14 Feb Pain-relief Options During Labour
Dr Katrina Reid and Dr Manisha Fernando discuss ways in which pain during labour can be managed and reduced.
The process of having a baby includes looking at ways to manage the pain involved in childbirth. There are a range of medical and non-medical pain-relief options, and for many women, knowing about these options in advance can make labour seem less daunting.
Causes of pain during childbirth
There are many causes of pain during childbirth, including uterine contractions, stretching of the tissues in the birth canal and pelvis, and pressure on the cervix, bladder and bowel as the baby moves through the birth canal. Contractions are usually felt as a cramping sensation in the abdomen, groin and back, and generally increase in severity throughout labour.
Factors affecting the pattern and severity of pain
These factors include preparedness (physical and mental) for labour, the size and position of the baby, the size of the mother’s pelvis, anxiety about the childbirth experience, the intensity and frequency of contractions, and the length of labour and associated fatigue.
Ways to prepare for labour
Being well prepared for labour may help to manage pain. Ways to prepare include attending childbirth classes, having regular exercise to help improve fitness and muscle strength before labour, good nutrition, and maintaining a healthy weight during pregnancy to avoid extra strain on your body. Including a partner or support person in your preparations, who will be present during labour, can also help.
Each woman and labour is unique, so pain-relief options will work differently in every circumstance.
It is also good to have a flexible outlook towards these options, as your needs may change during this and subsequent labours.
Pain relief options
Many women hope to be able to manage with non-medical pain relief. Nevertheless, it’s a good idea to be informed about medical pain-relief options, as labour does not always go to plan and some women find the pain worse than they anticipated.
Using medical pain relief during labour is not a sign of failure.
Non-medical pain-relief options
- Changing position or walking/rocking during contractions.
- Using heat packs, or warm water from showering or bathing.
- Relaxation and breathing exercises. Ideally, these should be learnt before labour.
- Massage from a partner or support person.
- Self-hypnosis, music or meditation. These can help women to relax and focus, but require training and practice before labour.
- Transcutaneous electric nerve stimulation (TENS). This involves an electrical current applied to the skin with the aim of providing pain relief. TENS machines are also useful in early stages of labour when women might still be at home, and can be bought or hired from pharmacies.
Medical pain-relief options
- Nitrous oxide and oxygen. This gas mixture is inhaled through a mask or mouthpiece. It works rapidly, but wears off quickly, and for this reason is generally used throughout contractions. It’s not known to have harmful effects on the baby. Side effects may include nausea, dry mouth and a tingling feeling in the hands or around the mouth.
- Oral pain-relieving medications. These may be useful in the early stages of labour, but are not commonly used once labour is established.
- Sterile-water injections. These are used for back-pain relief only (they won’t help with contraction pain), and since they are a relatively new procedure, may not be available at some hospitals/birthing centres. The procedure involves a small amount of sterile water being injected under the skin at four locations on the lower back. The injections can be repeated as needed throughout labour.
- Opioid injections. The most common of these are morphine and pethidine, which are typically injected into the thigh or buttock, and pain relief generally lasts a few hours. The advantage of opioid medication is that it is delivered quickly and easily, and doesn’t affect contractions or slow labour. Potential side effects include nausea, vomiting and drowsiness, and for this reason it is often combined with anti-nausea medication. As well, some of the medication can pass through the placenta and cause drowsiness in the baby on delivery. Opioid medication occasionally may slow the baby’s breathing after delivery (especially if an injection is inadvertently given close to the time of delivery), but this can be dealt with by your obstetric caregiver.
- Local anaesthetics. These are sometimes injected near the lower vagina or into the perineum shortly before the birth, numbing the area if an episiotomy is needed or there is a vaginal tear requiring stitches. They don’t relieve contraction pain.
Pain relief requiring an anaesthetist
All regional anaesthesia needs to be administered by an anaesthetist. This involves pain relief to one area of the body, which in the case of childbirth, numbs the nerves to the lower half of the body. The two methods are epidural and spinal anaesthetic, both of which involve injections near the spinal cord in the lower back.
Epidurals are a very effective form of pain relief in which anaesthetic can be delivered continuously throughout labour via a tube. Epidurals typically take 10 to 30 minutes to start working, so they may not be recommended if the baby is likely to be born before that time passes.
Spinal anaesthesia is similar to an epidural but involves a one-off injection into the spinal fluid. Since the solution is injected more deeply than an epidural, it can make the entire lower body feel numb and the legs very heavy. This type of anaesthetic works very quickly, and can last for a few hours, but unlike an epidural, cannot be topped up. It is often used for caesarean section or instrument-assisted deliveries.
Regional anaesthesia generally provides excellent pain relief without drowsiness, although women may still experience a feeling of pressure as the baby moves through the birth canal. This pressure can be helpful during the second stage of labour (pushing). Epidurals can also reduce many of the body’s stress-related responses to childbirth, such as increasing blood pressure. For this reason it may be recommended for women with particular medical conditions during labour, or if a long or difficult labour is anticipated.
Complications from regional anaesthesia
It’s also important to be aware of possible complications from regional anaesthesia and to discuss this type of pain relief with the obstetric caregiver before labour. Complications can include:
- A drop in blood pressure. To counteract this, an intravenous drip is inserted to allow fluids and medication to be delivered if necessary.
- Heaviness/numbness in the legs, which may keep women confined to bed during labour and can affect a woman’s ability to push effectively in the second stage of labour.
- Uneven distribution of pain relief. The anaesthetist can usually correct this.
- A leak of spinal fluid from the insertion site, which can cause headaches. This usually resolves by itself, but sometimes needs treatment.
- Serious complications are rare, but can include infection around the insertion site, and temporary or (more rarely) permanent nerve damage. Discuss these risks with your anaesthetist.
Many women make decisions about pain relief during labour that they then choose to abandon at the last minute, often for very good reasons.
Your ability to endure the pain of childbirth has nothing to do with your worth as a mother.
By preparing and educating yourself, you can be ready to decide which pain-management strategies will work best for you.
Note: This article provides general health information and in no way constitutes medical advice. Ideas and information expressed may not be suitable for everyone. Readers wishing to obtain medical advice should contact their own doctor.
Dr Manisha Fernando and Dr Katrina Reid are GP mothers who write about prenatal and pregnancy health.
Words by Dr M. Fernando