Childbirth - pain relief options

Childbirth is usually a painful experience. Some women are keen to avoid drugs or other medical interventions, while others are happy to consider all available options. For a woman having her first baby, the experience of labor, and her reaction to it, can be hard to predict.

For this reason, it is a good idea to learn about the pain relief options that are available before labor begins. You may have a plan for how you hope to manage your labor, but it is best to stay flexible. Research suggests that good preparation can help to reduce pain, or at least change how pain is perceived, which can help you cope better with labor.

Non-drug pain relief options#

Being in good physical condition is helpful, and knowing what to expect during the various stages of labor can reduce anxiety. Attending antenatal classes is strongly recommended.

Other approaches that many women find useful include:

• breathing techniques to help you ‘ride the waves’ of each contraction
• constant, close support from your partner, or a trusted friend or loved one, throughout labor to reduce anxiety
• distractions such as music to help take your mind off the pain
• hot or cold packs, massage, a warm shower, immersion in a warm bath, and staying active
• approaches such as acupuncture and acupressure, which have not been widely studied but may be considered

Transcutaneous electrical nerve stimulation (TENS) is a technique in which nerves in the lower back are stimulated using a small hand-held device controlled by the woman. It has no known side effects for mother or baby, and many women find it helpful, either on its own or combined with other methods of pain relief.

Medical pain relief options#

The three main medical pain-relieving options for labor are nitrous oxide, pethidine and epidural anesthesia.

Nitrous oxide#

Nitrous oxide, known as ’laughing gas’, is mixed with oxygen and given to the mother through a face mask or a tube held in the mouth. The gas takes a few seconds to work, so it is important to start breathing from the mask as soon as a contraction begins.

Nitrous oxide does not stop the pain entirely, but takes the ’edge’ off the intensity of each contraction. Many women prefer it because it gives them direct control: you can hold the mask yourself and take deep breaths whenever you feel the need. It does not interfere with contractions and does not linger in either the woman’s or the baby’s body.

Possible problems with nitrous oxide include:

• limited pain relief in some cases, and no pain relief at all for around one-third of women
• nausea and vomiting
• confusion and disorientation
• a claustrophobic feeling from the face mask

Pethidine#

Pethidine is a strong pain reliever, related to morphine. It is usually injected directly into a muscle in the buttock, but may also be given intravenously (directly into a vein). Depending on various factors, the effect can last anywhere from 2 to 4 hours. Pethidine can make you feel sick, so anti-nausea medication is usually given at the same time.

Possible problems with pethidine for the mother include:

• limited pain relief in some cases
• giddiness and nausea
• disorientation and altered perception
• reduced breathing (respiratory depression)

Possible problems for the baby include:

• exposure to the drug through the umbilical cord
• reduced breathing (respiratory depression) at birth, particularly if several doses are given or the baby is delivered soon after an injection; this can be reversed by an injection given to the baby
• a temporarily depressed sucking reflex and other reflexes

Debate continues over the effects of pethidine on newborns.

Epidural anesthesia#

Epidural injections are the most effective pain relief available. They are used for vaginal births and also for cesarean sections, because they allow the mother to stay awake and alert during the birth. Anesthetic is injected into the lining of the spinal cord through the back, which makes the mother feel numb from the waist down. Your baby’s heart rate will be monitored continuously.

Possible side effects and complications of epidural anesthesia include:

• the anesthesia may be incomplete, so you may still feel some pain, and the procedure may need to be repeated
• your blood pressure may drop after the epidural is inserted, causing you to feel faint and nauseated; this can also stress your baby, and is treated by giving intravenous fluid
• muscle weakness in the legs, so you may be confined to bed
• loss of sensation in the lower body, meaning you cannot tell when you need to urinate; a urinary catheter is inserted in most cases
• a longer second stage of labor, which reduces the likelihood of a normal vaginal delivery; if you are unable to push effectively, the baby may need to be delivered by forceps or vacuum cup
• headache immediately after the procedure, in around one per cent of women
• itchiness, which can usually be treated with antihistamines
• pain or tenderness where the epidural was injected
• ongoing patches of numbness on the back near the injection site, in around one in 550 women

Very rarely, complications include infection, blood clots and difficulty breathing, and an epidural can increase the length of the first stage of labor and the likelihood of a cesarean section. An epidural does not cause long-term backache.

Key points#

• There are several non-drug pain relief options, and being in good physical condition is helpful.
• The three main medical pain-relieving options for labor are nitrous oxide, pethidine and epidural anesthesia.
• With nitrous oxide, it is important to start breathing from the mask as soon as a contraction begins.
• A drop in blood pressure from an epidural can also stress your baby.
• An epidural does not cause long-term backache.

Where to get help#