Pain relief

Pain relief

When in labour your body immediately responds to the pain of the contractions by making endorfines. These are natural pain killers your body makes to feel less pain. Anxiousness and fear can obstruct the productions of endorfines. That’s why it’s important to feel as relaxed and comfortable asTry not to focus possible during labour. Try not to focus too much on the pain as long as possible. Try to get on with what you were doing and seek some distraction by listening to music for example.

In between contractions there is always a (small) break. Use those moments to relax again and prepare for the next contraction. Try to stay physically relaxed an not to tighten your muscle in your neck, back, bum and legs too much. Breath in and out during a contraction and try to focus on your breathing so you are less focussed on the pain. This will help you endure the contractions.

Warmth helps you to relax. Make sure the temperature of the room is pleasant and use a hot pack on your tummy or back during contractions. Most women like to take a (long) shower or bath to ease the pain of the contractions.

Sometimes all natural pain relieving methods just won’t do the trick and you need medical pain relief. Because this can cause complications during birth, your hartbeat, blood pressure and breathing will be monitored closely. The fetal hartbeat also needs continuous monitoring. Therefor medical pain relief is only administered at the hospital and you will be referred to the obstetrician. With gas & air there is no chance of complications, no referral is needed and we will still guide you one to one.

There are four types of pain relief:

Gas & air

Entonox (gas and air) is a colourless, odourless gas made up of half oxygen and half nitrous oxide. It’s also known as laughing gas. It can take the edge off labour pain, rather than blocking it out. Many women like it because it’s easy to use and they control it themselves. You breathe in the gas and air through a mask or mouthpiece, which you hold yourself. The gas takes about 15-20 seconds to work, so you breathe it in just as a contraction begins. It works best if you take slow, deep breaths.

Advantages:

  • It works after 1 minute
  • It’s easier to relax during the contractions
  • You (and your unborn baby) don’t need extra monitoring
  • After stopping gas & air its leave your body super quickly
  • Administered at the Bevalcentrum

Disadvantages:

  • There are no harmful side effects for you or the baby
  • Some women get nauseous, light headed of drowsy. As soon as you stop breathing in the mask, these side effects will disappear.
  • During second stage of labour (when you are pushing)  you can’t use it

Pethidine

Pethidine is a morphine-like opioid. It helps to relieve pain and make you feel more relaxed and is given by injection into your thigh. It works for two to four hours. The most effective time to have pethidine is during the first stage of labour, when your cervix is opening up from being tightly closed.

 

Advantages

  • It can help you to relax and get some rest. Some women say that pethidine makes them feel less worried about the pain
  • It won’t slow your labour down, if you’re already in established labour
  • It may help you to postpone or avoid having an epidural if you’re finding your contractions hard to cope with

Disadvantages

  • Pethidine works less fast as remifentanil and gas & air
  • Two out of three women are not satisfied with the amount of pain relief
  • It can make you nauseous, drowsy and sleepy which can make you less aware of the birt
  • You can’t walk around, you will have to stay in bed
  • The baby’s breathing can be affected if he is being born within 4 hours after you got the pethidine. This can be treated with medication

Remifentanil

Remifentanil is a powerful morphine-type drug used regularly in anesthetics. A drip is inserted into a vein in your arm or hand and attached to a patient-controlled analgesia (PCA) pump. You press the button on the pump and a small dose of remifentanil is given directly into your vein providing pain relief on demand, reducing the severity of labour pain. This starts working within five minutes of the drip being connected.

 

Benefits

  • Remifentanil works quickly, mostly the effect is felt after a few minutes already
  • Remifentanil takes away just as much of the pain as pethidine does
  • It makes you feel relaxed and sleepy

 

Side effects and risks

  • Failure to provide adequate pain relief
  • Nausea, vomiting and itching
  • drowsiness and dizziness
  • One in two women need extra oxygen to breathe as a result of slow breathing
  • Sometimes women need to stop using remifentanil due to low oxygen levels
  • Remifentanil can pass to your unborn baby and can cause him/her to be slow to breathe or drowsy at birth. However, remifentanil wears off very quickly and has been shown to be safe for babies.
  • A very rare side effect, which happens in less than one in every 2200 women, is when a woman stops breathing or has a slow heart rate needing emergency resuscitation

Epidural

An epidural is a special type of local anaesthetic. It numbs the nerves that carry the pain impulses from the birth canal to the brain. It shouldn’t make you sick or drowsy. For most women, an epidural gives complete pain relief. A needle is used (with local anaesthetic) to insert a ne plastic tube between the bones in your back. The anaesthetic infusion gives continuous pain relief. It can be helpful for women who are having a long or particularly painful labour. An anaesthetist is the only person who can give an epidural, so it won’t be available at home. An epidural can provide very good pain relief, but it’s not always 100% effective in labour. One in eight women who have an epidural during labour need to use other methods of pain relief.

 

Benefits:

    • Provides the most complete pain relief of all methods of pain relief in labour. Epidurals do not make you drowsy, but as they offer good pain relief women are often able to sleep after having one.
    • Minimal amounts of the drugs used pass to your unborn baby so your baby is unlikely to be drowsy at birth.

 

Side effects & risks:

  • An epidural may make your legs feel heavy, depending on the local anaesthetic used
  • Failure to provide adequate pain relief with one in every ten women needing adjustment or replacement of the epidural
  • Your blood pressure can drop (hypotension), but this is rare because the fluid given through the drip in your arm helps to maintain good blood pressure
  • Epidurals can prolong the second stage of labour. If you can no longer feel your contractions, sometimes less anaesthetic is given towards the end, so the effect wears off and you can feel to push the baby out naturally. There is also a higher chance a ventouse may be needed to help deliver the baby (instrumental delivery)
  • There is a higher chance a caesarean section is needed
  • As an epidural can slow down labour, an iv drip with oxytocin (the contraction hormone) might be needed
  • You may find it difficult to pee as a result of the epidural. If so, a small tube called a catheter may be put into your bladder to help you
  • About 1 in 100 women gets a headache after an epidural. If this happens, it can be treated
  • Your back might be a bit sore for a day or two, but epidurals don’t cause long-term backache
  • You can develop a fever, most likely as a side effect of the epidural but it can not be ruled out to be an infection. Therefor you will be treated with antibiotics and sometimes the baby will be treated with antibiotics the first days after birth