Towards the end of pregnancy you may feel your uterus tightening from time to time. When labor starts these tightenings become regular and stronger. Sometimes it is necessary to start labor artificially or to stimulate it if progress is slow, and this may make it more painful. This will usually get more severe as labor progresses. Your first labor is usually the longest and hardest. Over 90% of women need some pain relief.
It is helpful to attend antenatal classes in the hospital where you are booked. Understanding what may happen during labor will make you feel less anxious. It is good to visit the hospital where you plan to have your baby. All this will help you to relax and cope better.
Physiotherapists or midwives will teach you control of breathing and ways of helping you to cope with contractions. At these classes you can also learn about the types of pain relief that are used in that hospital. Ask to see an anesthetist (the doctors who provide epidurals, and who can also advise you about other types of pain relief) if you want further advice about certain types of pain relief and whether they may be suitable for you. In some hospitals the anesthetists give regular talks on pain relief to expectant mothers and their partners.
It is difficult for you to know beforehand what sort of pain relief will be best for you. The midwife who is with you in labor is the best person to advise you. Here are some of the facts about the main methods of pain relief that you may be offered.
In early labor.
Transcutaneous electrical nerve stimulation (TENS)
A gentle electrical current is passed through four flat pads stuck to your back. This creates a tingling feeling. You can control the strength of the current yourself. . It is sometimes helpful at the beginning of labor, particularly for backache. It has no known harmful effects on your baby. While you may manage your labor with only the help of TENS, it is more likely that you will require some other sort of pain relief in the later stages.
With stronger contractions…..
Pethidine
Usually given by injection, into a muscle, by midwives. It may make you drowsy, but make you less worried about the pain. It may make you feel sick, but you should be given something else to reduce this effect. It may make your baby drowsy, but an antidote can be given by injection after birth. If pethidine is given only shortly before delivery, the effect on your baby is very slight. It delays stomach emptying . You should not eat you have had pethidine. It may delay the establishment of breast-feeding. It has less effect on pain than Entonox. Though pethidine has less effect on pain than gas, many mothers find it makes them more relaxed and able to cope with pain, though some find it disappointing.
It can also be given directly into a vein for a faster effect, and some hospitals use a machine called Patient controlled analgesia, (PCA) which allows you to press a button to give yourself measured small doses when you feel you need them.
Other injected drugs
Those worth mentioning are diamorphine, fentanyl and meptazinol, which some doctors feel give better pain relief. They act in a similar way to pethidine.
Epidurals
Epidural is given into a very small tube in your back. It is the most effective method of pain relief , performed by an anesthetist. It has little effect on your baby. There is a small risk of headache. Epidurals may cause a drop in blood pressure.
Most people can have an epidural, but certain complications of pregnancy and bleeding disorders may make it unsuitable. If you have a complicated or long labor your midwife or obstetrician may recommend that you have one. In such circumstances it will benefit you and your baby.
You will first need a drip, that is fluid running in to a vein in your arm. This is often necessary in labor for other reasons. You will be asked to curl up on your side or sit bending forwards. Your back will be cleaned and a little injection of local anesthetic given into the skin, so putting in the epidural should not hurt. A small tube is put into your back near the nerves carrying pain from the uterus. Care is needed to avoid puncturing the bag of fluid that surrounds the spinal cord, as this may give you a headache afterwards. There is less than a one in 100 chance of your getting a severe headache after an epidural. It is therefore important to keep still while the anesthetist is putting in the epidural, but after the tube is in place you will be free to move.
Pain-relieving medicines can be given as often as is necessary, or continuously by a pump. While the epidural is taking effect, the midwife will take your blood pressure regularly. The anesthetist and your midwife will also check that the epidural is working properly. It usually takes about 20 minutes to work, but occasionally it doesn’t work well at first, and some adjustment is needed.
Nowadays it is usually possible to provide pain relief without numbness or heavy legs, in other words a ‘mobile epidural’. An epidural should not make you feel drowsy or sick, nor does it normally delay stomach emptying. Occasionally it drops your blood pressure, which is why you have the drip. An epidural may prolong the second stage of labor and reduce the urge to bear down. Occasionally this may result in you having an instrumental delivery, but you are still more likely to have a normal delivery than any other type of delivery. It removes much of the stress of labor, which is good for the baby. Breast-feeding is not impaired, in fact it is often helped.
If you develop a headache afterwards, it can be treated. . Backache is common during pregnancy and often continues afterwards when you are looking after your baby. There is now good evidence that epidurals do not cause long-term backache, though you may feel local tenderness for a day or two afterwards.. One in 2000 mothers gets a feeling of tingling or pins and needles down one leg after having a baby. Such problems are more likely to result from childbirth itself than from an epidural.
If you should need any operation such as caesarean section or forceps delivery, you may not need a general anesthetic, as the epidural can often be used instead. A stronger local anesthetic and other pain-relieving drugs can be injected into your epidural tube to provide an adequate anesthetic for your operation. This is safer for you and the baby.
Spinal
Epidurals are rather slow to act, particularly in late labor. If the pain-killing drugs are put directly into the bag of fluid surrounding the nerves in your back, they work much faster. This is called a spinal. A much smaller needle is used for a spinal than for an epidural, so the risk of headache is small.
In some hospitals spinals, or a combination of spinals and epidurals, are used for pain relief in labor and spinal anesthesia is commonly used for caesarean section.
Entonox
(50% nitrous oxide and 50% oxygen, sometimes known as gas)
You breathe this mixture of gases through a mask . It is simple and quick , and wears off in minutes. It sometimes makes you feel light-headed or a little sick for a short time. It does not harm your baby and it gives you extra oxygen, which may be beneficial for you and your baby. . It will not take the pain away completely but it will help reduce pain. It can be used at any time during labor. You, yourself, control the amount of gas you use, but to get the best effect timing is important. You should start breathing the gas as soon as you feel a contraction coming on so that you will get the full effect when the pain is at its worst. You should not use it between contractions or for long periods as this can make you feel dizzy .
