Pain relief in labour

EPIDURAL

How an epidural works as pain relief
An injection into your spine numbs your body from the waist down.
The procedure is as follows:
*You lie on your side or sit on the edge of the bed while an anaesthetist injects a local anaesthetic into your lower back.
*A hollow needle is inserted through the skin, then a fine, soft plastic tube is threaded through this hollow needle. The needle is then removed.
*Anaesthetic is injected through the tube for as long you need it. This might be a continuous infusion, or it can be delivered by top-ups.
*As the anaesthetic travels around your body, it feels like liquid ice, numbing your tummy, bottom and legs and deadening the nerves that carry pain signals from your uterus.

How effective is an epidural?
An epidural provides very good pain relief in 90% of cases.

The advantages of an epidural
*It kills the pain without affecting your mental state, so you stay alert.
*The tube stays in throughout labour so if you’re tired, you’ll also be able to sleep.
*It lowers blood pressure if it’s very high.
*You can have top-ups when you need them and may be able to self-administer these via a button attached to the drip.
*Some hospitals have mobile epidurals, so you can still move around in labour, which helps labour progress.
*It provides the most effective pain relief for very long labours.

The disadvantages of an epidural
*It doesn’t work for 10% of women and may then have to be re-sited, which can be very distressing.
*Some women find they get a ‘partial block’, with one side of their body numb, but the other still feeling pain. A change of position can sometimes help distribute the epidural more evenly.
*Intervention – forceps, ventouse or episiotomy - is more likely to occur with an epidural than with other forms of pain relief.
*You’ll have a drip set up to a needle in your hand in case your blood pressure falls, and possibly a catheter to drain your bladder as you won’t be able to go to the toilet.
*Your baby’s heart will have to be monitored constantly.
*Your contractions may slow down, in which case you might then need another drip to speed things up.
*Your movement is restricted throughout the birth unless your hospital has a mobile epidural.
*An anaesthetist has to be available throughout your labour and birth.
*You’re at risk of unpleasant side effects, including a severe headache (if the sheath around the spinal cord is pierced by accident) and bladder problems and infections (from the catheter).
*Your baby is more likely to have a lower Apgar score, which is how doctors evaluate a newborn’s condition.
*It can only be given in established labour, so won’t help with earlier contractions.
*Several groups of women are advised not to have an epidural: those who have a blood-clotting disorder; women who had back problems before they were pregnant; those who’ve had a caesarean and want a vaginal delivery. Any contraindications need to be discussed with your midwife or an anaesthetist in late pregnancy.

PETHIDINE

How pethidine works as pain relief
Pethidine is an opiate and is similar to morphine and heroin. It’s usually given by injection into the thigh or buttock, though it can also be given intravenously. It takes around 20 minutes to take effect and lasts for two to four hours. You can have several doses, but as it affects the baby, you should be wary of this.

How effective is pethidine?
It depends on when it’s given and on the amount administered. The normal dose is 50-100mg. Many mums-to-be find it more effective nearer the beginning of labour when the contractions are not at their strongest.

The advantages of pethidine
*Pethidine can be given by a midwife, which makes it quickly available.
*It will make even very anxious mothers relaxed, so that labour is not held back by fear.

The disadvantages of pethidine
*The drowsiness it produces can make you feel very detached in labour. You’ll probably feel too out of it to move around.
*You can’t use a birthing pool.
*Lying down from such an early stage of labour isn’t ideal and can slow things down.
*It can make you sick, although you can be given an additional drug to help prevent this.
*If it makes you relaxed and sleepy but doesn’t remove the pain, you won’t feel in control during labour.
*It can cause your blood pressure to drop, so if your pressure is usually normal you’ll feel light-headed and faint.
*The timing is difficult to get right. Its effects last two to four hours but can be difficult to gauge. It shouldn’t be given within two to three hours of the birth and it takes around 20 minutes to take effect. If a mother has totally relied on the pethidine to cope, it can be a real shock when it’s withdrawn.
*The drug crosses the placenta and can make the baby sleepy, even after the birth. Some babies whose mums had pethidine are slow to suck, which can mean early breastfeeding problems.
*Some newborns develop breathing difficulties from pethidine use and will need an injection to reverse the effects.
*There’s some evidence (though not conclusive) that babies who receive an opiate drug through their mum’s bloodstream are more likely to have an addiction problem later on in life.

GAS AND AIR

How gas and air works as pain relief
Gas and air, or entonox, is a pain-relieving gas made up of 50% oxygen and 50% nitrous oxide (also known as ‘laughing gas’). It comes from a gas cylinder and you take it in through a mouthpiece.

How effective is gas and air?
The effectiveness of gas and air ranges from person to person. Some women swear by it, others say it did little other than make them feel like they’d too much to drink!

The advantages of gas and air
*It’s self-administered, via a mask or mouthpiece, so you feel in control.
*It’s safe both for you and your baby.
*It only takes about 30 seconds for it to take effect, so you can use it as soon as you feel a contraction coming on.
*Some women find it helps them to get into a pattern with their breathing.
*It quickly clears from your system.
*It can be provided via a portable cylinder, and so can be used during a home birth, in a bath or in a birthing pool.
*You can keep it with you for as long as you feel you need to.
*There’s no indication for continual monitoring of your baby's heartbeat, so you can be mobile and change positions while using it.
*You can still use other pain relief methods, such as pethidine or an epidural.
*It can be ‘on tap’ – you don’t even have to remove the mouthpiece, but can leave it there as you exhale, taking deep breaths in and out, while awaiting the next contraction.
*It can be used at any stage of labour.

The disadvantages of gas and air
*Some women find that it makes them feel nauseous.
*Others may feel a bit out of control if it makes them light-headed .
*Standing is usually okay, but you may feel too woozy to walk around.

For more information and advice on your pregnancy, labour and birth, check out Practical Parenting magazine each month.