Thursday, February 17, 2011

Pain Relief in labour

Clients are often scared when it comes to pain in labour, and it is fear of the unknown for those of you expecting your first baby or, even a subsequent baby if the first time around was not a good experience for you.

I am not not going to lie to you, labour is painful but it is not pain that harms you in any way, in fact, it actually tells us your body and you are going through a completely normal physiological process.  

In early labour there are things you can do for yourself to help with the pain.  Rest and sleep in the early stages is important, to save your energy for later when the hard work begins.  You can also soak in the bath or sit on a plastic chair in the shower and let the warm water flow on your back (especially good for backache).  

In established labour
Walking around (being upright) helps gravity bring your baby's head down on your cervix (neck of the womb) to assist in dilatation. 
  • You can get into the warm bath water (see my blog on Waterbirths to see how this helps with pain relief).  
  • Having your support person massage your back can help to take that pressure off your back and help with pain.  
  • Warm packs applied to your abdomen or back can help with the pain, a lot of women find a warm pack very helpful for backache in labour.
When you are in pain and provided you have had no pharmaceutical analgesia, your body will produce its own 'opiates' which are very similar to morphine but not as strong and act as a natural analgesia or pain killer.  The endorphins act on the sensory nerves that carries pain messages to the brain and prevents some of those messages being sent.  For those who have been privileged enough to be with a labouring woman, you will notice a change in her as she goes into her 'own space' as she goes between being awake and asleep.  Michel Odent, a French obstetrician suggests that these endorphins pass from mother to baby, providing 'pain relief' for the baby.

Gas and air or entonox
A combination of nitrous oxide and oxygen.  The labouring woman inhales the gas through a mouth piece at the start of a contraction alll the way through until the contraction finishes.  If the apparatus is used correctly it can provide good pain relief although, the effects of gas and air are short lasting as the woman exhales the gas from her lungs when the contraction has finished.   Side effects are that, for some women it can make them feel nauseous.  

Is a synthetic narcotic drug similar to morphine that is injected in to a vein or buttock during the first stage of labour. It can take 15-20 minutes to take effect and because it can make the woman feel sleepy and crosses the placental barriet, it can make baby sleepy too, so for this reason it is not given within 2-4 hours of birth.  Pethidine does not take the pain away, it sedates the woman to enable her sleep between contractions.
Side effects that it can make women feel sleepy, 'out of it' or 'high.' which some woman like and some do not, although until you actually have the drug, it is difficult to say how it will affect you.  It can make the woman feel nauseous or even vomit, in which case your midwife can give you something to reduce or stop this.  If the pethidine is given near the time your baby is born it can make your baby is sleepy and slow to breathe at birth, the midwife may have to give an antidote called narcan to your baby to reverse the effects of pethidine.  
It can take a few days before the pethidine is eliminated from your baby's body so your baby's may be quite sleepy and slow to suck at the breast.

The anaesthetist sites the epidural which is an injection of local anaesthetic into the epidural space around the spinal cord.  Because there is a complete loss of sensation from the waist down, means that you will be confined to the bed.  Advantages are that it is a good form of pain relief although there are rare instances where the epidural block may not work or may partially work, in which case your midwife will contact the anaesthetist to come and check the epidural.

An intravenous drip with be sited in your hand or arm so fluids can be given to you through a vein - this is done as a precaution in case your blood pressure drops following the epidural.  You will be continuously monitored on a cardiotocograph, a machine that monitors your contractions and your baby's heart rate.  With your consent, a urinary catheter (tube into your bladder) will be inserted because you will not be able to feel the sensation of wanting to pass urine.
The disadvantages with epidurals are that, they can slow down your contractions so a hormone (oxytocin) drip may be needed to speed up your contractions again.  On rare occasions the dura or cover of the spinal cord may be punctured and cause leaking of spinal fluid and you develop headaches.  If this happens, there is a remedy and the midwife will ask the anaesthetist to see you.  An epidural relaxes the muscles of your pelvic floor and may lead to an instrumental (forceps or ventouse) delivery or even a caesarean section.  There can be some tenderness over the epidural site for some days following the birth of your baby.

Please chat with your midwife about the benefits and disadvantages of the types of pain relief and options available to you.

Here are some links :
Pain relief in labour

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