Pain relief at the birth: the options

It is important to remember that what we see on TV is not always representative of real life and not to make assumptions based upon edited and dramatized television programmes about how it will be for us.

Pain in labour is a tricky subject – the reality is the experience of pain varies tremendously from one woman to the next. There are lots of choices about how to minimise or cope with labour pain, from things you can do easily at home to drugs which need to be prescribed at the hospital (and a lot more in between!)

It is useful to discuss in advance the pros and cons of various types of pain relief, and if you plan to use coping techniques, have practised using them as much as possible in the run-up to labour. This will help you to make informed choices about anything you definitely do or don’t want to use, and give you confidence in any skills you do wish to use. These should all go on your birth plan so that you can communicate these wishes with your midwife.

Birth plan: what’s that all about?

What is my role in regards to pain relief?

Just being there and giving her your support makes a world of difference; whether that’s holding her hand or communicating the birth plan for her.

• If you are asked about something make sure you stick to her wishes and follow the plan. If she has chosen a natural birth, don’t start suggesting she has an epidural at the first groan.
• Research shows that women whose partners are there supporting them during the delivery feel less pain, end up taking less medication and feel more positive about birth experiences than women whose partners don’t participate.
• If you can help to keep the environment as relaxed as possible, you can help her to cope with the pain. Keep the lights dimmed, voices low, play some soft music and stay with her.

Being at the birth: the pros and cons

When it comes to pain relief, there is so much choice – here are the highlights:

Option 1: Natural techniques – breathing, hypnosis, meditation

Labour does not necessarily always mean unbearable pain and there are now numerous antenatal classes designed to support women to learn techniques to aid a more comfortable labour and birth by learning techniques such as breathing techniques, relaxation exercises, massage, and so forth.

Research classes such as Natal Hypnotherapy – while these are usually not free, do often have fantastic results: www.natalhypnotherapy.co.uk

PROS

• The great thing about these techniques is that you can use them from the moment labour starts (you don’t need a midwife or doctor to access them).
• Using this form of pain relief doesn’t stop you using anything else available
• Your partner can use them anywhere – at home, in the car, etc.
• Your partner can still keep mobile and move around as she needs
• If your partner decides she wants additional pain relief, these techniques can be really helpful for while she has to wait, as pain relief like epidurals are not always immediately available if the anaesthetist is elsewhere in the hospital or in theatre, and take a while to administer.
• You are likely to meet other like-minded parents to be at classes, which can be great for building confidence about birth and building a support network. 

CONS

• Your partner will need to be prepared to practice what she learns so that it really works effectively on the day, so this is important to consider that she needs to invest time and practice.
• Attending classes to learn the techniques may cost money.

Option 2: Water

It might seem too simple to be true but warm water can have a massive relieving effect in labour. In fact, evidence has shown that women who used a water for labour felt less pain, were less likely to use drugs, or have an epidural. Indeed, using warm water has been shown to be the next most effective form of pain relief to an epidural!

If we think about it for a while, it makes sense, we often take a hot bath to relax, or to help with any aches and pains, such as back or stomach ache!

PROS

• Your partner can stop using water at any time if she doesn’t like it – she can just get out of the water! She can use it for part of her labour or all of it. She can give birth in the water, or get out of the water to birth. There are lots of choices.
• If using a decent size birth pool, your partner can still keep mobile and move around as she needs
• There are no lasting side effects
• You can hire a birth pool so you can use water easily at home.
• It is an effective form of relaxation

CONS

• Water may not always be easily accessible – if there isn’t a pool available where you are giving birth for instance, or someone is already in it!
• In some higher risk pregnancies, you may also be discouraged from using a birth pool.
• Hiring or buying a birth pool to use at home can cost money

Option 3: TENS

TENS stands for transcutaneous electrical nerve stimulation. A maternity TENS machine basically consists of a hand-held controller which connects via leads to sticky pads which are placed on your partner’s back. 

The machine gives out little pulses of electrical energy. It is not known exactly how the TENS works to helps women to cope in labour, but one theory is that the electrical pulses may stimulate the body to release endorphins, the body’s natural inbuilt painkiller. 

PROS

• Your partner can still keep mobile and move around as she needs
• Your partner is in control – she can use it for as long as she wishes, and take it off when she chooses.
• There are no lasting side-effects, and it is safe for mum and baby
• You don’t need a midwife or doctor to use it
• You can use it at home
• It’s easy to use (provided you have both read the instructions in advance!)

CONS

• Your partner will probably need someone to help to position the pads onto her back.
• It may only help in early labour.
• There is usually a cost to hire a TENS machine
• Your partner may need to stop using it if your baby’s heart is to be monitored
• If your partner wants to get into a birthing pool or bath, she cannot use the TENS in the water.
• It can make it more difficult to massage her back.

Option 4: Entonox

Entonox, also known as gas & air, is a mixture of laughing gas (nitrous oxide) and oxygen taken through a mask or mouthpiece.

Gas and air is usually available wherever you have both chosen to give birth. If you are somewhere where there is not a regular supply (for example, at home) the midwife can bring it with her in a portable cylinder.

PROS

• It is fast-acting and easy to use.
• Your partner can control how and when she uses it – if she doesn’t like it, she can stop.
• It doesn’t stay in her system. Within seconds of her stopping, it leaves her system and any side-effects will stop.
• It can help take the edge off contractions
• It can give her a sense of focus
• It’s safe for baby 
• Your partner can use if she is labouring in water

CONS

• It’s only a mild painkiller, so it might not give the relief your partner would like
• It can make your partner feel drowsy, light-headed or nauseous
• It may give her a tingling, pins and needles sensation
• You need to hold a mask or mouthpiece to use it, which can become difficult for your partner is she is trying to move around

Option 5: Pethidine

Pethidine is part of the opiate drug family – a painkiller which also has properties to aid relaxation by its ability to mimic endorphins. It is administered via injection.  Sometimes Diamorphine or Meptid will be used instead of Pethidine, but for the same effect.

Painkilling drugs such as Pethidine should be available wherever you give birth, including at home. 

PROS

• A midwife can administer it, you don’t need a doctor
• It can help mum to relax and rest.
• Some women really find pethidine helpful
• It may help mum to avoid having an epidural
• It can be used at a home birth.

CONS

• Opiate drugs such as pethidine are found to be unpleasant for one in three women, and the side-effects they experience may make it more difficult for them to cope with labour than before
• If your partner doesn’t like how the injection makes her feel, there is no way of making it stop, she has to wait for it to leave her system, which could be hours.
• You can’t have it and use a birth pool
• It can make women feel nauseous, dizzy or make them vomit
• It can affect your baby’s breathing if given too close to birth, so they will need monitoring afterwards
• It may be more difficult to get breastfeeding started. This is because pethidine has crossed the placenta to baby, and may make them feel drowsy for several days as well as affect their rooting and sucking reflexes.
• It takes 30 minutes to work, so mum will still need other coping methods while she waits 

Option 6: Epidural

During an epidural, painkilling drugs are passed into the small of the woman’s back via a fine tube by an anaesthetist. It is a regional anaesthetic, so the drug works on the local nerves to numb the region around your partner’s abdomen.

PROS

• It can be a very effective form of pain relief
• Your partner will feel less pain, and often, no pain.
• If your partner has high blood pressure, it can help to lower it. So in some cases, this can increase her chances of having a vaginal birth.

CONS

• For about 1 in 8 women, the epidural doesn’t work adequately and only numbs parts of the abdomen, which for some women may be harder to manage as they will now be immobilised
• Though it works fairly quickly once it has been set up, your partner may have to wait until an anaesthetist is available to do it. This could be minutes or hours depending on their availability.
• An epidural is not quick to administer either. It can take up to 20 minutes to set up the epidural, and then the same time again for it to work, which is a lot longer than most other types of pain relief.
• It may make your partner feel shivery, or she may develop a fever.
• Your partner will need to stay in bed, as her legs are likely to feel very weak or heavy.  
• It can affect your partner’s ability to wee, so she may need a catheter until the epidural has worn off after the birth.
• She will need monitoring to make sure her blood pressure and your baby are both ok
• Your partner is more likely to have labour augmented with a Syntocinon drip Interventions in pregnancy and labour
• The second stage of labour can last longer and your partner may not feel an urge to push.
• There is an increased risk of your baby being born with forceps or ventouse or by Caesarean.
• There is a 1% risk of mum having a severe headache if the epidural needle punctures the bag of fluid that surrounds the spinal cord.
• There is a very small risk of nerve damage, causing a numb patch on the leg or foot, or a weak leg.