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Pain Relief in Labour
How to manage it

Some medical schools teach their students not to refer to labour contractions as labour pains because this may make a woman think labour is painful. Most women in labour figure this out for themselves, although it is a unique experience for each person. For some women, labour pain may feel fairly minor. For others, it may be very painful. Managing this pain is not just the act of administering the appropriate drugs at the appropriate moments. It is an entire management plan.

Childbirth education

Women who attend childbirth classes are taught about labour and usually have less anxiety and fear. This, in turn, usually reduces the pain they feel. They are aware of the normal birth process and have learned coping strategies such as distraction to help them.

Support

Comfortable surroundings and a support team for encouragement help reduce many women’s perceptions of pain in labour. Studies have shown the benefits for a woman who has a support person, as well as her husband or partner, to attend to her needs. She needs less pain relief, labour is shortened and there are fewer forceps and cesarean deliveries.

Ambulation

Ambulation means being up and about. The upright position of ambulation during labour is especially effective in reducing the severity of back pain during contractions. It also reduces the chances of having continuous back pain between contractions.

A helpful way to understand the relief from moving around and constantly changing position is to think of childbirth as similar to putting on a pair of tight cowboys boots. You have to change the position of the boot and your foot as you try to fit into the cowboy boot. In the same way, the pelvis and the baby have to change positions relative to one another while the baby tries to fit through the birth canal.

Dealing with other discomforts

Pain may seem worse when other uncomfortable conditions are present. While moving about relieves the discomforts of staying in one position too long, there are several other body discomforts that need attention. Nausea or vomiting, muscle cramps, bladder spasms or a full bladder, and feeling too hot or too cold can all add to the feeling of pain. By attending to these needs, a woman is more likely to be able to cope with the normal pain of delivery.

Comfort measures

There are several ways to deal with the pain of labour that do not involve using drugs. Some of these involve using the mind to control the pain. Relaxation techniques and patterned breathing are extremely helpful. Biofeedback and hypnosis can also be used.

Some methods provide an alternative sensation to distract the mind from the pain. Soaking in a tub, jacuzzi or shower is amazingly effective. Using TENS (transcutaneous electrical nerve stimulation) creates a buzzing, tingling, prickling sensation to change the way pain is felt.

Acupuncture and injections of sterile water under the skin of the lower back are also thought to work in this way.

Medications

The medications used in the past were often sedatives but these frequently make the mother too drowsy. Nowadays, narcotics (pain relievers) are most often used, although they may cause some drowsiness or nausea as well. The medication is usually injected into a muscle but can be given directly into a vein if quick but short-lasting action is needed. Certain amounts given shortly before birth may result in a sleepy or lethargic baby. This problem can be dealt with at birth and is not a valid reason to withhold pain relief in labour.

Nitrous oxide gas (commonly called laughing gas) can be used for up to two hours. Although there is still pain while using the gas, women who find it helpful do not seem to mind the pain as much. At the beginning of a contraction, the woman holds the mask to her face and draws in deep breaths so that the gas will be effective by the time the contraction peaks. After the mask is removed, the gas is out of the blood stream within a few deep breaths.

Epidurals

If the pain of labour is not well enough controlled by the above methods, an epidural may be used. This procedure requires a physician trained in the technique and not all facilities can offer epidural analgesia. Discuss this with your obstetrical care provider.

Epidural analgesia is given through a fine tube into the space surrounding the spinal cord. The tube is put in place by inserting a small hollow needle and threading the tube through it. A combination of anesthetic (freezing) and narcotic is often used. If the effect wears off, more solution can be given through the epidural tube, either by the anesthetist or, in some cases, by the patient. If a low concentration of the anesthetic is used, many women are still able to walk around, empty their bladders and feel the urge to push effectively while still enjoying the benefits of complete pain relief.

The procedure can be uncomfortable. As with any procedures, the results may not be 100 per cent perfect and complications can occur. The most common, significant complication is a “spinal headache” that results from the needle entering the spinal fluid unintentionally. With new small needles the risk of headache can be as low as one per cent. Overall, the risk involved in an epidural is far less than the risk of being pregnant.

For most women, pain in labour is a normal event. There are many methods available to help women cope with this pain. Using a combination of relaxation and comfort measures is the best way to start.