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HealthInfo Canterbury

Pain relief when having a baby

woman in labour sitting on exercise ball, with her husband massaging her neckLabour is a normal and natural part of life – but there's no doubt it's challenging and life-changing.

Women sometimes worry about how they'll manage pain during labour. There are many medical and non-medical options to choose from, ranging from relaxation techniques to strong pain-relieving medicines. Understanding the different options can help you plan what you want, and choose what you need. Talk to your midwife or LMC about your options.

Getting ready

Learn all you can about what happens during labour and what to expect. Arrange for someone to be there to support and encourage you while you're giving birth. Consider having them come to an antenatal visit and go to antenatal classes with you so they're prepared to support your plans for working through labour and birth. Being confident about what's happening and getting the support you need will make you feel more secure and in control.

Managing pain non-medically

Antenatal preparation

Going to antenatal, or pregnancy and parenting classes can help you prepare positively for labour and birth. Read the section on pregnancy & parenting education to see what's available and what might work for you.

Relaxation

Being as relaxed as possible can make a real difference to the pain you feel during labour. Feeling a lot of tension or anxiety is likely to increase how much pain you feel. It may also make you release more adrenaline, which will interfere with how well your labour progresses. If you can remain as calm and relaxed as possible you're likely to feel less pain. One reason for this is that being calm can help you release endorphins, which are your own, natural pain-reducing hormones.

It can seem to be a big ask to stay calm and relaxed during labour, but every little bit can help! You can work with your senses to plan an environment that will help you to relax.

Movement

Standing up and moving around may help to speed up your labour. Gravity and the pressure of your baby's head can help your cervix to dilate more quickly. Many women find that walking, rocking, and swaying give them relief. This may help your baby descend into your pelvis.

Touch and massage

Getting someone to hold your hand, or stroke or massage your arms, legs, or back can help to relax tense muscles. They can also help you to stay calm. You may find that pressure to your lower back (sacrum) can help to relieve discomfort.

Water and temperature

Woman in labour in a birthing poolRelaxing in a large bath or pool, or standing under a shower, can help you to relax, calm any anxiety, and make you feel less tired. Using a bath or birth pool in labour can help reduce the length of labour due to its relaxing effects.

It isn't a good idea to lie or stand in very hot water for a long time. It's important that the temperature of the water isn't too hot as that can make your baby's temperature rise. Keeping the water at or near body temperature is best. If you feel hot, get out of the bath for a while. When you're thirsty, sip on water to keep hydrated.

Heat and cold

Many women find hot wheat packs can be soothing, especially if their back hurts. A cold flannel on your face or around your neck between contractions may also help.

Using hot, wet towels on your lower back during the strong part of labour can give you comfort and relief during contractions. You need a bucket, two hand towels and hot (not scalding) water. Roll the towels and soak them in the bucket of shallow hot water. When a contraction begins, your partner or support person should wring out one of the towels and lay it over your lower back. They should change the hot towel as needed and remove it at the end of the contraction, ready for the next one. Talk to your midwife or LMC for more details about this option.

Your support person must not wear gloves to wring out the towels as they may make the water too hot without realising it.

Acupuncture and acupressure

Acupuncture involves inserting fine needles in different points on your body, while acupressure involves applying pressure to those points. There have been no studies of whether this works during labour, but some women find it helpful. Talk to your LMC if you'd like to arrange this. Have a look at this free e-book by New Zealand midwife Debra Betts about acupressure in labour. It's also available in several European languages on her website.

Aromatherapy and hypnotherapy

Aromatherapy involves using essential oils such as rose, lavender and clary sage, either in massage, through smell (vaporisation), or even in the water. Some women find this helps to relieve stress and tension and it may also strengthen your contractions, but there have been no scientific studies into this. Talk to your midwife or LMC about it.

Hypnotherapy can help you to relax, which can help you concentrate and manage the discomfort of contractions. Self-hypnosis is best for childbirth. Learning the techniques of self-hypnosis take time and you'll need to practice to prepare for your labour. Hypnobirthing instructors offer private classes to teach this technique. Talk to your midwife or LMC for more information.

TENS

TENS uses mild electrical stimulation to help manage pain.

The TENS machine is a small battery-powered machine, which you control. You'll have four electrodes on your back to provide electrical stimulation, which interrupts the pain signals and may also increase your endorphins. It can help with back pain during labour.

Managing pain medically

Any medicine you use during labour will pass through the placenta to your baby. If you think you may use medical pain relief, discuss it fully with your midwife or LMC, including all the benefits and possible risks.

Gas (Entonox)

The gas you use during labour is a mixture of nitrous oxide and oxygen, which you breathe in through a mouthpiece or a mask. It's also sometimes called laughing gas. When used effectively it can provide enough pain relief to get you through labour.

You're in control of the gas, and breathe it in when you want it. It offers mild pain relief, but Entonox gas may make your mouth dry. Some women feel light-headed or sick (nauseous). Sipping water in between breathing in the gas may help. The good thing is that if you don’t like it, it gets out of your system quickly once you stop breathing it in.

Opioids

Woman holding her newborn baby immediately after birthOpioids are strong medicines used for strong pain. Morphine and pethidine are the opioids used during labour. They're both given as an injection into your buttock or thigh. If you give birth in hospital, you can also have morphine through a drip into a vein in your arm.

Pethidine can make you less aware of how strong the contractions are, and may make you drowsy. Both morphine and pethidine may make you feel sick (nauseous) and possibly vomit. Both cross the placenta and may make your baby sleepy.

Pethidine may mean your baby needs help breathing. Very occasionally, they may be given a drug called naloxone, which reduces the side effects and helps them breathe.

Pethidine may also reduce your baby's sucking reflex, which will affect its feeding in the first few days. You may need extra support for breastfeeding in the first few days.

Fentanyl is a short-acting, strong opioid that you take through an intravenous line. You'll have a button to push to get more of the drug when you need more pain relief. This medication can give very effective pain relief but it can also make you very sleepy and may slow down your breathing. If you have this medication, you and your baby need to be closely monitored.

Epidural

An epidural is a mixture of a local anaesthetic and an opioid, which you receive through a small tube put in your lower back. It's delivered gradually, throughout labour.

An epidural usually blocks labour pain well, although you may feel some pain in the area between your vagina and anus (your perineum). However, it may mean you're in labour for longer and may need oxytocin to make your contractions stronger. Your baby may need to be delivered with forceps or ventouse (suction) because you won’t be able to push as effectively when you can’t feel the contractions.

Other possible side effects for you include an increased temperature, a fall in blood pressure, feeling sick (nausea) and being sick, short-term back ache and shivering. You will need a tube to drain your urine (a urinary catheter), because you stop feeling the need to wee (urinate). Epidurals don't make it more likely you'll need an emergency caesarean.

Possible side effects for your baby include an increased heart rate if the epidural has been in for some time, a sudden drop in heart rate, and sleepiness after they're born. During labour, your baby’s heart rate will need to be continuously monitored with a CTG (a monitor that's attached to your tummy with elastic belts).

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Written by Capital & Coast DHB. Adapted by HealthInfo clinical advisers. Endorsed by midwife liaison, Canterbury DHB. Last reviewed June 2018.

See also:

Water labour and birth

Sources

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