Pain Relief Options in Labour, from a Midwife
When your labour commences, contractions will generally be mild and short in length. As your labour progresses and it is nearly time to meet your baby, your contractions will generally be around 45-60 seconds in length and feel more intense. Labour can be varied; you may describe the pain to be manageable while others could need strong pain relief. Pain is subjective, meaning it is personal and experienced differently by everyone, with every woman responding and coping in different ways with the pain of labour and childbirth. There are several pain relief methods you can use to help you cope in labour. Remind yourself that the pain of labour is a positive and progressive pain, with a beautiful reward of your baby at the end.
Remember to choose the best coping technique or combination that suits you and your needs, you may want to avoid medications or consider all available options, also be open to your plan changing throughout your labour. Evidence included in this blog has been researched and stated by The Royal Australian and New Zealand College of Obstetricians and Gynaecologists (RANZCOG).
Being aware of the pain relief options you have in labour is important, even if you don’t think you’ll want to use any. Knowing your options prior to labour means you and your birth partner know the benefits and risks of every method and can make a quick decision in labour if needed. Research suggests that adequate preparation through antenatal education can help to reduce pain, anxiety and the perception of pain, which can assist you to cope better in labour. Don’t forget to discuss your pain-relief preferences with your healthcare provider and your birth partner in the antenatal period, and record them in your birth plan. Keep in mind that not all birth facilities offer every option of pain relief, so chat to your healthcare provider about what options are available before you go into labour. During labour, your midwife will continue to guide and work with you according to your wishes. It is important to keep an open mind, have a positive attitude and have confidence in your ability to labour.
Non-pharmacological pain relief
- Movement & positioning including maintaining upright positions and being able to freely move during labour will help you cope with contractions. RANZCOG refer to this as an ‘active birth’, where moving around and changing positions uses gravity to assist your baby to move down into your pelvis. Using equipment like a birth ball or birth stool can help you get into comfortable positions while remaining upright. Different positions you can try in labour include; side-lying, leaning forward over a bed or your partner, kneeling on all-fours on the bed or in the shower, and squatting.
- Relaxation techniques during labour will allow your body to release oxytocin and natural pain-relieving endorphins. Breathing techniques will help you ride the waves of each contraction and focus on something, with or without music to guide you. Relaxing and trusting that your body knows exactly what to do will help you manage the contractions. Alternative therapies such as acupuncture, acupressure or aromatherapy can also be very effective in labour. Remember that a relaxed face and mind will help relax your pelvis and cervix too.
- Touch & massage from your birth partner in labour can help you relax during and in between contractions. Often pelvic squeeze or pressure on the lower back during contractions can be beneficial for you. At some stages of labour, massage and touch will feel good and at other times you may find it distracting or annoying.
- Heat in the form of heat packs or warm water is a simple and convenient way to ease discomfort in labour. Try heat packs on your lower back for back pain or on your stomach to assist with cramps. A warm shower can be relaxing at any point during your labour, even if bub needs CTG monitoring you should still be able to access a warm shower in labour.
- Warm water immersion in a bath is a popular way to cope with contractions in labour due to the warm water covering your whole body. RANZCOG state a warm bath significantly reduces pain and tension in your muscles and pelvis, as well as helping release those natural pain-relieving endorphins. If you have had a low-risk pregnancy and cleared by your healthcare provider then you can use a bath or birth pool in labour.
- Sterile water injections are a great non-pharmacological pain relief if you experience severe back pain in labour, common when bub is in a posterior position (back towards your back). Sterile water injections involve a small needle containing sterile water being injected just under the skin into several different points on your lower back. At the time of the injection, you will feel an intense stinging sensation, like a bee sting, that will quickly pass and then you should have relief of the back pain for a few hours without any side effects for you or your baby.
- Transcutaneous electrical nerve stimulation (TENS) machine is a small portable device that attaches to pads placed on your lower back. The machine sends electrical pulsations to the pads on your back which interrupt the pain pathway when you are experiencing contractions and also stimulate your body to release endorphins. Using a TENS machine is very safe with no side effects for you or your baby, and can be used alone or in combination with other methods of pain relief (except with water or an epidural).
Pharmacological pain relief:
- Nitrous oxide gas is commonly known as ‘happy gas’ or ‘laughing gas’. The gas is made up of nitrous oxide and oxygen, with your midwife being able to control the strength of the gas you inhale. You breathe the gas in through a mask or mouthpiece during a contraction, intending to take the edge off the pain. The gas takes up to 15 seconds to take effect, so it is important to inhale it as soon as you feel a contraction starting. The gas is great to use if you are still wanting to be active in your labour and move around, and also gives you something to focus on during each contraction. There are no effects of the gas on your baby, but it can make you feel dizzy or nauseated and often gives you a dry mouth.
- Morphine is the only narcotic, or very strong pain killer, safe to have in labour. Morphine is given via an intramuscular injection into your leg or bottom which can work quickly and be very effective in relieving pain. After having morphine in labour, you will still be able to feel your contractions although they shouldn’t be as severe, and it also helps your body relax to allow your cervix to open. Morphine is useful if you are in established labour but cannot be given if you are close to giving birth. This is due to morphine crossing the placenta and having an effect on your baby’s breathing if it is given close to birth, so for this reason it is only to be used in early labour. The side effect of morphine for you is nausea, but this is often eased with anti-sickness medication.
- An epidural is the strongest and most effective pain relief option in labour as it completely blocks the pain impulses and numbs painful sensations from your waist down. An epidural is a procedure performed by an anaesthetist and consists of an injection of local anaesthetic and a thin tube inserted into your lower back which provides you with a constant infusion of anaesthetic medication. For this procedure, your midwife will position you sitting on the side of the bed curled over so your lower spine is flexed which makes it easier for the anaesthetist to insert the needle. The medication that will run through your epidural will mean you won’t be able to feel any contractions or pain for the rest of your labour and birth, meaning you should be comfortable and pain-free to relax and recover before it is time to begin pushing and meet your baby. You should still have some movement in your legs with an epidural, but they might feel heavy and tingly. The anaesthetist will explain the procedure to you as well as any risks and side effects. The most common side effects include; shivering, itchiness, nausea, low blood pressure or a patchy block where you might still have a small area where you feel pain. All these side effects can normally be corrected by the anaesthetist.
- After the epidural is inserted your midwife will closely monitor your blood pressure and observations. Because low blood pressure is a side effect of an epidural you will have an intravenous drip placed into your hand for extra fluids if needed, and your baby’s heart rate will also be continuously monitored by a CTG machine. Due to your legs becoming quite weak after an epidural, you will need to remain in bed for the rest of your labour and birth. It is also recommended practice to have a catheter inserted into your bladder until after you give birth as you will not experience the sensation of a full bladder, and it is vital to keep your bladder empty during and after childbirth.
- It is important to discuss all options, pros and cons with your midwife.
Blog written by midwife Aliza Carr from Bumpnbub. Beautiful image by @lophotobirth