Regardless of whether you go into labour naturally or are undergoing an induction of your labour you will still have some level of anxiety and with that anxiety comes the fear-pain cycle; the more anxious you become the more pain you appear to feel.
If you can manage your levels of anxiety then you should be able to cope with your labour pain more effectively. This is not possible for everyone as people feel different levels of pain and anxiety levels, for that reason there are many forms of pain control available to use.
The most amazing thing about labour and birth is not just the birth itself but the way women will instinctively behave, as if they have all read the same textbook. Their behaviour is so similar that midwives are able to relatively accurately pinpoint the stages of labour that they may be in. Those women who become fearful or who have little in the way of emotional support tend to be those who will request pain relief. Those women who have good emotional support and are prepared for labour without fear will use very little pain relief if any.
If you wish to give birth without using strong pain relief then your options are water, TENS heat, massage and relaxation and all of these options should be at least tried first as they are the safest options and you may not need anything else.
Back Rub
Sit down facing the back of a chair and lean forwards.
Just above the crease of your bottom your partner will see a diamond shape.
Ask them to put your thumbs either side of the diamond.
When you have a contraction ask your partner to press firmly with both thumbs until the contraction has stopped.
They can also use the heel of their hand on the same area.
Occasionally women find it increases their pain. If this is the case ask you partner to stop and use a heat pack or hot water bottle instead
TENS
You also have the option of using a TENS machine and it stands for Transcutaneous Electrical Nerve Stimulation. It works by interfering with the pain message from the sensory nerves through your spine to your brain. You’ll notice it as a buzzing, warming feeling on your back and you can safely use it at any time in your pregnancy and labour just remember to take it off before you get in the bath. There is an old midwives and nurses saying that ‘pain is what the patient says it is’ in other words if you can feel pain and need pain relief, no matter what stage of labour you are in your midwife will accept that and provide you with what you need.
That in itself however can be a problem. As midwives we have spent many years ensuring that women receive pain relief when they want it regardless of the stage of labour they are in. If you come into hospital in the early stages of labour in pain your midwife may offer you strong pain relief that you cannot get at home in the mistaken belief that you have exhausted these simple methods at home. On the other hand, if your cervix is still one centimetre dilated after two days of contractions, that you are no longer coping at home and you feel that you need strong pain relief don’t be put off calling your hospital or midwife. If you explain that you have tried all of the simple methods at home and you need something stronger they will invite you in, if not you simply need to inform the midwife you are speaking with that you are on your way in.
Codeine
Codeine is a form of pain relief usually used in the early stages of labour. It is most often used with paracetamol as this helps your body maximise its effects. It is an opiate of the same family as morphine and is also a controlled drug so it will have similar effects albeit less so. It is given in tablet form, either on its own, with paracetamol or as one tablet also containing paracetamol known as co-codamol. However, recent studies have shown that the separate tablets are more effective. As with all opiates they cause constipation so be aware of this after you have had your baby, you may need a stool softener. Other side effects include drowsiness, nausea and vomiting which can all be treated but be aware that the drowsiness can also affect your baby. They do offer pain relief for two and a half to three hours. Codeine will have the same effect on your breathing and that of your baby’s if taken in large enough doses and in view of that may interfere with your baby’s feeding.
Entonox
Entonox (known as gas and air) is an extremely effective form of pain relief especially in the latter stages of labour. It comes in the form of a gas that you inhale and has the benefit of being able to be used during a water birth. It is either available in cylinders, or through a main hospital supply which is attached through the wall. The main benefits of entonox are its ease of use and the speed at which you will notice its effect. Because it is already ‘active’ meaning that your body does not need to do anything with it, it has its peak action thirty seconds after using it. It is also breathed out in the same state so its effects are out of your system in around sixty seconds. As it takes thirty seconds to become effective it should be used as soon as you feel the first flutter of your contraction and stopped when the sensation subsides.
Epidural
Apart from spinal anaesthetic which is used in operations, such as caesarean section, an epidural is the only form of pain relief that can completely remove the pain. The medication is given through a thin plastic tube which is inserted into your lower back by an anaesthetist. You will be required to stay very still during most of the procedure and will be sat upright on the bed facing you partner.
The anaesthetist will use sterile equipment so it is important not to touch anything. The procedure itself takes an average of fifteen minutes and you should feel it starting to work after around twenty minutes. Once the plastic tube is in place it will be taped down and attached to a pump which will deliver a set amount of pain killing drug continuously; it will not run out. You will then sit upright to ensure that the medication is evenly distributed and your midwife will begin monitoring your blood pressure and your baby’s heart rate.
Occasionally the medication can cause your blood pressure to drop and if this happens you will be laid flat and moved onto your left hand side. You will be given fluid into a needle in the back of your hand and after a few minutes your blood pressure should normalise. During that time it is usual for your baby’s heart rate to drop and this should also recover before six minutes. Providing there were no concerns about your baby’s heart rate before this it shouldn’t cause great concern.
For one in ten women the epidural is only partially effective or not at all. In these cases you may be given a higher dose of medication or the anaesthetist will either move or reinsert the plastic tube in your back. During the time that the epidural is working your midwife will keep a close eye on your blood pressure and monitor your baby’s heart rate. If your labour is still classed as low risk then you will not normally require a continuous heart rate trace. Some labour wards offer mobile epidurals while others feel that in order to have a proper effect they require higher doses of medication which leaves you less mobile.
There are disadvantages of an epidural and they include a higher rate of assisted birth including Forceps or Ventouse birth. This is partly due to the effect that it has on slackening your pelvic floor, on the inability of knowing exactly where to push and that you are laying down in bed to push. You may also develop a severe headache sometime after the procedure which may require treatment with something known as a ‘blood patch’. Some midwives will offer to stop the epidural before you begin to push which may allow you to have more sensation of where to push. Whether or not you choose to use epidural as a form of pain relief is up to you and no one should influence that decision. Remember, although one of the disadvantages of having an epidural is an increased risk of assisted birth you will be pain free for the procedure.
Diamorphine
This is the general name for heroin and it is an effective form of pain relief but it is ultimately a form of sedation in that it removes you mentally from the pain. It is given by injection into a muscle or, as in morphine directly into a vein. Its side effects include sleepiness, nausea, vomiting and respiratory depression (your breathing becomes less frequent and effective). It also crosses over the placenta and into your baby’s circulation. Depending on when your baby is born he may be very sleepy which may affect his feeding especially if you are breastfeeding and he may need some help with his breathing at first.
Pethidine
Pethidine is a synthetic form of injectable pain relief and offers similar pain relieving effects as morphine. Although it has more side effects its effects do not last as long. Like morphine side effects include nausea, vomiting, dizziness, sedation and respiratory depression.
The labour ward environment can be the antithesis of the perfect environment for labour. The lighting is bright and stark, the rooms are small with little room to mobilise in and the bed is usually the focal point of the room. Midwives have long held the belief that the right environment will provide women with the ability to labour and birth without any intervention or pain relief. In fact many Midwifery Led Units are modeled around a home from home environment.
We cannot escape from the fact that home is the best environment to labour in. It is where you feel safe and secure and you have access to all your home comforts. It is also the place where you are in control and any member of staff would be a guest in your home. You then have to leave this warm, safe environment where your body is attuned to your surroundings and enter a very noisy, cluttered and clinical environment. You also become a guest in the hospital, however psychologically it does not have the same effect as a stay in a hotel would.
Your body is now fighting the urge to return to your home. It is primitive instinct is a feeling of unease and it is primed to leave. When you first arrive in hospital you will notice that your contractions will not feel as frequent as strong or have the same intensity as before. Thinking back you will realise that they have slowly diminished since you left your home. On your arrival in hospital your midwife will ask you how often your contractions were coming or how far apart they were. It is now you will realise that they are probably half as frequent as they were and no longer require the pain relief that brought you in. Don’t worry, this is a normal response, in fact it may benefit you that your contractions are no longer as strong or that you no longer feel that you need pain relief. It may be that you just need some time to adjust to your knew environment and feel safe and supported by your midwife.
It is worth bearing in mind that if you are on labour ward it is because you are in active labour. By its very definition your cervix will be dilating now and it may be that it has dilated more quickly than you imagine. In view of this you should avoid fixating on the dilatation of your cervix when you arrived. It really is just a number and it is not uncommon for women to dilate eight centimetres in ten minutes whether it is their first baby or their fourth. Before you decide on pain relief it is also worthwhile giving your body time to produce more quantities of endorphins to combat the pain, as with oxytocin it too has to work its way back into your system so be patient. Just as you noticed the return of your contractions, given time you will notice that they become easier to cope with. Change position regularly during that time and try to focus on your breathing and relaxing your shoulder and neck muscles. Think of your new baby and his first feed, the colour of his hair. Think of the first time you take him outside to meet the world or introduce him to the rest of his family.
Waiting for your natural pain killers to become effective will not take long but if you focus and fixate on the pain it will seem like an age. If you need to don’t be afraid to tell your midwife your fears and she will also help you through this time. If you find that the sensation and intensity is increasing it is probably because you are reaching the end of your pregnancy. You may only have a few hours or minutes of it left so enjoy it.
