Pain Relief during Labour

This booklet will give you an idea of what to expect from labour pain and what can be done to relieve it.

We hope that if you are prepared and choose the right pain relief (if required), you will find the birth of your baby both comfortable and enjoyable.

What will labour feel like?
Towards the end of pregnancy you may notice your uterus tightening from time to time. When labour starts, these tightenings become regular and much stronger. This may cause pain that at first feels like strong period pain but usually becomes more severe as labour progresses. The amount of pain varies.

Your first labour is usually the longest and hardest. Sometimes it is necessary to induce labour artificially or to stimulate it, if progress is slow, and this may make the process more painful.
Over 90% of women find they need some sort of pain relief.

What methods of pain relief are available?
There are several ways of helping you cope with pain depending on the
circumstances. It is difficult for you to know beforehand what sort of pain relief will be best for you.

The midwife who is with you in labour is the best person to advise you.

Here are some of the facts about the main methods of pain relief that you may be offered.

Simple methods
Pain in early labour can often be managed by simple methods. A supportive companion is invaluable. Relaxation is important and moving around sometimes helps.

Bathing in warm water and massage can help you relax and ease some of the pain. Music and aromatherapy can also be helpful.

Epidurals

•  Injected through a very small tube into your back.
• Most complicated method, performed by an anaesthetist.
• Little effect on your baby.
• Small risk of headache.
• May cause a brief drop in blood pressure.
• Most effective method of pain relief.

Who should have an epidural?
Most people can have an epidural, but certain complications of pregnancy and bleeding disorders may take it unsuitable. If you have a complicated or long labour the obstetrician may recommend that you have one. In such circumstances it will benefit both you and your baby.

What does it involve?
You should discuss with your obstetrician or midwife whether an epidural is suitable for you. The anaesthetist will need to be called,
and he/she will want to be sure you understand the benefits and possible side effects. You will be asked to sign a consent form.

You will first need a drip (fluid running into a vein). This is often necessary in labour for other reasons. You will be asked to curl up on your side or sit bending forwards.
Your back will be cleaned and a little injection of local anaesthetic injected into the skin, so inserting the epidural should not hurt. A small tube is put into your back near the nerves carrying pain from the uterus.

Care is needed to avoid puncturing the bag of fluid that surrounds the spinal cord, as this may cause headache afterwards. It is therefore important
to keep still while the anaesthetist is inserting the epidural, but after the tube is in place you will be free to move.

Once the tube is in place, pain- relieving drugs can be given as often as necessary or continuously by a pump. While the epidural is taking effect, the midwife will take your blood pressure regularly.

The anaesthetist and your midwife will also check that the epidural is working properly. It usually takes about twenty minutes to work, but occasionally it doesn’t work well at first and some adjustment is needed.

What are the effects?

• Nowadays it is usually possible to provide pain relief without numbness or heavy legs.
• An epidural should not make you feel drowsy or sick, nor does it normally delay stomach emptying.
• Occasionally it drops your blood pressure, which is why you have the drip.
• It sometimes makes you shiver at first, but this usually stops quite soon.
• It may prolong the second stage of labour and reduce the urge to bear down, but with time, the uterus should push the baby out. You are more likely to have a normal delivery than any other type of delivery.
• It removes much of the stress of labour, which is good for the baby.

What are the benefits?

• By using an epidural catheter, low concentrations of local anaesthetic are given which leave you with some sensation of the contractions and of the pressure of the baby in the birth canal, so you can to push effectively at the right time yet without pain.
• Should a forceps delivery or caesarean section be required, the epidural can be “topped up” to provide pain relief.

What effects are there on the baby?
Very little of the epidural drug reaches the baby, so the baby is not sedated and there are no noticeable effects.
However, the fall in your blood pressure that can occur with an epidural could, if severe, be harmful – for this reason your blood pressure is checked regularly and any major fall corrected immediately.

However, the fall in your blood pressure that can occur with an epidural could, if severe, be harmful – for this reason your blood pressure is checked regularly and any major fall corrected immediately.

What are the disadvantages?

• It is necessary to have an intravenous drip (salt and water solution) inserted into your arm to counteract the fall in the blood pressure that can occur.
• Occasionally the local anaesthetic solution does not spread to all pain nerves and a second epidural injection is needed at either a higher or lower level.
• If your pain requires stronger solutions or frequent doses, you may have a reduced awareness of your contractions and your legs may become numb and heavy. Later when you are ready to deliver, there may be no desire to push the baby out. If this occurs, the epidural can be allowed to wear off a bit or forceps can be used to help lift the baby out.
• The loss of sensation may lead to difficulty passing urine and a catheter may be passed into your bladder to empty it. Once the anaesthetic wears off, the bladder function returns.
• Epidurals are very safe when managed by experienced doctors and midwives. Like everything in medical practice, however, there are some risks. In about 1 in 200 cases, difficulty in inserting the epidural results in the mother getting a headache after delivery. This is not serious and can be treated, if it occurs.
• More serious problems of injection of the local anaesthetic into an epidural vein, or if it is spreading too far, occur in about 1 in 300 epidurals and
  therefore, you are carefully monitored. A patch of persistent numbness occurs in 1 in 15,000-20,000 people.
• An injection site can become infected – although very rare, occurring in about 1 in 10,000 people, but needs to be treated seriously. Cases of paralysis occur in about 1 in 50,000 epidurals – a similar risk to dying under a general anaesthetic.
• Backache is a very common condition after delivery, irrespective of what method of pain relief is used, due to back strain caused by relaxation of the joints during pregnancy, changes in posture and exertion in labour and delivery. Epidurals occasionally cause a few days of local back tenderness.
• Headache too is common after delivery and not normally related to the epidural.

What if you need an operation?
If you should need any kind of operation such as caesarean section or forceps delivery, you may not need a general anaethetic, as the epidural can often be used instead. This is safe for you and the baby.

What about spinal anaesthesia?
Epidurals are rather slow to act, particularly in late labour. If the pain- killing drugs are put directly into the bag of fluid surrounding the nerves in your back, they work much faster. This is called a spinal. Spinal anaesthesia is also used for caesarean section.