you can safely get out of bed.

Injections
Another method of pain relief is what’s known as the intramuscular injection of a drug (such as pethidine or diamorphine) into the muscle of your buttock or thigh. This can have a relaxing, calming effect, which in turn can alleviate pain and make labour more manageable. The effects from an injection take about 20 minutes to kick in and last from 2 to 4 hours.

Are there any possible side effects?
Yes, there are a few:

  • There is the possibility that these injections could make you feel light-headed, sick and forgetful.
  • If the effects haven’t worn off towards the end of labour, it may be difficult to push. For this reason, some women try half a dose initially and see how they get on with that.
  • If diamorphine or pethidine are administered too close to your time of delivery, they may affect the baby’s breathing. In such cases, you will be given an antidote.
  • These drugs can present problems for breastfeeding.

Complementary/Alternative Therapies
Some women would prefer not to undergo more traditional kinds of pain relief methods, and would rather opt for alternative techniques instead – such as homeopathy, hypnosis, acupuncture, massage and hypnotherapy. Many of these methods are not reported to offer strong pain relief, but you can try them if you wish.

We would recommend discussing your plans with your obstetrician or midwife well in advance, and only choose fully qualified practitioners who have the right training and credentials to work with a woman in labour.

If in doubt, contact the Institute for Complementary Medicine.

Aromatherapy
The use of calming oils such as chamomile, bergamot and lavender can be relaxing for some women during labour, particularly when combined with massage, which has been shown to help release anti-stress hormones like oxytocin. There’s no evidence to suggest it will greatly reduce pain, but some women have said they found it very helpful.

Aromatherapy combined with massage can be relaxing during labour

Frankincense has been said by aromatherapists to be especially useful for the end of the first stage of labour – it is said to help keep you calm if your contractions are very strong. You can either rub, or ask your birth partner to rub, a single drop of frankincense oil onto the palm of your hand.

If your labour is moving along slowly, you could check with your midwife if it’s okay to use essential oils to try to help things progress. Lavender, clary sage and jasmine may be useful but only in small amounts and it is imperative to check with your midwife or doctor first.

Reflexology
The philosophy behind reflexology is that your feet represent a map of your body. Pressure points located on your feet correspond to tissues and organs throughout your body. Reflexology is said to work in a similar way to acupuncture. Although many midwives are not trained in it, some will be, so if you are interested, ask questions.

If you are struggling with your contractions, ask your birth partner to squeeze your heels a few times during a contraction. Your heels are the reflexology point representing your pelvis. If your contractions slow, then you could try having the backs of your big toes massaged. This is believed to relate to the brain’s pituitary gland, which is responsible for producing labour hormones.

Acupuncture, Acupressure and Shiatsu
Acupuncture involves the use of little needles inserted into targeted points of the body, and some think it can help to induce labour and reduce pain. Shiatsu and acupressure employ the same pressure points: shiatsu involves massaging the points, and acupressure employs the use of fingertip pressure on the points.
Some midwives are trained in acupuncture but in all likelihood you’ll need to have a private acupuncturist in the room with you.

Your midwife or birth partner can employ acupressure techniques to help with pain and contractions. For example by firmly pressing thumbs into the dimples either side of your lower spine, beginning at your coccyx (tailbone) and shifting up to your waist.

Herbal Remedies
The incorrect use of herbal remedies in pregnancy and labour can be dangerous for both you and baby, so be extremely cautious if you are considering using them. Only take them on the advice of a fully-qualified medical herbalist or a midwife trained in herbal medicines.

Remember that although herbal medicines are ‘natural’, they work in the same way as drugs do, and some are dangerous to pregnancy, can interfere with prescribed drugs, and create serious side effects in women and babies.

Raspberry Leaf Tea is a famous herbal remedy for pregnancy and labour. It’s said to tone the muscles of your womb and help with contractions, possibly cutting down a woman’s time in labour. But there’s not really a lot of evidence in terms of its safety or effectiveness.

There’s not much evidence for raspberry leaf tea

Avoid blue cohosh – it has been associated with serious side effects in babies, including heart problems and stroke.

Some women have been known to use evening primrose oil, black cohosh and castor oil to help start labour, but there is little available evidence as to their safety and effectiveness and many argue that they could do more harm than good.

Homeopathy
Homeopathic remedies are mild and don’t interfere with prescribed drugs. Although there’s no real evidence to support homeopathic remedies, some women have found them useful. It is possible to obtain a special labour ‘birthing set’ from some homeopaths. They should come with instructions, and it’s very important that you read them carefully. Or you can hire a homeopath who works with pregnant women, or find a midwife trained in homeopathy.

Arnica is often used to treat shock, bruising or trauma. You could start on arnica within an hour of your little one’s birth and then take it 3 or 4 times every day for up to 5 days. If you have a caesarean section or an assisted birth then you may need to take it more often.

You decide what’s best
So there it is. We’ve given you a breakdown of the different pain relief options available and now it’s up to you to decide what’s best for you.

This is your birth and your baby so it’s not the time for worrying about anyone else

Have a good talk with your midwife and/or obstetrician about this. They can help you to create a birth plan that best reflects your wishes and any health needs you may have.

This is your birth and your baby – it’s not the time for worrying about anyone. By all means speak to others about your options, but remember that the more your pain relief has been your decision then the more likely you will be to be relaxed and confident.

Sometimes women are completely prepared to have a natural birth and then as labour progresses, they find they need pain relief after all. If you prepare yourself mentally for any eventuality then you’re more likely to be happy with whatever choices you need to make when the time comes.

All the best for your big day!

[For more articles, see our Useful Articles]