Pain Relief In Labour - What Are The Options?

Labourispainful- ask your doctor to explain what's available so you can decide what's best for you. Remember that you need to keep an open mind.You may find you want more pain relief than you'd planned, or your doctor or midwife may suggest more effective pain relief to help the delivery.

Self-help in labour

You're likely to feelmore relaxed in labour and better placedto cope with the pain if you:

• learn about labour– this can make you feel more in control and less frightened about what's going to happen; talk to your doctor, ask them questions,and go toantenatal classes

• learn how to relax, stay calm, andbreathe deeply

• keep moving– your position can make a difference, so try kneeling, walking around, or rocking backwards and forwards

• have a bath in early labour

Gasand air (Entonox) for labour

This is a mixture of oxygen and nitrous oxide gas. Gas and air won't remove all the pain, but it can help reduce it and make it more bearable. Many women like it because it's easy to use andthey control it themselves.

You breathe in the gas and air through a mask or mouthpiece, which you hold yourself. The gas takes about 15-20 seconds to work, so you breathe it in just as a contraction begins. It works best if you take slow, deep breaths.

Side-effects

• there are no harmful side effects for you or the baby

• it can make you feel light-headed

• some women find that it makes them feel sick, sleepy or unable to concentrate– ifthis happens, you can stop using it

If gas and air doesn't give you enough pain relief, you can ask for a painkillinginjection as well.

Pethidine injectionsin labour

This isan injection of the drug pethidine into your thigh or buttock to relieve pain. It can also help you to relax. It takes about 20 minutes to work after the injection. The effects last between two and four hours, so wouldn't be recommended if you're getting close to the pushing (second) stage of labour.

Side-effects

There are some side effects to be aware of:

• it can make some women feel nauseous, sick and forgetful

• if pethidine is given too close to the time of delivery, theymay affect the baby's breathing–if this happens, another drug to reverse the effectwill be given

• the drugs can interfere withthe baby's first feed

Epidural

Anepiduralis a special type ofanaesthetic. It numbs the nerves that carry the pain impulses from the birth canal to the brain. It shouldn't make you sick or drowsy.

For most women, an epidural gives complete pain relief. It can be helpful for women who are having a long or particularly painful labour.

An anaesthetist is the only person who can give an epidural. If you think you might want one, check whether anaesthetists are always available at your hospital. How much you can move your legs after an epidural depends on the local anaesthetic used. However, this also requires the baby's heart rate to be monitored.

An epidural can provide very good pain relief, but it's not always 100% effective in labour. One in eight women who have an epidural during labour need to use other methods of pain relief.

How does an epidural work?

To have an epidural:

• A drip will run fluid through a needle into a vein in your arm.

• While you lie on your side or sit up in a curled position, an anaesthetist will clean your back with antiseptic, numb a small area with some local anaesthetic, and then introduce a needle into your back.

• A very thin tube will be passed through the needle into your back near the nerves that carry pain impulses from the uterus. Drugs (usually a mixture of local anaesthetic and opioid) are administered through this tube. It takes about 10 minutes to set up the epidural, and another 10-15 minutes for it to work. It doesn't always work perfectly at first and may need adjusting.

• The epidural can be topped up through a machine.

• Your contractions and the baby's heart rate will need to be continuously monitored. This means having a belt around your abdomen.

Side-effects of epidurals in labour

There are some side effects to be aware of:

• An epidural may make your legs feel heavy, depending on the local anaesthetic used.

• Your blood pressure can drop (hypotension), but this is rare because the fluid given through the drip in your arm helps to maintain good blood pressure.

• Epidurals can prolong the secondstage of labour. If you can no longer feel your contractions, the midwife will have to tell you when to push. This means that forceps or a ventouse may be needed to help deliver the baby's head(instrumental delivery). When you have an epidural, your midwife or doctor will wait longer for the baby's head to come down (before you start pushing), as long as thebaby is showing no signs of distress. This reduces the chance you'll need an instrumental delivery. Sometimes less anaesthetic is given towards the end, so the effect wears off and you can feel to push the baby out naturally.

• You may find it difficult to pass urine as a result of the epidural. If so, a small tube called a catheter may be put into your bladder to help you.

• About1 in 100 women gets a headache after an epidural. If this happens, it can be treated.

• Your back might be a bit sore for a day or two, but epidurals don't cause long-term backache.

• About1 in 2,000 women feels tingles or pins and needles down one leg after having a baby. This is more likely to be the result of childbirth itself rather than the epidural. You'll be advised by the doctor or midwife when you can get out of bed.