What pain relief is available?

It is difficult to know beforehand what sort of pain relief will be best for you. The midwife who is with you in labour should be the best person to give you advice. Here is some information about the main methods of pain relief available.

Complementary methods

Calm breathing may increase the oxygen supplied to your muscles, and so make the pain less intense. Also, because you are focusing on your breathing, you are less distracted by the pain.

Having a massage while you are in labour is often very comforting and reassuring, and can help you relax. It has also been shown that if you have your labour in water (eg a birthing pool or bath), you will find it less painful.

Aromatherapy, acupuncture, and calming music are other strategies that you may find useful to reduce fear and anxiety, improve your wellbeing, and encourage you to keep going.

Transcutaneous Electrical Nerve Stimulation (TENS)

A gentle electric current is passed through four flat pads stuck to your back. This stimulates the nerve endings and creates a tingling feeling, which interrupts the pain messages travelling to the brain. It also causes the release of natural pain-killing chemicals, such as opioids and endorphins, which raises the pain threshold.

TENS is sometimes helpful at the beginning of labour, particularly for backache. It is available from your local physiotherapy clinic, and can be started at home. It has no known harmful effects on your baby. The strength of the current is controlled by you, and can be increased as your contractions get stronger.

TENS may be used with other methods of analgesia such as Entonox or Pethidine. However if you elect to have an epidural the TENS will need to be removed before it can be inserted.

Entonox

Entonox is a gas made up of 50% nitrous oxide and 50% oxygen. It is sometimes known as 'gas and air'. It is breathed in through a mask or mouthpiece and is simple, quick to act, and wears off in minutes. It may make you feel light-headed or a little nauseous for a short time.

Entonox will not take the pain away completely but it may help. It can be used at any time during labour. It will not harm your baby.

To get the best effect from Entonox timing is important. You should start breathing the Entonox as soon as you feel a contraction starting, so you will get the full effect when the pain is at its worst. You should not use it between contractions as this can make you feel dizzy.

Opioids

Opioids are chemical painkillers such as Pethidine, Morphine and Fentanyl. They may be given by a midwife injecting them into a large muscle in your arm or leg. They may also be given in smaller amounts into an intravenous drip in your arm. When injected into a muscle the pain relief usually starts after about half an hour and should last for a few hours. When injected into the drip the pain relief is more immediate, often starting within a few minutes, but will only last for about an hour.

These drugs all act in similar ways but may have varying effects. The amount of pain relief they provide can vary from person to person, and may sometimes be limited. Some women say these drugs make them feel more relaxed and less worried about the pain. Other women say they feel removed from the process and less in control, which may be a disappointment. This feeling in particular may be more common with Pethidine than the other drugs.

Other possible side-effects of these drugs include:

• Opioids may make you feel sleepy
• They may make you feel sick. You can be given an anti-sickness drug to prevent or stop this
• They delay stomach emptying, which may be an issue if you need a general anaesthetic
• They may slow down your breathing. If this happens, you may be given extra oxygen from a face-mask and have your oxygen levels monitored.
• They may make your baby slow to take its first breath. An injection can be given to your baby to aid this if it becomes a concern.
• They may make your baby drowsy, and this may mean that it cannot feed as well as normal (particularly with Pethidine)

Epidurals and Spinals

Epidurals and spinals are the most complicated methods of pain relief and are carried out by an anaesthetist. An anaesthetist is a doctor who is specially trained to provide pain relief and to administer drugs that make you go to sleep. Epidurals and spinals are the most effective method of pain relief.

For an epidural, the anaesthetist puts a needle in the lower part of your back and uses it to place an epidural catheter (a very thin tube) near the nerves in your spine. The epidural catheter is left in place when the needle is taken out, so you can be given painkillers during all of your labour. The painkillers may be local anaesthetic that numbs the nerves carrying pain messages to the brain, small doses of opioids, or a mixture of both.

An epidural does not provide instant pain relief. It may take half an hour or longer to put the epidural in and get it working properly. Once in however it can be used for the duration of your labour. It can also usually be used to provide pain relief should you require delivery by ventouse, forceps or caesarean section. An epidural will have minimal effect on your baby.

A spinal is slightly different to an epidural, in that the drugs are injected directly into the bag of fluid surrounding the spinal cord and nerves in your back. As a result of this they work much faster, but a catheter is not left behind so the drugs will wear off after an hour or two. Spinals are most commonly used to provide anaesthesia for caesarean sections.