Pain relief in labour

Pain Relief in Labour

It is difficult to know before how you will best manage your labour. The midwife who is caring for you should be the best person to give you advice. Here is some information about the main methods of coping that are available at the Royal Surrey County Hospital.

Simple Self-Help Methods

A supportive companion is invaluable. Relaxation is important so bathing in warm water, massage, particularly having your back rubbed or lightly stroked,  the use of a birthing ball and staying active wherepossible during labour can help, allowing labour to progress and to feel less intense. Music can also be helpful.

Calm breathing can increase the oxygen supplied to your muscles, and so make the labour feel less intense. Also, because you are focusing on your breathing, you may be less distracted by the pain. Some mothers find aromatherapy, hypnosis, homeopathy and reflexology very helpful. Ask your midwife about these simple methods.  (see our classes for more information on our hynobirthing preparation classes)

Hydrotherapy (Water Pool)

We have a 3 birthing pools available at the Royal Surrey. 2 within our Midwifery Led Unit (MLU), for women with uncomplicated low risk pregnancies and a 3rd pool located within the main delivery suite for the use of women who do not meet the criteria for the MLU or their baby requires continuous monitoring in labour (e.g. VBAC).

Many women find that labour in water is less painful and they are better able to relax.

Regardless of whether you use the pool in the MLU or on delivery suit, the midwife will continue to monitor your progress and your baby’s well-being throughout your labour.

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 works by encouraging your body to produce its own natural painkillers, (endorphins) and also by blocking the pain signals, which are sent by the spinal cord to the brain.
  • It is sometimes helpful at the beginning of labour, particularly for backache. If you hire one, you can start it at home.
  • It has no known harmful effects on your baby.

If you choose to use a TENS machine, it works well from early labour and can be used in conjunction with Entonox and pethidine later in labour . To hire a TENS machine please ask your midwife for a leaflet.

Entonox (50% nitrous oxide and oxygen)

Entonox (Gas & Air) is the most commonly used form of painrelief in labour due to it being highly effective and only lasting while you are breathing it in.

Facts about entonox:

  • You breathe this through a mask or mouthpiece.
  • It is simple and quick to act, and wears off rapidly once you stop breathing it in.
  • 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 good for you and your baby.
  • It will not take the pain away completely, but it helps keep you distracted, relaxed and able to focus on your breathing.
  • You can use it at any time during labour.

You control the amount of Entonox you use, but to get the best effect timing is important. You should start breathing Entonox as soon as you feel a contraction coming on, so you will get the full effect when the pain is at its peak and most intense. Do not use it between contractions or for long periods as this can make you feel dizzy and tingly. 

Pethidine

Pethidine is opiate medication (similar to morphine) given by a midwife as an injection into a large muscle in your leg.

  • It starts working after about 10-15 minutes and may last up to 4 hours.
  • Many mothers find it makes them more relaxed and less worried about the pain, allowing them to rest. It is particularly affective in early labour or for women who have had a long latent phase.
  • Some women are disappointed with the effect of pethidine and say they feel less in control.
  • Pethidine will generally make you feel sleepy.
  • It may make you feel sick, but you are usually given an anti-sickness medication to stop this.
  • It may slow down your breathing. If this happens, you may be given oxygen from a facemask and have your oxygen levels monitored.
  • Given late in labour it may also make your baby drowsy and less interested in an early breastfeed. Though uncommon, it can make your baby slow to take its first breath, but an injection can be given to your baby to stop this.

Epidurals and spinals

Epidurals and spinals are the most complicated but most effective method of pain relief and are carried out by an anaesthetist. This is a doctor who is specially trained to provide pain relief and to give drugs that make you go to sleep.

  • Epidurals are given into a very small tube that the anaesthetist places in your back.
  • Epidural and spinals involve the insertion of a needle into your back to thread through a small, long plastic tube through which the medication is administered during your labour. The needle is then removed and the tube taped to your back.
  • You do need to sit very still during the procedure, consequently the further on in your labour you are, the less likely it is to be successfully put in or have time to work.
  • Once inserted, it takes the medication 20-30 minutes to start working and can be effective for a minimum of an hour before your midwife can then ‘top up’ your epidural again.
  • Not all epidurals are 100% effective. They do not always remove the sensation of pressure or you can have 1 side or ‘windows’ where you are still able to feel the pain. If this cannot be managed by topping up your epidural, it may need to be put in again by the anaesthetist.
  • They have little effect on your baby, though their is some eveidence to suggest it can also interfer with the initial breastfeed.
  • There is a small risk of a headache and needing a second procedure to correct it after you have birthed your baby.
  • They may cause a drop in blood pressure.
  • They increase the probability of having a forceps or ventouse delivery.

Who can and cannot have an epidural?

Most people can have an epidural, but certain complications of pregnancy and bleeding disorders may mean that it is not suitable for you. Other conditions such as previous back operations or if you are overweight may make an epidural more difficult and take longer to put in place. However, once it is in you will have all the benefits.

The best time to find out about this is before you are in labour and we run an anaesthetic clinic if you wish to see and discuss this with an anaesthetist.

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