Pain Relief During Labour By Marie Louise

“It's going to hurt” is the response I usually get when I ask my patients about their plans for labour care. I cannot deny that labour is painful. There have been a few reported cases of women not experiencing pain during labour and birth but from my experience I have never come across a woman that experiences no pain at all. Some women say “It's not that bad” others say it is “extremely painful”. The aim of this blog is to give you an overview of what’s available if you need it when the time comes!

I will start with the milder options available and work my way up to the strongest:

1) Breathing and aromatherapy or massage
Yoga during pregnancy is fantastic. It helps women with their breathing control in labour. If you can't attend classes try some breathing techniques. There are plenty of YouTube videos to coach you through. Aromatherapy and/or massage may also help you to relax, encouraging a release of oxytocin and endorphins, which are natural pain killers. Oxytocin is one of the main hormones responsible for labour progression.

2) Mobilisation and positioning (Active Birthing)
There have been numerous studies that suggest that as well as helping to speed up the 1st stage of labour, mobilisation, or moving around during labour and changing positions, is also a form of pain relief.

3) Your birth partner’s support (don't under estimate it!)
Your birth partner(s) are really important. They can encourage a calm atmosphere and most of all they provide comfort and reassurance, which may help if you are in pain.

4) Hydrotherapy Water is a wonderful thing.
It can help women get into positions in which they may struggle on dry land, it helps with back pain and it may also relax you. Some women like to get into the pool for labour but deliver on dry land and some women like to labour mostly on dry land but get into the pool shortly before its time to push, it is entirely up to you and what makes you comfortable. The only suggestions your midwife/doctor might make is that you are 5cm dilated before entering the pool as it can slow early labour down. Make sure you drink plenty of water during labour, especially if immersed in warm water.

5) Entonox (gas and air)
Entonox commonly referred to as gas and air should be supplied in every maternity wing on the wall or through a mobile cylinder. Entonox is 50% nitrous oxide and 50% oxygen. It is fast acting, short lived and does not cross the placenta. It is the most common form of pain relief in labour and is self-administered. It is most effective when inhaled just as a contraction begins as it gives a peek action 30 seconds after the first inhalation. Entonox may cause nausea and vomiting. I have known a few women to dislike the effects of Entonox but as its wears off so quickly discomfort doesn’t last any more than a few minutes.

6) Pethadine
Pethadine originates from the family of opioids and is a synthetic drug (man-made). It is administered through intramuscular injection by a healthcare professional. Pethadine does cross the placenta and may cause babies to be slightly drowsy at birth if administered too close to the time of birth.  There are mixed reports on the effectiveness of Pethadine amongst women. Some say that it really made a difference and others report getting hardly any relief from the pain. From my personal experience I have found that Pethadine is most useful during early labour as it may help to relax women allowing them to get some much needed rest, but best of all as it is a muscle relaxant on occasions it may help cervical dilatation. I would not recommend the use of Pethadine past 6cm dilated, or if birth is perceived to be close, to avoid the potential risk of your baby becoming drowsy at birth.

7) Epidural
An epidural is the only form of pain relief that (if effective) will take the pain away. Everything else discussed above may help you manage pain during labour and perhaps obscure your perception of pain, but none of them will actually take the pain away. An epidural is performed by an anaesthetist.
First of all you will need to be cannulated, this means having a plastic tube placed into your vein via a needle. One of the more common side effects of an epidural is a drop in blood pressure. To help maintain your normal blood pressure it is recommended that intravenous fluids should be administered prior to or whilst the epidural is being sited. The anaesthetist will request that you adopt a position in which he/she finds it easiest to work with. This may be sitting on the side of the bed leaning over a pillow or on your side. Local anaesthetic is administered in the point of entry for the epidural needle to help relieve discomfort from the larger needle.
The epidural itself sits in the “epidural space” in your back via a catheter (a thin plastic tube). There are different methods of administration of the drugs infused going into the epidural space. Some are self-administered; where you would usually press a button when you begin to feel pain or a continuous infusion can be set up to slowly administer the drugs over a period of time. Hospital policies on the matter vary.
If the epidural is in the right place and effective it may cause you to feel a tingling sensation or numbness and a reduction of mobility in your legs. In extreme cases, an epidural may rise and affect the respiratory system. As you will be unable to get out of bed, a catheter is placed in the bladder to collect urine. Once the need for the epidural has elapsed it can take a few hours before the effects wear off. You should remain in the delivery suite until the epidural has worn off. Like any procedure there are risks involved with having an epidural.
Your anaesthetist will discuss these risks in detail with you before any part of the procedure is commenced.
For first time mothers, I would make use of an epidural after trying at least one or two of the options above. The main reason for this is that you may find other methods that are less invasive, yet substantial for your pain management.  

I hope this blog can help you to make an informed decision about your pain relief. Remember that it is your body and your baby so you are in control. Do what is best for you at that time. I also hope to get the chance to meet some of you at The Baby Show Excel where I will be launching my brand new product! I am also offering my expert advice as a senior midwife and maternity educator at the show! If you can't make it, come and join the conversation on our Facebook page or contact me directly at Marie Louise Maternity.  

I wish you all the best,   Marie Louise