Controlling contractions

Your options for pain relief in labour – Christine Hill on what you’ll be offered, what’s effective, and when

Breathing techniques and will power don’t determine the length and type of labour you’ll have. It depends much more on the position of your baby. So rather than having set ideas about whether or not you’ll accept pain relief, start out with an open mind. There’s no virtue in suffering, and it’s better to have realistic expectations. Remember that pain is exhausting and whatever else you do, you’ll need to conserve your strength in labour.

When to have pain relief

If you’re having difficulty relaxing between the contractions, it could well be time to accept some pain relief, but discuss this with your midwife and ask her advice. She’ll know how far your cervix has dilated, and this has a bearing on which of the three options for pain relief would be best for you.

As a rule of thumb:

  • If your cervix is 3-7 cms dilated – your best choice is an epidural.
  • If your cervix is 8 cms or more – you may get by on gas and air.
1. Pethidine (not often used)

A pain-relieving drug which is given as an injection in your thigh or buttock muscle by your midwife. It’s best used if you need help during a long latency stage (before you’re 3 cms dilated), when it’s too soon to have an epidural but the contractions are preventing you from sleeping.

How it works

  • Takes 15 minutes to work, and the effects will last between two and four hours
  • The dose may be repeated
  • You’ll feel sleepy and distanced from your pain.
Drawbacks
  • Pethidine crosses the placenta, so the baby is a little sedated if he is born within four hours of your injection
  • You won’t be allowed to walk around
  • If you don’t like the effects, you’re stuck with them until the injection wears off.

2. Epidural / Spinal

This is a local anaesthetic, given by an injection into the small of the back and gives total pain relief in nearly all cases. It has to be set up by an anaesthetist – it may take time to find him/her, so don’t wait until you’re absolutely desperate - takes between five and 30 minutes to set up and take effect, but will then last for between half an hour and three hours. Initially, you’ll be monitored in the bed, with a drip in your arm. The drip will help prevent your blood pressure from falling too low. An epidural will allow you to recharge your batteries and even sleep, if you want to. This procedure is invaluable for a long or difficult labour because your midwife can top it up as necessary.

After you’re about 8 cms dilated, the contractions are often very close together, making it very difficult for the anaesthetist to set up an epidural quickly. This is why some midwives will tell you it is ‘too late’ for an epidural.

Drawbacks

For some mothers the contractions tend to slow down. If this is the case, a Syntocinon drip has to be set up, which will accelerate the contractions, and your baby will need to be monitored at the same time. This is why it’s better to wait until you are 3 cms dilated (unless you are being induced by Syntocinon, when the epidural is given at the same time).

For more information – see our article about epidurals.

3. Entonox – ‘Gas and Air.’

This is a gas which you administer with a mask or mouthpiece. When it takes effect, two things happen:

  • It will suppress pain (effectively)
  • You will feel floaty and ‘high’
It’s an ideal short term pain relief, particularly at the end of the first stage of labour. It must be used properly to be fully effective, and there’s a gap of around ten seconds before it’s absorbed and takes effect
  • Put the mask firmly over your nose and mouth at the beginning of the contraction
  • Breathe deeply but gently
  • Remove the mask once you are over the top of the contraction.

Drawbacks

It’s better not to use gas and air for longer than three hours. After that the body becomes ‘saturated’. This means that you may become disorientated and won’t return to your usual self between the contractions. Some women say that the Entonox makes them feel nauseated, but this usually passes.

TENS

Transcutaneous electrical nerve stimulation – this isn’t a painkiller as such, but has the effect of increasing your tolerance to pain. It’s difficult to estimate by how much, and it seems to work better on some people than others. As a rough guide, it will increase your pain tolerance by 15% to 25 %, which means it won’t give you a pain-free labour but it’s worth a go.

A TENS machine needs to be fitted for you at the beginning of labour, probably when you’re at home. It’s operated by you to produce 2 types of current:
1. Pulsating (low frequency) for use between contractions. Stimulates the production of your body’s own painkillers (endorphins).
2. Continuous (high frequency) for use during contractions. ‘Interrupts’ pain pathways from your contracting uterus to the brain. An easy way to remember this is C for contraction and C for continuous current.

  • Allows you to walk around
  • Increases your pain threshold and sense of well-being
  • Does not cross the placenta or affect your baby
Drawbacks

None really. Most hospitals have TENS machines, but it’s better to hire your own, so you can use it before you go into hospital. A company called Pulsar hire them – freephone 0800 515413.

Incidentally, no studies have yet shown that babies born to women who had a ‘natural’ birth end up at better universities than children born to women who had pain relief. There has, however, been a study which shows that if a woman is determined to give birth without any pain relief and it doesn’t happen that way, she’s much less likely to enjoy her baby for the first few months. So don’t be a martyr – if you need relief from pain during labour, it’s there for the asking in various forms. After all, what really matters about giving birth is that the baby is OK and that you then enjoy having him or her with you. For more information - see our article about what to expect in labour