Pain Relief during Labour: Your Options
Natural childbirth has gained in popularity among women over the last few decades, partially out of concern for how drugs might affect the newborn, and partially out of a desire to have the full experience of giving birth. But as anyone who has given birth -- or been in attendance when a woman gave birth -- can attest to, labour can really hurt! Most hospitals offer several methods of pain relief to labouring women. What method is used is generally left to the judgement of the mother-to-be, unless medical reasons prevent you from using your method of choice. Each option has advantages and disadvantages, so it makes sense to be well aware of what your options are before you head to the maternity ward.
In early labour, before the pain becomes great, natural methods can help alleviate the discomfort of contractions. Some women give birth using only the natural methods, but most find this form of pain relief insufficient once labour progresses and contractions become frequent and intense. Natural methods for relieving pain during labour include special breathing techniques, meditation, aromatherapy and, of course, 'grin and bear it'. With the exception of the last method, these techniques help you to relax your body and distract you from the pain.
TENS, which stands for Transcutaneous Electrical Nerve Stimulation, is a drug-free method of pain relief used to treat chronic pain, as well as to ease the pain of labour. Instead of medication, TENS utilizes a machine that sends electrical impulses to pads placed on your back. It is not well understood how TENS relieves pain, but it is thought to interfere with the transmission of pain signals as they travel to the brain. TENS may also prompt your brain to release endorphins -- your body's natural painkiller. TENS can be quite helpful during early labour, but seems to lose its effectiveness as contractions become more intense.
Gas and Air (Entonox)
Entonox is a mixture of nitrous oxide (laughing gas) and oxygen. It is administered through a breathing mask that you may remove and replace as needed during labour. The gas may cause you to feel dizzy, light-headed, or nauseous, but these side effects usually disappear within a few minutes of removing the mask. Entonox can reduce the amount of pain you feel during contractions, but it does not provide complete relief. Nitrous oxide does pass through the placenta and into the baby's bloodstream, but it does not seem to cause any ill effects.
Opioid painkillers (similar to morphine) can be injected into a muscle to relieve pain during labour. If the pain is very severe, some hospitals may administer painkillers through an IV, although this practice is uncommon. Doctors usually use one of three painkillers to relieve pain during labour: diamorphine, pethidine, and meptazinol. Ironically, the strongest of these (diamorphine) can only be used in early labour because there is a risk the baby may have trouble breathing if it is given shortly before birth. Pethidine may be used in early and middle labour, and meptazinol may be used at any time before the mother commences pushing. These drugs are passed to the baby, but are unlikely to cause problems unless the birth takes place much sooner than anticipated. Any problems that do arise are easily treated with an injection of an opioid antidote.
Painkiller injections are notorious for the side effects they cause in the mother-to-be. These include a feeling of euphoria, light-headedness, sleepiness, and nausea. A dose of anti-nausea medication is usually provided at the same time as the painkiller is injected. This has the added bonus of enhancing the painkilling effect of the opioid medication.
The epidural is, without a doubt, the most effective method of pain relief during labour. In this method, an anaesthetist injects a tiny dose of one or more drugs into the mother's back. Since the drugs go directly to the nerves of the lower body, they are less likely to cause side effects than other medicines for pain relief. The dose used is so tiny that it does not cause effects in the newborn, even if the epidural is left in place during the pushing phase of labour.
Depending on the type of epidural you receive, you may or may not be able to get out of bed during labour. Standard epidurals tend to make your legs feel quite heavy and numb, but mobile epidurals may allow you to walk a bit. For most women, these side effects are a small price to pay for near-total pain relief.