The majority of women need some sort of pain relief during childbirth
and various forms of pain relief are available providing different
levels of respite. Methods vary from drugs, to more natural methods,
such as acupuncture and hypnotherapy, and it is worth considering
the various options available to you well in advance. Read on to
discover what is to be had and its effects on you and your baby.
Gas and air is mix of 50% oxygen and 50% nitrous oxide (Entonox),
which slows activity in the nervous system and is given through
a mouth -piece or facemask, which you hold. As soon as you feel
a contraction coming, you breathe the mixture quickly and deeply
through your mouth. After an adequate number of breaths, you put
the gas aside and breathe naturally for the rest of the contraction.
Gas and air are usually given if pethidine is wearing off, towards
the end of the first stage of labour, or if you have not had pain
relief until then and acts instantaneously. Some women find it useful
for the second stage and delivery. You are in control of the amount
you receive and you can move about in between doses.
Gas and air does not cause any side effects for the baby, however,
some women have reported that they have experienced light-headedness,
queasiness and disorientation. It is therefore not suitable as a
pain relief for long periods.
Pethidine is a strong sedative injection, which is given into your
thigh or buttock. It takes effect within 15 minutes but its effect
lasts for a short time compared to other analgesics. This means
that doses can be timed during labour to minimise adverse effects
on the baby. You may require a repeat dose if it isn't giving ample
relief in 45 minutes. However, it can cause side effects such as
dizziness, nausea, vomiting, drowsiness, constipation and confusion.
However, most women find that it helps them deal with their breathing
and relaxation better. It doesn't stop the pain but does dull it.
If you have had two doses in the eight hours preceding delivery,
there is a possibility that the baby may be sleepy, not feed well
or be slower to breathe.
This drug also passes into breast milk and may affect the baby.
It is therefore important that you discuss any concerns with your
An epidural is a local anaesthetic injected into the tissues around
the spine in the lower back. It operates on the nerves, blocking
messages through the spinal cord to the brain, effectively numbing
you below the waist. Given in the latter half of the first stage
of labour, it takes 30 minutes to start working, but once it has
taken effect, the pain ceases and you are much more able to relax.
An epidural has to be administered by an anaesthetist and needs
to be set up before the pain becomes a real problem. You lie or
sit curled up and a fine tube is threaded through a needle, which
is passed between the bones of your lower back. The needle is removed
and the tube left in so that the anaesthetic can be topped up as
required at two or four hourly intervals. After about 15 minutes
you will notice your legs going numb. You will probably lose most
sensation in the lower part of your body. Once you have the epidural
you have to remain on the bed, but there is no difficulty in getting
comfortable as most, if not all, of the pain has gone.
Occasionally the epidural is not entirely effective and may only
partially numb the area. If this should occur then it can be re-sited
but it is possible that you still experience some pain. Sometimes
the epidural can cause a fall in blood pressure, but turning you
on your side, or tilting the bed so that your head is lower easily
An epidural can mean that you are not able to push so effectively
in the second stage. This makes a forceps delivery a greater possibility.
However, if there is time, the epidural can be allowed to wear off
in the second stage so that you are more likely to be able push
the baby out by yourself.
A mobile epidural blocks abdominal pain but leaves some feeling
and mobility in the legs.
Epidurals are sometimes used instead of a general anaesthetic for
Caesarean deliveries. One of the advantages of this is that you
are conscious when your baby is born and you can participate in
the excitement of his/her arrival.
Metip is a weak narcotic analgesic, drug similar to pethidine, used
to reduce pain during childbirth. You are in control of the system,
which delivers doses into your arm. It has less effect on the baby
than pethidine but can make you feel sick. The safety of this drug
during pregnancy has not yet been established, so it is important
that you discuss its use with your doctor.
The paracervical block involves two injections to each side of the
cervix. It is simple to perform and is excellent for the pain in
the early stages of labour. However, it does not really provide
pain relief in the later stages. It does not block sensation from
the perineum (pelvic area) and therefore pain from pelvic dilation
and delivery can be significant.
The main advantage of a paracervical block is that it is quick
and easy to administer, compared to an epidural, which is technically
more difficult to perform and requires attention throughout to ensure
that it is working properly.
Its major disadvantage is that there is a high incidence of slowing
of the foetal heart rate. This is often associated with decreased
oxygen delivery to the baby. This may be due to the high levels
of local anaethesia around the blood vessels that supply the uterus
and/or high levels of the medication in the foetal blood.
A pudendal block is a local anaesthetic injected in a similar fashion
to the paracervical block, and deadens the nerves leading to the
vulva. Given at the delivery stage, it acts quickly and is helpful
for deliveries requiring the use of forceps or venthouse.
A general anaesthetic is administered via a needle in the back of
the hand at delivery stage. It works fast and is used when it is
necessary to perform invasive but life saving procedures, such as
an emergency caesarean
Moving, rocking, rubbing, massaging and shifting pressure are the
body's natural defences against all kinds of pain as they help to
divert pain sensations away from the brain. Also, by moving around
in an upright position, the forces of gravity make contractions
more proficient and can cut down the time it takes for the cervix
Along with breathing exercises, antenatal classes teach various
positions for labour, which can help to ease the pain of contractions.
It may be that all that is required is for you to walk about, pausing
for each contraction to lean against a wall or your partner for
The pressure created by massage can help to counteract pain signals
and promote relaxation in the early stage of labour. It is drug
free, non-invasive and comforting and has no unpleasant effects
on either you or your baby. However, massage during labour is very
much down to personal choice as some women cannot bear to be touched
during a contraction, while others find that back rubbing helps.
Reflexology is a form of treatment that involves working 'reflex
points', most often on the feet, although reflex points can be found
all over the body. The reflexology method of application involves
firm pressure using specific thumb and finger techniques. The main
technique used in the treatment is applied by using the outer side
of the thumb, which is moved along the foot in a slow caterpillar
fashion - ensuring that all areas are covered. The index finger
is used on the bonier surfaces of the foot in the same way.
As well as helping with all the normal effects of pregnancy, like
morning sickness and dizziness, reflexology treatment is believed
to promote a healthy uterus. It is also believed to encourage the
pelvis to extend more easily and the cervix to dilate more rapidly.
It is normally recommended that if you have never received reflexology
treatment, that you wait until week 18 of your pregnancy before
starting treatment. However, if you have had treatment previously
then it should be safe to have treatment from conception. It can
be helpful if treatment is performed fortnightly up until week 38
although this can be increased if you have specific problems, such
as backache or high blood pressure.
Reflexology will aid pregnancy by stimulating the liver, endocrine
glands, and lymphatic drainage. Attention is of course paid to the
pelvic and reproductive areas.
If all is going well, it is quite in order to have treatment during
the early stages of labour and currently more hospitals have a policy
of allowing access to complementary practitioners. This would of
course need to be discussed with your medical team during pregnancy.
Transcutaneous electrical nerve stimulation involves attaching a
portable unit to your lower back, which passes electrical impulses
through electrodes directly into the main area of labour pain. The
machine releases small electrical impulses that interrupt the pain
signals to the brain, resulting in less discomfort.
It is also believed that TNS encourages the release of endorphins,
the body's natural painkiller. Used in the first stages of labour,
you are in control of the intensity of the impulses, which you can
increase or decrease as required. This technique is appealing as
it is non-invasive and has no reported side effects however, Tens
does not guarantee pain relief for all users. Some hospitals have
TENS machines, but they can also be hired out in advance.
All women will benefit somewhat from breathing and relaxation exercises
even if they know that they will be having a caesarean or epidural
delivery. Breathing and relaxations techniques are taught at all
antenatal classes and Psychoprophylaxis is a particular method of
training for childbirth. Advocated by the Active Birth Movement
and the Natural Childbirth Trust, it teaches women to manage and
control the pain of labour. The theory behind this approach is twofold.
The first is that fear generates pain as it causes women to tense
up and fight the contractions rather than relax and ride with them.
The second part is a way of distracting the brain from messages
of pain by concentrating on another sensation. In this case a series
of breathing exercises designed for all stages of labour and delivery.
Water encourages the release of endorphins, which, together with
buoyancy, counteract pain signals and increases your ability to
cope. Baths and showers are helpful but birthing pools are best
and can be used throughout labour and even for the birth. Many hospitals
now provide a purpose built pool, while for home births; several
firms will hire out a pool that can be erected in the home.
The pool is filled with warm water and is kept at a constant temperature.
The warmth and buoyancy effect of the water is believed to be helpful
in coping with the pain of contractions. However, there is no scientific
evidence that water births encourage a quicker or less painful labour
and not all women find it beneficial. Also, if complications arise
it is very likely that it would be considered safer to deliver the
baby in a more conventional way.
The main disadvantage with a water birth is that it is not as easy
to monitor the birth, so water births are only recommended for women
who have had no complications during their pregnancy.
Do not be concerned about your baby drowning if is born into the
water as it is still receiving oxygen through the placenta and umbilical
cord and does not take its first real breath until it is lifted
from the water.
Acupuncture can be used quite successfully during childbirth to
ease the pain of contractions and delivery. Ultra fine needles are
inserted into the body, which encourages the release of endorphins.
It is drug free with no side effects and can speed up labour while
you remain mobile. However, not only can it be expensive with variable
pain relief it is also most likely that you will have to make your
own arrangements for a practitioner to attend the birth as very
few hospitals will have one on staff. You will also need to obtain
the agreement of your consultant.
Hypnosis is not, as many people imagine, a matter of going into
a trance so that you do not know what is happening, instead, through
hypnotic induction, the mind can be given what is commonly called
a post hypnotic suggestion. While under hypnosis, the suggestion
is made by the hypnotist that the body will not experience any pain.
As a result, effective pain reduction/elimination can be achieved.
It is advisable that in the couple of months before your baby is
due you attend two or three hypnotherapy sessions with a qualified
practitioner. He will discuss your anxieties before testing your
level of susceptibility, as not everyone can be hypnotised. Practitioners
have various ways of treating their clients, however, you can probably
expect to be taught self-hypnosis and will often be provided with
a tape to listen to at home and during labour.
<< back to Birth