What Are the Pain Relief Options During Labour?

There are many pain relief options to consider when having your baby. If this is your first baby, it may be difficult to decide if you need pain relief and if so, what type. You might decide to ‘see how you go’ or that you would like to birth without medicinal pain relief. Now is a good time for you to think about the options that will be available to you, during your labour and birth and prepare for using some of these options. Talk to your midwife or doctor to make sure that your wishes are desirable and achievable. Pain relief options can be natural (not using drugs or medicines) or pharmacological methods (drugs or medications).

Natural

Many women choose to birth without drugs or medications to ease their pain. There are many natural ways to be relieved of pain, including:

• Relaxation (imagery, breathing techniques)
• Yoga
• Music
• Water
• TENS machine
• Acupuncture
• Acupressure
• Hypnosis
• Massage

Relaxation methods are also shown to reduce the chance of you having a forceps or suction cup birth (assisted birth or instrumental birth).

• Imagery can be initially guided by an instructor or an audio recording, recorded by you or someone else. It can be termed as ‘focused day dreaming’ and it is an effective form of relaxation.
• Breathing techniques (slower deeper breathing) can be practised through yoga, meditation or hypnosis. These techniques focus your mind and body to increase your own awareness and reduce distractions around you to promote your own health and wellbeing.
• Each of these have an overall calming effect and can be a distraction from the awareness of your contractions. It may be beneficial for you to blend some of these natural options or you can use each of them on their own.

Water is very effective in relieving pain and has been shown to be safe for mothers and babies. Water immersion (getting into a deep bath or pool) during labour reduces the use of other pain relief and has no harmful effects on the length of your labour or on your baby. Immersing your body in water also provides an element of privacy. A TENS machine is a device that has four pads that you place on points of your back. These pads deliver small electrical impulses that relieve pain. Some women find TENS machines effective for relieving pain in labour. Make sure to remove your TENS machine if you’re having a shower or a bath. Acupressure involves you or your partner pressing on specific pressure points in your body to relieve pain during labour. Acupuncture involves having very tiny needles inserted gently into specific pressure points in your body to relieve pain during labour. These points are usually on your hands, feet and ears. If you don’t like the idea of needles, laser acupuncture or acupressure (applying pressure on these points) may be an option for you. Women feel less intense pain when using acupuncture or acupressure. Hypnosis can be used in the form of hypnobirthing. You will first be shown how to do it and then given information for how to use it to improve on your birthing experience. Using self-hypnosis has been shown to change your perception of pain. Massage has been shown to increase comfort during labour. You may find it very soothing for your birth partner to give you a lower back massage during a contraction. Often, pressing right on the tip of your spine can relieve contraction pain and, particularly, strong back pain of labour.

Medications

Entonox (Gas and air)

• The ‘gas’ is nitrous oxide (sometimes called ‘laughing gas’ because it makes you very happy), and the ‘air’ is oxygen.
• Gas and air is safe for you and your baby if used for a short time.
• It takes 20-30 seconds for the gas and air to work.
• It is short acting – the effects are mostly gone 3-5 minutes after using it.
• It is effective in reducing pain.
• You can remain mobile and walk around, so long as someone is with you.
• The first 2 or 3 times you use the gas and air you may feel dizzy and nauseated. Don’t worry, this feeling will wear off.

Ask your midwife to tell you when to start breathing the gas and air so that you have taken a few breaths before you feel the contraction, and then continue breathing until just after the peak of your contraction. On the next contraction, as you breathe the gas and air you should not feel dizzy, only relaxed, happy and with less pain. The effects of the gas and air wear off quickly. If you don’t like it, maybe use it for every second contraction or breathe deeply with every contraction. When it becomes time to start pushing your baby out, try to focus on your breathing as you feel the pressure. Relax your muscles and breathe in the gas & air as the contraction starts – this will take the edge off the pressure and keep you relaxed. Entonox can be provided at a planned home birth and in all birthing centres and hospitals. Epidural

• This involves an epidural catheter being placed into the epidural space in your back. An epidural numbs the lower half of your body so that you feel no pain.
• If you choose to have an epidural, ask your midwife if a low-dose epidural is available so that you can stay mobile (if possible).
• If that is not possible, try to avoid lying flat on your back, as this can affect the blood flow to your baby.
• May increase women’s satisfaction rates with the overall birth experience, but not necessarily with pain relief.
• Increases your risks of a forceps or suction cup type birth (instrumental birth).
• You will need a catheter to drain urine (a tube in your bladder).
• You may not be able to get up and walk for 6 hours after your baby’s birth.
• You will be in bed for the duration of labour (unless a walking epidural is available).

When it gets to the stage of pushing your baby out, talk with your midwife if you are having difficulty sensing the urge to push. Epidurals can only be provided in maternity hospitals where there is an anaesthetist in the hospital.

Drugs given by injection

Drugs (called opiates) can be injected into your hip or thigh muscle to decrease the sensation of pain. Sometimes, the drug used can make you feel sick or drowsy so an anti-sickness injection may be given at the same time to counteract this. Most drugs take about 20 minutes to work and last a few hours. They can interfere with breastfeeding in the first few days after birth as they make babies feel sleepy. Injections can be provided at planned home births and all other birthing centre and hospitals.