Coping in labour including pain relief

Lots of women and birthing people find TENS machines very helpful throughout the early and first stages of labour. This is a small machine, about the size of a mobile phone, which is attached to your back using sticky electrode pads. It sends mild and painless electrical pulses through your body which disrupt the nerves that transmit pain. TENS may also boost your body’s natural pain-killing endorphin production.

TENS machines are widely available to hire or purchase online or in some larger retailers. It is important to check the machine you use is designed specifically for labour and pregnancy, as there are many different types.

Using water in labour is known to be a very effective method of providing pain relief and aiding relaxation in labour. This can be done by using a bath or birthing pool.

We have birthing pools available in every room in our BBC, as well as one available on Labour Ward. The water is kept around body temperature and you will be able to move positions and get in and out of the pool as you wish during your labour. Many women and birthing people chose to give birth in the pool, which is a safe option if you and your baby have been well during labour.

If you are planning a home birth we have a small number of inflatable birthing pools that you can loan. Please discuss this with your community midwife if you are planning to give birth at home.

Entonox, also known as gas and air, is a mixture of oxygen and nitrous oxide gas. It is inhaled in through a mouthpiece which you have control of yourself. It can be used when you are in established labour and can help reduce the amount of discomfort you feel from contractions.

You can use Entonox within the birthing pool and you will be able to mobilise whilst using it. There are no harmful side effects to using Entonox for short-term use during labour. Sometimes, you can feel sleepy, light-headed or nauseous when using it. If this happens you can stop using it and the side effects will subside.

Entonox is available in all of our birthing rooms in the BBC and Labour Ward. If you are birthing at home your community midwife will bring a cylinder of Entonox to your home for you to use.

Pethidine is a strong, opioid based drug which is given by injection. The injection is usually given in the thigh or buttocks. It takes around 20-30 minutes to take effect and lasts for up to four hours. Pethidine may help you relax and rest between contractions as well as help you to cope with the pain of labour. It is usually given within the early or first stage of labour.

Pethidine does have some side-effects that need to be considered before you make the decision to have this kind of analgesia. These include: making you feel very sleepy, nausea and occasionally vomiting. Your midwife will offer you an anti-sickness medication at the same time to try and minimise this happening.

Pethidine is known to cross the placenta to the baby and can affect your baby’s ability to breathe if it’s given a short time before their birth. This is why midwives will not recommend you use it as a pain relief option if you are nearing the second stage of labour (the pushing stage). It may also make your baby feel sleepy which can affect your baby’s first feed after birth. If your midwife doesn’t think you have enough time for Pethidine to wear off before your baby is born, it will not be recommended as a pain relief option for you.

Remifentanil is a strong, opiate based drug which is given directly into a vein, using a pump attached to a drip. This means you will need to have a dedicated cannula for this analgesia. The cannula is usually placed in the back of your hand or in your arm.

Remifentanil is known as a “patient controlled analgesia” as you are only given a dose of the medication when you press a button requesting it. It works very quickly and breaks down quickly too. This means that it is only effective for about 2 minutes. The idea is that when you feel a contraction starting, you press the button and this will give you a dose of the medication. The pain relieving effects should last the duration of your contraction. The medication pumps have a program built in which means you cannot overdose on the medication if you press the button too many times. Your midwife will support you with when to time pressing your button.

Some of the advantages of remifentanil are that you can move into different positions and you can continue to use Entonox (however most women find they do not require it). Once you stop pressing the button the drug wears off quickly meaning after birth you will be able to walk around as normal. This pain relief is particularly good for the first stage of labour and is popular with women and birthing people who may not want an epidural.

There are some serious side effects that need to be considered before having remifentanil. As this drug is a strong opioid, as well as being effective pain relief, it can also cause your breathing to slow down and your oxygen levels to drop below normal levels. Whilst using remifentanil your midwife will be with you all of the time and will be monitoring for this. You will be asked to wear a small oxygen saturations monitor on your finger whilst using this medication. If you show signs of this happening, your midwife will administer oxygen to you by a small tube that sits under your nose. This oxygen treatment very quickly returns levels to normal and you can continue to use the analgesia. Due to the short effect of remifentanil, once the drug is stopped it wears of within minutes for you and your baby. Multiple large studies have shown that it does not have any effect the baby when it is born. If you use remifentanil it is recommended that your baby is monitored continuously throughout labour using a CTG machine.

Epidurals are the most effective pharmacological form of pain relief that we can offer at Warwick Hospital for childbirth. The epidural service can only be offered on Labour Ward and by an anaesthetist. An anaesthetist is allocated to Labour Ward at all times.

An epidural is a special kind of anaesthetic that is given into the lower back. It works by numbing the nerves that carry pain impulses to the brain. The medication is given through a very small tube called an epidural catheter that the anaesthetist inserts into your back. To allow you to have a consistent level of epidural anaesthetic throughout your labour and relief from any pain, the epidural catheter is connected to a pump which gives you the right amount of medicine. You will also be given a button to allow you to top-up the medication to maintain your comfort levels throughout your labour.

To put in the epidural, you will be asked to sit on the side of the bed and position yourself in a slouching forward position which will allow the spaces in your back to open and allow the epidural catheter to be inserted.  To insert the epidural catheter safely it is important that you are able to keep still and listen to the instructions provided by the anaesthetic and midwifery team. They will support you to stay calm and remain in a good position throughout the procedure. Epidurals usually provide very good pain relief, however occasionally some women and birthing people find it does not always work fully. If this is the case, sometimes the epidural catheter may need to be repositioned or re-sited by the anaesthetist.

Epidurals provide excellent pain relief during the first stage of labour and can only be given to women and birthing people who are in established labour. Epidurals that are inserted in the second stage of labour are less likely to be effective. Epidural does not take away the pressure that is felt during childbirth but will usually remove the pain associated with it.

After having an epidural it is very common for your legs to feel heavy. Most women are able to move their legs but are not able to walk or support their weight. These symptoms wear off within 60 – 90 minutes following discontinuing the epidural. This means, if you have an epidural it is very likely that you will be required to stay on the birthing bed during your labour. The birthing bed can be adjusted to allow you to move into different positions such as sitting upright and lateral positions. You can also use a peanut birthing ball.

Sometimes, epidurals can cause you to have a drop in blood pressure. Therefore it is important for your midwife to continuously monitor your observations throughout labour. You will also need to have a drip in your hand and continuous fetal monitoring. Most women and birthing people find it difficult to pass urine whilst they have an epidural because of the loss of sensation. Therefore, it is recommended that you have a urinary catheter inserted during your first stage of labour to ensure your bladder is kept empty and protected throughout your labour.

It is also known that epidurals can make the second stage of labour longer and may increase the likelihood of you needing an assisted birth. There are other rarely occurring risks which include severe headaches and nerve damage. Before you have your epidural you will be given an information card with all this information and you will have a conversation with the anaesthetist to ensure you fully understand the procedure and risks prior to having an epidural.

Labour Pains is the public information website of the Obstetric Anaesthetists’ Association. They provide reliable, unbiased information to expectant parents on pain relief and anaesthesia choices for birth that is well worth reading, also available in a wide range of translations.