Pain relief options in labour
Has anyone ever said this to you upon finding out you're pregnant? "Oh as soon as labour starts, just take all of the drugs" planting the seed that birth is intolerable and impossible without outside assistance and interference from the get go. It's a phrase we hear thrown around all of the time, but do you even know what pain relief options are available to you during labour? Do you know their risks and their benefits? Do you know the alternative non pharmacological pain relief methods of coping with labour sensations? Read on to find out.
I'm going to start by taking about the pharmacological pain relief options that are on offer to you during labour (in the UK at least), I'd like to say here that I am categorically not against using any these drugs to help you birth your baby and I will give as rational a description as possible. Whether you want to birth your baby pain relief free or with every drug going there's absolutely no judgement here, as long as you and only you have made that decision yourself and feel confident and informed in your choice to do either.
Let’s start at the very beginning: Gas and Air (Entonox)
What is it: A colourless, odourless gas you can breathe in through a mouthpiece or mask.
What does it do: The pain-relieving effect is caused through the release of the body's own opioids, so it has a similar effect to morphine but it is incredibly short lasting, ideally you’d take a deep breath of it at the beginning of a contraction to feel the benefit at the peak, then within minutes it will wear off.
Where can you have this: Anywhere really! Hospital, midwife led unit (attached or freestanding) and even at home, the midwives attending you will bring canisters in their car.
What are the benefits: It doesn’t harm baby in any way, there are no serious risks to birther, if you change your mind it wears off quickly, no medical procedures needed to administer it, you control how much you take.
What are the cons: It can make you feel a bit sleepy, nauseous or dizzy, wears of quickly (good for if you have an adverse reaction, but can be annoying to keep taking it over and over), makes your lips incredibly dry so pack a lip balm in your birth bag if you’re considering trying it out.
Pain killing drugs: Opioids such as pethidine, diamorphine and meptid
What is it: Opioid drugs are pain killers, usually administered by injection into the thigh.
What does it do: The drugs work to alter your mood during labour to make you either more relaxed and better able to deal with the pain, or go to sleep and rest.
Where can you have this: In the hospital or in a midwife led unit, they may be available at a home birth if requested in advance but check with your trust.
What are the benefits: They can relieve some of the pain, however a systematic review found that “while pethidine is known to alleviate labour pain for some women, the quality of evidence is low”.
What are the cons: They pass through to the baby and can cause respiratory depression and drowsiness which may last several days, in the birther they can induce involuntary muscle spasms, cause drowsiness vomiting and dizziness, and can slow down breathing which may require you to need oxygen. You can’t use a birthing pool or water for at least 2 hours after taking them and they can make breastfeeding more difficult immediately after birth as babies ability to suckle effectively may be affected, as well as birthers' oxytocin levels being disrupted which can affect the flow of milk.
Local anaesthetic: Epidural and spinal
What is it: A local anaesthetic and painkiller administered through a fine tube into the back
What does it do: Epidurals work to numb the nerves to stop you feeling the sensations of labour, you can choose to either get completely numbed or to take a lower dose allowing you to remain mobile whilst still feeling some of the sensation
Where can you have this: Only in the hospital on a labour ward as an anesthetist is needed to administer it
What are the benefits: Thought to be the most effective form of pain relief for labour, the dose can be controlled so you can start off weak and top up if needed, can help you feel back in control of your labour if you are finding it difficult to cope before having one, they have no direct effect on the baby
What are the cons: They carry risks including - causing low blood pressure, making it difficult to pass urine (which can make it harder for baby to descend), bad headaches, increased temperature, temporary nerve damage and depressed breathing as a result of the opioid pain killer included. If you are unable to move from a back lying position this in itself comes with it’s own risk as space in the pelvis is drastically reduced and you are unable to adopt active birth positioning. There is also a high chance of needing a synthetic oxytocin drip after having an epidural which again comes with a whole host of risks including being more likely to need further interventions and affecting breastfeeding, bonding with your baby and becoming more likely to suffer from PND. You also cannot have them too early in labour or too late so you need to find the sweet spot in between!
So, I hope that’s given you a lot to think about, if you’d like any more information on pharmacological pain relief options then speak to your midwife or GP, or have a look on the NHS website. You can never be too informed! Now let’s have a look at non pharmacological pain relief options.
Transcutaneous electrical nerve stimulation machines are hand held devices which send mild electrical impulses to your back via sticky pads. They are thought to work by blocking pain signals in the spine, as a distraction technique, and by building up endorphins (your body's natural pain killer), most models come with a “boost” function which can be used during contractions to make the impulses even stronger too. They can be used by anyone, anywhere except in a pool or any other water, and don’t cause any side effects or come with any risks but some people do find them incredibly annoying and/or don’t feel the benefit.
On that note if you would like to try a TENS machine I have a lovely little discount code for you!
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Water can be a huge source of comfort during labour, get in a birth pool, the bath, or hop in the shower and aim the shower head at the place of your body that is feeling the most pressure.
Sacral counter pressure or a hip squeeze consists of your birth partner, doula or midwife applying steady, continuous pressure to one area of your back or hips. This can help to alleviate back pain and pelvic pressure.
Breathing techniques & other hypnobirthing tools
Breathing exercises improve the cardiovascular system, energise us, calm the nervous system and release muscle tension which are all incredibly important for straight forward labour, combined with hypnobirthing techniques which have been proven to contribute towards higher chances of successful vaginal deliveries.
Movement & gentle exercise
Gentle exercise and movement such as swaying, walking, dancing, and yoga can help relieve pressure in the pelvis, encourage baby into optimal positioning and can act as a distraction technique.
Active birth positioning
As above, active birth positioning can relieve pressure and encourage babies positioning, it can also help to create more space within the pelvis which can sometimes contribute to lower levels of pain compared to people delivering their baby for example laid on their back with less space available.
Bringing warmth to the body signifies safety and brings us out of the adrenaline controlled fight or flight response which contributes to the fear-tension-pain cycle which affects how we cope with the sensations of labour,, you could try things like popping a rice bag or hot water bottle on your back or popping on a dressing gown, on the flip side of this bringing coldness to the body e.g popping ice on pressure points or a cold flannel on the forehead distracts the mind which can again break the fight or flight response.
Light touch massage
Light touch massage works on two levels, first of all it creates oxytocin - the hormone which stimulates the uterus to contract also known as the love hormone, feeling loved up and full of oxytocin helps interrupt the aforementioned fear-tension-pain cycle. It also creates endorphins which are your body's natural pain killers! They have a calming and pain reducing effect, the best thing about them is that you can build them up during early labour and your body will store them to use further down the line, clever, right?!
Aromatherapy is using essential oils either in massage, inhalation, in the air through a diffuser or in water e.g the bath, different blends have different properties and can be used to calm the mind and the nervous system. Clinical trials have proven that using lavender in your blend during labour offers pain relief as well as being soothing and comforting.
Can you think of any more? Let me know in the comments what you’ve found useful during your labours x