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Pain Relief in Labour

There are many different methods which can be used to help relieve pain during labour.

AROMATHERAPY

An aromatherapy service is available in the Haven Birth Centre to help you during your labour and the birth of your baby. This involves the use of essential oils in a non-invasive way to aid you physically, mentally and emotionally. Midwives who have undergone extra training are able to offer this service.

WATER

There are some fantastic benefits of using the birthing pool. in labour, Even if you do not wish to have a waterbirth, water can be a wonderful form of pain relief as it is calming and relaxing. Water pools are available on both the Haven Birth Centre and the Central Delivery Suite.

Other benefits include:

  • A greater feeling of control and choice
  • It can shorten the length of your labour
  • Less painful contractions
  • Less likely to need an epidural for pain relief
  • Relaxing and contributes towards a feeling of wellbeing
  • Aids buoyancy and offers support to allow you   to change position more easily, encouraging your baby to get in the best position possible for the birth
  • Reduces anxiety, muscle spasm and tension

TRANSCUTANEOUS ELECTRICAL NERVE STIMULATION (TENS)

A TENS machine is a small battery-operated pulsar which sends gentle electrical impulses through four electrodes taped to your back. The machine is designed for use in labour, and the impulses stimulate your body to produce natural pain-relieving hormones called endorphins which will help your body cope with the contractions. TENS is most effective if used from early labour, as it takes around 30 to 40 minutes to build up the endorphin levels and the electrical stimulation can be increased as the contractions become more intense.

Your birth partner or companion can apply the TENS at home while in early labour and you may use it for the journey to hospital and then throughout your labour. Using TENS gives you the freedom to move around and change your position.

It is not possible to use the TENS in water, so if you wish to use the birthing pool you should remove the TENS. However, water works in a very similar manner by encouraging your body to increase its natural endorphins. If you leave the pool the TENS can be reconnected with very little loss of effect.

There are no known side-effects, but TENS should not be used if you have epilepsy or a pacemaker. Do not use your TENS machine before 37 weeks of pregnancy.

PARACETAMOL

Paracetamol may be taken by mouth in tablet or solution form. It is particularly useful in early labour at home. It can help during early labour, allowing you to have some rest, but will become less effective as your labour progresses.

Although rare, some women may experience side effects as listed on the packaging. Paracetamol should not be taken if it is known that you have an intolerance or allergy to it.

ENTONOX ('GAS AND AIR')

Entonox is a gas which is a mixture of 50% oxygen and 50% nitrous oxide. Many women refer to it as ‘gas and air’. The gas is piped from a wall attachment or can come from a cylinder. The gas is breathed in through a mouthpiece during a contraction to reduce the intensity of the contractions. To get the best effect, the timing is very important – your midwife will help you with this. Each mouthpiece is disposable and only used for one woman. Entonox is available in the Haven Birth Centre , Central Delivery Suite  and via your community midwife if you are having a home birth.

If you choose to use Entonox you will hold the tube yourself, which enables you to control how much you have. The effects of Entonox wear off very quickly once you stop using it, usually within a few minutes. Entonox can be used with other pain relief and can be used in the birthing pool. It can also be used at any time during labour and in any position.

PETHIDINE

Pethidine is a strong pain-killing injection, from a group of drugs known as opioids. An opioid injection is normally given into your buttock or leg. You can have two injections during your labour, four hours apart. You can have pethidine if you are having your baby at home too.

After an Pethidine injection you will probably feel very sleepy and relaxed and you may even go to sleep in between your contractions. You may feel sick after you have the injection, but we can give you something to reduce this effect at the same time.

Because it is likely that you will become drowsy, you may be less mobile, but your midwife will advise you on adopting active birth positions in which you will still be able to rest.

REMIFENTANIL

Remifentanil is a strong morphine-like painkiller that works very quickly and wears off equally quickly. Although it cannot provide total pain relief it has been shown to significantly reduce pain from contractions.

What is patient controlled analgesia (PCA)?

Remifentanil is given in small doses through a tube placed in one of your veins. The PCA machine contains the remifentanil which is connected to this tube. You will be given a button to hold that, when you press it, will make the PCA pump give you a small amount of remifentanil. The PCA has a timer on it so you cannot give yourself too much of the drug.

Who can use it?

Remifentanil is mainly reserved for women who cannot have an epidural. However, if you decide to try the remifentanil and do not like it you can still decide to have an epidural instead if there is no other reason for you not to have one. It is not safe to use if you have an allergy or sensitivity to morphine-like drugs, or your anaesthetist or obstetrician advise against it.

How do I use it?

The pain relieving effects happen within 20-30 seconds of pressing the button. You should press the button as soon as you feel a contraction starting. The effects will wear off in minutes. You can continue to use it up until your baby is born.

Are there any side effects?

Some women do find that the remifentanil has some side effects. These include feeling sleepy, sick or dizzy. You may also feel itchy. However these will rapidly disappear once the drug is stopped. Some women find it slows their breathing and occasionally the amount of oxygen in their blood falls. This is easily treated by giving you oxygen but because of this you will need to have a small clip on your finger while you are using the PCA to monitor your blood oxygen levels. Remifentanil does cross the placenta to the baby in a similar way to pethidine but, unlike pethidine, any effect wears off much more quickly. This type of pain relief has now been used in large numbers of women in labour with no side effects to the baby.

When can I ask for the PCA?

You can have the PCA at any time once your midwife has confirmed you are in active labour and your anaesthetist has agreed that it is safe for you to use.

EPIDURAL

The nerves from your womb and surrounding muscles pass through the lower part of your spine to reach the brain. Most of the pain felt during labour comes from these nerves. An epidural is an anaesthetic which is injected into this part of your spine to numb the nerves so you don't feel the contractions as much during labour.

An anaesthetist performs the procedure. A drip is inserted into a vein in your hand or arm. Your back is cleaned and local anaesthetic is injected. Then, a fine hollow tube (known as a catheter) is inserted into your back whilst you sit up very still, curled forwards. This is securely taped into place so that you can freely move into comfortable positions on the bed. Pain relieving drugs are then given through this catheter continually by a pump. The epidural aims to provide adequate, sometimes complete, pain relief within about 20 minutes. If the pain relief is complete, you will be able to rest.

Are there any side effects?

Normally epidural analgesia (pain relief) is straightforward and very effective, with little risk of harmful effects. Some complications of pregnancy and some blood disorders may make epidural unsuitable for you – your midwife and doctor will advise you about this.

Epidurals may cause low blood pressure, and for this reason you will be given a drip in your arm so that we can give you fluids to try to prevent low blood pressure. Your baby’s heartbeat will also be monitored continuously when you have an epidural in place.

Approximately 1 in 100 women can experience a headache after an epidural. If this happens it can be treated, but it is unpleasant.

You will have reduced sensation to your bottom, hips and legs and may lose feeling altogether. Normal sensation will return within a few hours after you have had your baby.

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Poole Hospital NHS Foundation Trust, Longfleet Road, Poole, Dorset BH15 2JB. Tel: 01202 665511

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