Pain Relief

If you decide you might need pain relief, do your homework and check out what's on offer.

09:15 09 June 2009

For most women, labour hurts. A lot! This article also appears on www.bbc.co.uk/parenting/having_a_baby

Breaking through the pain barrier

That's not to say it's always unbearable, or continuous. Labour pains come as contractions which build up to a peak and then fade. Thankfully you do get a break in between them. The breaks between get shorter as your labour progresses, but there is always a gap.

How you feel about the pain and cope with it will depend on your pain threshold, your personality, how well supported you feel, your levels of anxiety, whether you are under stress and so on.

If you decide you might need pain relief, do your homework and check out what's on offer. You should find out about what the side effects are, if any, and how effective a particular method is. Talk about your options with a midwife or doctor, and discuss it with other mums at your antenatal class. It will certainly be on the agenda " it's something everyone wants to know something about!

Drugs for pain relief

• Nitrous oxide, also known as gas and air, or Entonox. This comes from a cylinder attached to a tube and mouthpiece or a mask, which you put on your face to allow you to breathe it in. It takes the edge off the top of the pain, and allows you to relax a little. You can't overdose on nitrous oxide, and it only reaches your baby in insignificant amounts. Not everybody likes it " it has a distinctive smell and taste which some people find unpleasant.
• Pethidine and diamorphine. You usually get these in a syringe, injected into your bottom. They can help with the pain, although can take up to 20 minutes to kick in. Once administered, they will last between two and four hours. If you have them too close to delivery, they can sometimes affect the baby's breathing at birth, which will leave them sedated for a day or two, making initial feeding tricky.
• Epidural. This anaesthetic drug is injected into the epidural space at the side of the spinal cord. It numbs the lower back and all parts of the body from there downwards. A thin tube is left there to allow for top-ups as needed. An epidural takes away most of the feeling from below the site of the injection. Research indicates that if you've had an epidural, it's more likely for the baby to have an assisted delivery with an episiotomy, forceps or ventouse. Newer epidurals give a lower dose of anaesthetic and research indicates that they allow some feeling in the muscles, and reduce the need for assisted delivery.
• Meptid. This is a weaker narcotic than pethidine; it's not widely used in the UK, possibly because it is a lot more expensive.

In all cases, if you've opted for no drugs and then have a change of heart, don't be afraid to say so. Bear in mind that once your labour is fully underway and you are becoming more dilated, it may be possible that not all pain relief will be available to you. Discuss this with your midwife as your labour progresses.

Pain relief doesn't necessarily mean taking drugs to reduce or take away the pain. Fear can often make pain much worse than it actually is. Especially in the case of first-time births, the fear of not knowing what is happening or what to expect can make labour seem more fraught and painful than it needs to be.

"...learning to relax can make a big difference..."

Learning to relax can make a big difference to your mentality during labour, as can feeling in control. Do not be afraid to ask your midwife questions. Your position can make a difference too. Don't be afraid to move about, kneel up or walk around. Whatever you feel most comfortable with.It helps to think about the pain positively " each pain is bringing the baby's arrival closer.

It's perfectly natural to worry about how you'll cope with the pain, but many women are able to really enjoy their births.

Other methods which don't involve drugs include:

• massage, usually done by your birth companion
• relaxation, learnt at antenatal classes
• breathing exercises, learnt at classes
• TENS (Transcutaneous Electrical Nerve Stimulation), this gives your nerve endings a sight electrical charge via electrodes, which stick to the skin of your back. You usually have to hire the equipment in advance, though some maternity units have their own " ask when you book in
• hypnosis, either learnt in advance, or given by a therapist
• acupuncture, given by a therapist
• water, in a birth pool or a deep bath.

None of these have any side effects on your baby, and have no after-effects on you, either. The drawback is their effect is limited, and if you are in great pain, you may feel they don't help you enough.

What's available?

If you choose to have your baby at home, all the non-drug forms of pain relief will be an option. The midwife will be able to give you nitrous oxide and/or pethidine should you want it. In hospital, all forms are available, but you might want to check epidurals are available at all times, as an anaesthetist is needed to give one.

Anaesthesia for caesarean section

Obviously, you'll need a complete form of pain relief for a 'c-section'. Most sections these days are done with an epidural, which means you're conscious throughout and you can hold your baby straight away. An alternative is a spinal anaesthetic which has similar effects, and which also allows you to stay awake. See our feature on Caesarean section.

Occasionally, you might be given a general anaesthetic. This could be by choice, or it might happen as an emergency, as it takes effect more quickly than an epidural. A general anaesthetic knocks you out completely, but you should still come round fairly soon after the procedure, even if you take a few hours to be 'all there'.