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Maternity

Caesarean section

Pain relief

Pain relief in labour


It is useful to attend antenatal classes run by midwives or professionally-trained teachers (for example National Childbirth Trust – NCT). Some of these classes will tell you about the types of pain relief available to help with pain in labour. Understanding about the types of pain relief available will make you feel less anxious. This should help you to relax and cope better.

You may like to write down your wishes in your birth plan but remember you may need to be flexible and keep an open mind. You may also find labour is more painful than you expected and you need more pain relief than you had planned. It is helpful to learn about the different types of pain relief before you go into labour. If you wish to attend a class ask your midwife for details.

Types of pain relief

It is difficult to know in advance what sort of pain relief will be best for you. The midwife who is with you in labour is the best person to advise you at the time.

Self-help: what you can do for yourself

  • A supportive birthing partner is invaluable and has been shown to reduce the need for pain relief. If you do not have anyone with you don’t worry – your midwife will give you lots of support
  • Relaxation is important – music and massage may help
  • Birth classes can teach ways of breathing that may help you cope with the pain of contractions
  • Your position can make a difference and some mothers find that keeping mobile is helpful.

Water

  • A warm bath may help you to relax in early labour. Mothers who have a lot of backache in pregnancy often find the birthing pool particularly helpful
  • Continuous monitoring of the baby’s heartbeat is not possible when you are in the pool and so use of the pool is not recommended if there are concerns about the wellbeing of the baby
  • You cannot use TENS, Pethidine or have an epidural if you are in the bath but you can use gas and air.

‘Gas and Air’ Entonox

  • This is a mixture of oxygen and another gas called nitrous oxide
  • You breathe it through a mouthpiece or facemask which you hold for yourself
  • It is simple and quick to act. It wears off in a couple of minutes after you stop breathing it
  • It will not remove all pain but many mothers find it very helpful
  • It can be used at any time during labour
  • It is available in the community
  • It does not harm the baby and gives you extra oxygen during the contractions
  • It may make you feel light-headed or a little sick for a short time
  • If you do not like these feelings stop using it and it will wear off in a couple of minutes
  • Many mothers like using it because you control it yourself.

To get the maximum benefit from gas and air timing is very important. It takes 15-20 seconds to work. You should start breathing the gas as soon as you feel a contraction starting. That way the pain of the contraction and the relief from the gas and air peak together. Breathe the air in the room between contractions. If you breathe gas and air all the time it can make you feel dizzy and a little ‘spaced out’.

TENS (Transcutaneous Electrical Nerve Stimulation)

  • A gentle electric current is passed through four flat pads stuck to your back. This causes a tingling feeling in your back. You control the strength of the current yourself
  • There are no known side effects to you or your baby and you can move around while using it
  • It is believed TENS works by stimulating the body to increase production of its own natural painkillers called endorphins. It also reduces the number of pain signals that are sent to the brain by the spinal cord
  • TENS machines are available for use when you are in labour.

Alternatively you may hire a TENS machine from a number of shops. Ask your midwife for advice about this. Generally you may loan the machine for one month around the time the baby is due. If you have hired a machine, you may find it useful to practise using the machine before you go into labour to get used to the controls and positioning of the pads. You can then start using it at home as soon as you go into labour.

N.B. It may be wise to put a new set of batteries into the machine when you go into labour to make sure the batteries do not run out.

Pethidine

  • Is an injection given by midwives. It takes about 20 minutes to work and lasts about 2-4 hours
  • Usually makes you drowsy and can make you feel woozy and forgetful but this may make you less worried by the pain and more able to cope
  • May make you feel sick. If this happens you can be given another injection to reduce the nausea
  • Has less effect on pain than gas and air
  • May make your baby drowsy but an antidote can be given to the baby by injection after birth
  • If the baby is very sleepy it may cause a delay in establishing breastfeeding
  • You should not use the birthing pool if you have had Pethidine.

Diamorphine


Following a very successful research study comparing two morphine-like pain managing drugs, Diamorphine and Pethidine, we are now offering the option of either drug for women in labour.

Pethidine and Diamorphine are both powerful opiates used for pain relief.

The study was carried out over a two year period in Poole and Bath maternity units, by randomly selecting mothers to receive either Diamorphine or Pethidine for pain management in labour. We were looking at the pain relief provided and the effects on mother and baby.

The results showed that Diamorphine provided a better pain management over the first three hours after injection.

The study also revealed that women who were given Diamorphine had better pain relief but their labour was slightly longer. For this reason we will still be offering the choice of Diamorphine or Pethidine. Your choice will be discussed with the midwife who is looking after you.
The dose you will receive depends on your weight at the end of your pregnancy.

This will not affect your choice to use other pain relief methods such as Entonox (gas and air) or an epidural which you may still request at any time.

If you have any questions or concerns, please contact your named local midwife.

Epidurals

  • An epidural is a small tube put into your back. Local anaesthetic is injected down the tube to numb the pain nerves
  • They are set up by anaesthetists and take 20-30 minutes to work
  • The anaesthetist should come to do the epidural within 30 minutes of being called but occasionally it may be longer
  • They have very little effect on the baby
  • Sometimes epidurals cannot be given due to safety
  • If you suffer from certain medical illnesses you may not be able to have an epidural.

What does it involve?
You will first need to have a drip put in your arm. You will then be asked to sit bending forwards or curl up on your side. Your back will be cleaned with antiseptic and a little injection of local anaesthetic will be given into the skin so that putting the epidural in should hardly hurt. A small tube is put into your back near the nerves carrying the pain signals from the womb.

Care is needed to avoid puncturing a membrane surrounding the spinal cord as this might cause a headache later. It is important you keep still whilst the epidural is being put in. If you have a contraction the anaesthetist will stop until the contraction has passed. Once the tube has been put in it will be secured in place with tape and then you will be free to move around the bed and adopt any comfortable position.

Advantages

  • It should remove the pain of labour
  • Good pain relief should allow you to relax
  • An epidural does not make you feel drowsy or sick
  • Epidurals have no long-term effects on the baby
  • They have no effect on breastfeeding.

Disadvantages

  • Only available in an acute general hospital
  • Occasionally they cause a drop in blood pressure which may make you feel sick. The drip should prevent this
  • You will need to stay on your bed during labour and for several hours afterwards
  • Sometimes epidurals only work on one side but the anaesthetist should be able to remedy this
  • Labour may take longer and you may require a drug to speed up the contractions
  • Your contractions and the baby’s heart beat will need to be continuously monitored
  • If you have an epidural you may find it difficult to pass urine. If this happens the midwife can help by inserting a little tube (catheter) to empty the bladder
  • Because of the pain relief it may reduce your urge to bear down. Because of this it is more likely you will need ventouse or forceps for delivery
  • Your skin may itch. If this is unpleasant the anaesthetist can change the drugs used in the epidural
  • In this country as a whole there is a 1 in 100 chance of getting a headache. If you develop a headache afterwards it can be treated
  • You may feel a little local tenderness on your back for a day or so after an epidural. There is good evidence epidurals do not cause long-term backache
  • Some mothers have small numb patches on their legs that stay numb after birth. Such problems are much more likely due to the process of childbirth than the epidural. The problem does get better on its own but may last three months or so. Permanent, serious nerve damage is extremely rare
  • If you have had an epidural you must stay in Princess Anne Wing for at least 12 hours after giving birth
  • You will not be able to use a birthing pool if you have an epidural.

What if you need an operation?

If you should need an operation such as a caesarean birth and you already have a working epidural, strong local anaesthetic can be injected down it. This will make you completely numb from the abdomen down so you would not need a general anaesthetic for surgery. This is safer than a general anaesthetic for you and your baby.

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