Managing pain in labour

Labour and how you experience the pain of labour is very individual.

Your pain can often be managed with relaxation techniques, letting go and trusting that your body knows what to do. Fear, tension and resistance are a normal response when you feel out of control or you are not sure what to expect next. On the other hand, relaxing and trusting your body will help you manage your pain.

Your pain can also vary according to the environment in which you give birth, your support people, whether you’ve had a baby before, the position of your baby as well as your method of pain management.

There are a number of natural and medical methods you can use to manage your labour pain.

• Natural pain relief 
• Assisted non-medical pain relief
• Medical pain relief

Natural pain relief

Active birth

Active birth, or moving around and changing positions, is one of the most important things you can do to manage the pain of labour and birth. Being able to move freely can help you to cope with the contractions. If you stay upright, gravity will also help your baby to move down through your pelvis.

Heat and water can also help to ease tension and backache in labour. Both hot and cold packs are useful, as is being immersed in water in either a shower or a bath. 

Touch and massage can reduce muscle tension as well as providing a distraction between and during contractions. Practice with your partner during your pregnancy and find out how you like to be massaged.  Sometimes during labour massage will feel good and then it might be suddenly annoying (which is important for your partner or support person to know).

Similarly, some women use music during labour. Music is a good distraction and can be very relaxing but it can also be suddenly and unexpectedly annoying. Be prepared for any eventuality.

Complementary therapies, such as acupuncture or acupressure, can also be very effective but should only be practised by qualified practitioners.

Labouring and birth in water

These days, many hospitals are set up to allow you to labour in a bath. Many women will find that this helps with relaxation and pain management. Some hospitals also make it possible for women to stay in the bath for the birth. This will usually depend on the availability of a midwife or obstetrician who is trained in water birth and whether your birth is progressing without any problems. The midwife needs good access to your baby during the birthing process and needs to be able to get you out of the bath should there be any problems. If these conditions are met, then water birth is very safe.

Assisted non-medical pain relief

TENS or Transcutaneous Electrical Nerve Stimulation

The TENS machine is a small, portable, battery-operated device which is worn on the body. The box is attached by wires to sticky pads that are stuck to the skin. Small electrical pulses are transmitted to the body, like little electric shocks. There is no harm is using a TENS machine and many women find it helpful.

Intradermal water injections for back pain

Many women have lower back pain that persists throughout their labour. Midwives can use a technique involving sterile water injections in the lower back.  Usually injections are given in four different places in your lower back, just beneath the skin. The injections cause a strong stinging sensation, like a bee sting. The sting will last for up to 30 seconds before disappearing along with the back pain. The injections can bring up to two hours of pain relief to your lower back but you will still feel the contractions. There is still not enough research evidence to show that sterile water injections are effective in reducing the need for other pain relief. There are no side effects for you or your baby.

Medical pain relief

You and your carers will have discussed your preferences for pain relief long before you go into labour. You can also record your preferences for pain relief in your birth plan. During your labour, the midwife will continue to guide you and work with you according to your wishes. 

Gas

The gas given to women in labour is a mixture of nitrous oxide mixed with oxygen; sometimes known as laughing gas. It helps take the edge off the pain during a contraction. It is inhaled during a contraction through a mask or a mouthpiece. You may feel a little nauseous or light-headed and you may have dry mouth for a short time. There are no after effects for you or your baby.

Morphine

Morphine is a strong painkiller given by injection.It helps reduce the severity of pain, but does not take it away completely. It can take up to 20 minutes to work and effect lasts three hours or more. Morphine is preferable to pethidine because it lasts longer and has fewer side effects. Unlike an epidural, you do not need to have an IV (intravenous) drip, a catheter or CTG monitoring.

Morphine can make you and your baby sleepy. Morphine may contribute to breathing problems in your baby if given within two hours of birth. This is uncommon and the effects can be reversed by giving your baby an injection. Babies who need this injection will need closer observation for a few hours after birth.

Epidural

Epidural is a local anaesthetic, which is injected into your back (not the spinal cord). After an epidural you will have altered sensation from the waist down. You won't be able to walk around but you will still be awake. A very thin tube will be left in your back so the anaesthetic can be topped up. Sometimes the tube is attached to a machine so that you have control over when the epidural is topped up.

An epidural can take away the sensation to pass urine so you will also need a urinary catheter (a thin tube) to drain your urine. You will also need an IV (intravenous) drip inserted into your hand to make sure you are getting enough fluids. A cardiotocography or CTG machine will continuously monitor the baby’s heart and your contractions. Your blood pressure will also be monitored more closely. You may still feel the urge to push, but the sensation is reduced.

The benefits of an epidural are that it takes away the pain of contractions, it can be effective for hours and can be increased in strength if you need to have an emergency caesarean. In a long labour, it can allow you to sleep and recover your strength.  If a woman’s blood pressure is high an epidural might be recommended as it can reduce hypertension.  

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