Pain Relief in Labour

However high your pain threshold, there is no doubt that giving birth hurts. However, with a natural birth the pain isn't always unbearable or even continuous. The pain occurs as your contractions peak, but then fades until the next one starts. As your contractions get closer together, the pain can feel more intense and may become a continuous pain.

How you feel about the pain and how you handle it it will depend on your own pain 'threshold', your personality, whether you feel supported, anxious, scared or under stress and so on.

If you decide before you go into labour that you want pain relief, it is always best to research what's available. Make sure you find out how effective a particular method of pain relief is and about any possible side-effects.

Talk to your midwife or doctor, and certainly discuss it with friends who have had children. But bear in mind that everyone's birth experience is different and yours will be too. Keep an open mind about pain relief because until your labour starts, you could end up changing your mind.

Drugs for pain relief
Nitrous oxide (gas and air or entonox) - comes from a cylinder attached to a tube and mouthpiece/mask. You can use it to numb the pain a little. You cannot overdose on gas and air and only insignificant amounts reach your baby. For some women, the smell and taste brings on sickness or dizzyness. For others, it's a gentle yet effective relief through contractions and actually assists breathing through each contraction pain.

Pethidine and diamorphine - usually injected into your bottom - take up to 20 minutes to work, but last for between two and four hours. If given too close to delivery, they can affect the baby's breathing at birth and leave him sedated for a day or two, making feeding tricky. Again, some women experience a nauseous feeling with pethidine.

Epidural - an anaesthetic drug is injected into the epidural space at the side of the spinal cord. It numbs the body from the lower back downwards. A thin tube is left in place to allow top-ups as needed. Research has shown that you're more likely to have an assisted delivery with an epidural, although newer types of the anaesthetic give a lower dose, which is thought to reduce this. In some cases, the epidural is allowed to 'wear off' when you are ready to push so that the actual delivery is controlled by you and is more 'natural'.

If you're determined to have a drug-free labour but when it actually comes to it, you change your mind - make sure your request pain relief. It is important to remember though, that as you get closer to actually delivering your baby not all pain relief remedies will be available to you. Discuss this with your midwife as your labour progresses.

Natural pain relief

Pain relief doesn't necessarily mean chemical drugs. Fear of the unknown can make pain feel worse than it actually is. Armed with everyone else's horror birth stories doesn't help either. (Bear in mind that a great deal of mums go on to have more than one child - so it can't be that bad!) Learning to relax and feel in control is very important when experiencing labour.

Move about, kneel or squat or walk around. Find a position that feels more comfortable through each contraction. Some women feel glued to the spot, others keep active throughout. It sounds corny but it also helps to think about the pain in a positive way - each moment of pain is bringing you closer to being a mum.

Drug-free Pain-relief includes:

• Relaxation, learned at antenatal classes
• Breathing exercises, learned at classes
• TENS (transcutaneous electrical nerve stimulation) - electrodes are placed on your back, which deliver a slight electrical charge to the nerve endings (you may have to hire a machine in advance)
• Hypnosis, either learned in advance or given by a therapist
• Massage - usually done by your birth partner
• Acupuncture, given by a therapist
• Water, in a birth pool or a deep bath
• Homeopathy - administered by practioner - ensure you inform your midwife if you are taking homeopathic medicine during labour
• Warmth - a wheat husk filled heat pad warmed in a microwave eases pain. Some hospitals and antenatal clinics sell them
• Rest between contractions - get as comfortable as possible
• Being loved! - research has proved that having someone special with you during labour you give birth more easily and quickly. A loving partner, mother, friend or sister perhaps. Always check with the midwife if you require more than one person in the delivery room.

None of these has any side-effects on your baby and there are no after-effects for you, either. The downside can be that their effect is limited - if you're in great pain, you may feel they don't help at all.

What's available and where?
If you are going to have your baby at home, all the drug- free forms of pain relief would be available. The midwife should also be able to give you gas and air and/or pethidine should you want it.

In hospital, all forms are available, but check whether epidurals are available at all times, as an anaesthetist is needed to give one. Also when an epidural is administered, a midwife is required to stay with you and monitor you and the baby's progress. In some cases, the anaesthetist is unavailable so your labour will progress too far on for an epidural to be a viable option.

Anaesthesia
A caesarean will require a complete form of pain relief. They are carried out with an epidural, which means you're conscious throughout yet your lower body will be numb (from the stomach down) and providing the baby is born without complications, you can hold your baby as soon as it's born. An alternative is a spinal anaesthetic, which has similar effects and also allows you to stay awake.

Occasionally, you might be given a general anaesthetic. This is usually in the case of emergency as it takes effect more quickly than an epidural. You should come round fairly soon after the delivery, even if you take a few hours to be fully aware.

visit: www.nhs.uk

www.patient.co.uk

www.nct.org