What pain relief options do I have?
As your labour nears, we will tell you more about your pain relief options. It is important for you to feel as relaxed as possible during the birth of your baby. If you would like to make use of pain relief, it is a good idea to discuss this with us and record your wishes in a birth plan. There are several methods of pain relief, with and without medications.
Remifentanil is a powerful analgesic with a short effect (3 to 5 minutes) that quickly leaves the body. It is administered via an intravenous drip with a pump so that you are in control of your own pain relief, up to the maximum dosage. You can use this method throughout the full dilation period though it may lose its effectiveness with prolonged use. It is an overall suitable analgesic if you are expected to deliver within 4 hours.
One disadvantage of Remifentanil is that approximately 13% of women do not find this method sufficient and request an epidural. Additionally, monitoring equipment is required during use of Remifentanil due to the risk of respiratory issues with the mother.
Laughing gas (also known as Entonox and Relivopan) is safe for mother and baby. This pain relief is a suitable option for nearly all women. It is, however, important that the birth is progressing without issues. Regular laughing gas is diluted before being administered. This is often done when you are more than 4cm dilated. After inhaling laughing gas, your consciousness is reduced, and you will feel somewhat high. This minimises pain and allows you to relax. Contractions become more tolerable. Each of our midwives is certified for the administration of laughing gas.
Benefits of laughing gas:
- Fast results
- If the gas is no longer inhaled, effects wear off within minutes
- Has a noticeable, moderate pain relief effect
- Can be used during the active phase of delivery
- Has few side effects for the mother
- Has no side effects for the baby
- Your midwife can continue to guide you through the birth, a gynaecologist is not required
Pethidine is administered via an injection in the buttocks or upper leg. Only hospitals are authorised to administer this medication. The worst pain will decrease, allowing you to relax between contractions. This medication is no longer used regularly. It is only given if the birthing mother is experiencing pain and exhaustion and the midwife is confident that the baby is doing well. Pethidine can also be combined with a sleep aid such as Phenergan or Normison.
Advantages of Pethidine
- Strong analgesic effect which allows you to rest between contractions and cope with the pain better. This facilitates dilation
- Administered quickly and easily
Disadvantages of Pethidine
- Only available in the hospital
- Walking is no longer permitted. You must remain in bed.
- Due to the relatively short effect (2 to 4 hours), other forms of pain relief may be required.
- Possible side effects (nausea, headache, dizziness, or drowsiness)
- May be disadvantageous when combined with other medications
- Side effects for the baby: heart tones may become less variable and if the baby is born within 4 hours of administering the medication, he or she may be somewhat drowsy and struggle with breathing. There is a medication available to give to the baby after birth to reverse these effects.
During the pregnancy, we will provide more information about the use of an epidural as a form of pain relief. An epidural is the most effective form of pain relief during labour. In most cases, you will no longer feel any pain. Your legs may become weak or you may feel a tingling sensation in your abdomen and/or legs. These effects stop after the medication is discontinued.
An epidural is placed by an anaesthesiologist via a narrow tube (epidural catheter) between your vertebra. The nerves carrying pain stimulus from the uterus and pelvic floor run along this area. By deactivating these nerves, you no longer feel the pain of contractions. The needle is inserted quickly, and local anaesthetic numbs the area so that minimal pain is felt. You will feel the effects after approximately 15 to 30 minutes.
During labour, the anaesthesiologist will continuously monitor you and your baby via the monitoring device. We will also regularly check whether the pain relief is sufficient. Once you are fully dilated, we will reduce the pain relief. This will allow you to feel the contractions required to push your baby into the world.
One disadvantage of the epidural is that you will receive an intravenous drip and will be connected to monitoring equipment and you must therefore remain in bed. For 5% of women, this form of pain relief is insufficient.
Side effects and complications of an epidural
Drop in blood pressure
The analgesic liquid causes the blood vessels in the lower half of your body to expand which may cause a drop in blood pressure. To prevent this, additional fluids will be administered via your intravenous drip. Low blood pressure may cause you to feel unwell or dizzy. Lying on your side will alleviate this discomfort and prevent a further drop in blood pressure. Low blood pressure may influence your baby’s heartbeat. Your baby is therefore monitored via an ECG.
Approximately 1 in 5 women develop a fever. While this is usually in response to the epidural, an infection cannot be ruled out. You and your baby will both receive an antibiotic treatment and will remain in the hospital for at least three days until tests for infection have come back negative.
No bladder control
An epidural numbs your lower body. This makes it difficult to feel whether your bladder is full, and it may be difficult to urinate. As a precaution, you receive a catheter and you will be monitored carefully.
Itchiness and shivering
Another side effect of an epidural is mild itchiness and shivering. This is not a cause for concern and is usually over shortly.
The area around the spinal cord is punctured in 1% of cases where an epidural was applied. The leak of fluid out of this hole can cause heavy headaches. This often presents itself the following day. Headaches are treated with rest, medication, and additional fluids. If the headache does not subside, the anaesthesiologist will look for an alternate solution.
Many women experience back pain after giving birth. This back pain is not always caused by the epidural and may have been caused by a long stretch in an uncomfortable position during delivery.
If an epidural is administered, the mother is extensively monitored before and after inserting the needle. There is a small chance that large quantities of anaesthetic fluids will enter the bloodstream or cerebrospinal fluid. This can make it difficult for you to breathe.