Pain relief options

Labour can be categorised into the latent phase of labour and the active/established stage. The pain relief options will be slightly different for each stage.

The Latent Phase

This is the early phase of labour where your cervix will be softening and getting ready for established labour.  You may experience some period type discomfort and irregular tightening’s, the sensations you feel will most likely be in your lower abdomen and lower back as your cervix softens.

For this stage of labour, there are lots of things you can do to help yourself feel more comfortable:

• Use a hot water bottle on your lower abdomen or back
• Soak in a warm bath, if its helping just keep topping it up with warm water
• Stand in the shower and hold the shower head over your stomach or back
• Keeping mobile, women tend to report being upright is more comfortable
• Massage, ask your birth partner to massage or apply pressure to your lower back
• Paracetamol

Every woman experiences this phase differently.  If you are really struggling to cope at home, please phone triage and discuss your situation with a midwife.  If you feel that you need more support and/or pain relief there is the option of being admitted to maternity ward for this.

Pethidine – this is an opioid medicine, therefore it will make you feel very sleepy and relaxed.  It is given as an injection in the side of your thigh. It takes around 15 to 20 minutes to take effect.  It doesn’t take the sensation of the contractions away but it will help you to cope with them and hopefully help you to get some rest if you have been unable to sleep for a long time.  A possible side effect of pethidine is nausea and vomiting, an anti-sickness medication is given at the same time as the pethidine, but this doesn’t always work. Your midwife may ask to do a vaginal examination before giving pethidine, because if it is given close to the birth it can affect baby’s breathing.  If this happens an antidote can be given to your baby at birth.

Established labour/Active phase of labour

This is when your cervix has opened up to at least 4cm dilated and you are experiencing regular, strong contractions.  Pain relief options at this stage are:

Water – we have two birth pools on delivery suite (see water birth section for more information)

Pethidine (please see above)

Entonox (gas and air).  Gas and air is a form of pain relief that you inhale through a mouthpiece. It contains 50% nitrous oxide and 50% oxygen.  It works because it encourages your body to release its own pain relieving hormones.  Once you starting inhaling, it takes around 15-20 seconds to work, therefore you need to start breathing it in as soon as you feel a contraction building. The effects of it leave your body within minutes.  Possible side effects are feeling light-headed and nauseas. It doesn’t affect labour progressing.

Epidural - An epidural is when an anaesthetist inserts a small tube into your lower back which administers local anaesthetic and numbs you from the upper abdomen down to your legs.  In order for an epidural to be sited, you will need to sit on the side of the bed and lean over into a curled position in order for the anaesthetist to feel your back.  A needle will be inserted into the epidural space in your back, the needle will be removed and a small tube will be left in place in order to administer the anaesthetic.  The epidural will then be secured well with dressings.  You will be in control of how much anaesthetic you receive via a hand held device.  It usually takes around 20 minutes for the anaesthetist to set up and then 20 minutes until the first dose is given.  Having an epidural will mean that the baby will need to monitored continuously due to it being a medical intervention.  You will also need a cannula and intravenous fluids will be given, this is because a side effect of an epidural is a lowering of your blood pressure. The IV fluids help to counteract this.

Other possible side effects of an epidural are:

• Low blood pressure for the mother, which could affect the baby.  If you already have low blood pressure, you may be offered an alternative to an epidural.
• Difficulty passing urine. 
• A bad headache that lasts for days or weeks if not treated (one in 100 women).
• An increase in temperature, which may lead to antibiotics if it is a sign of infection. 
• Temporary nerve damage (one in 1,000 women).
• Severe complications (one in 250,000 women).
• Itchiness and depressed breathing as a result of the opioid.
• A longer second stage of labour (pushing).
• Increased chance of instrumental birth or caesarean section.