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Pain relief in labour: an overview

Expectant mums now have a wide range of choice when it comes to coping with labour, whether through medical relief, alternative therapies or both

Posted: 5 November 2009
by Maria Muennich

While there are many different kinds of birthing experience it's fair to say that, however labour pans out, it is usually an incredibly intense, emotional and eventually euphoric experience, but one that's rarely completely pain-free. It makes sense then, to have a good think about the various pain-relief options that may be available to you during labour well in advance.

Mums-to-be approach pain relief in labour with varying expectations, apprehensions and emotions. Some will want to take any pain relief that's offered if it will minimise the pain they experience, others will want to get some relief, but may be concerned about compromising their control over the birth, and yet others will be determined to go it alone and to feel every physical sensation that birth entails.

The good news is that advances in both medical technologies and alternative forms of pain relief mean that these days expectant mums have a range of pain relief choices, whether you are open to medical pain relief - such as gas and air, an epidural - or hope to rely solely on alternative therapies - for instance, water therapy, aromatherapy and massage.

Medical pain relief
When the topic of medical pain relief comes up, many people think immediately of epidurals or chemical pain relievers such as pethidine. However, increasingly popular now to take the edge off pain are both gas and air and TENS machines, which are less powerful pain relievers but leave you in more control over your labour and can be stopped at any time if you don't get on with them.

These are the most common forms of medical pain relief, in a nutshell. Click on the name or use the 'find out more' link for details and the advantages and drawbacks of each.

TENS - Transcutaneous Electrical Nerve Stimulation - you can see why they shorten it - sends electrical signals to nerve endings in your skin to block out the transmission of pain to your brain. Find out more...

Entonox, or gas and air - Called gas and air, but actually a 50-50 mix of oxygen and nitrous oxide (an anaesthetic otherwise known as laughing gas) inhaled through a mouth-piece. Dampens pain and may leave you feeling lightheaded and laughing. Find out more...

Epidural - A highly effective anaesthetic-analgesic mix delivered to the spine via a fine tube inserted under local anaesthetic which allows you to remain conscious while effectively blocking labour pains. Can be topped up throughout labour or used solely as a means of providing temporary respite. Find out more...

Spinal block - Similar to an epidural but faster to adminster and so may be used in emergencies or when time is otherwise tight. A local anaesthetic is injected into the spinal fluid using a fine needle. Unlike epidurals, spinals cannot be topped up. Find out more...

Pethidine (Morpine) - Derived from morphine, pethidine is an analgesic (pain killer) that also helps you relax. It is usually administered via injection but may also be given intravenously. Find out more...

Meptid - A pain killer that may be offered as an alternative to pethidine.

Local anaesthetics - Local anaesthetics may be used if you need an episiotomy or have a tear and require stitching down below.

'Alternative' pain relief
Non-medical pain relief is becoming increasingly widely accepted and promoted by birthing professionals in the UK. In many cases it is now used alongside medical pain relief to ease the experience of labour, and not just as a tree-hugging alternative. However, attitudes can vary widely and so can services offered: You may find your hospital offers acupuncture or a birthing pool, or their interest in alternative therapies may start and end with allowing you to burn aromatherapy oils in the labour room, if that!

Here's an overview of the most common alternative therapies:

Waterbirth / water therapy - Just as you use a long soak in the bath to relax your body and ease aches and pains, water can help ease pain and discomfort in childbirth. Depending on how labour is progressing you may be able to use water for early-stage pain relief or right through to birth. Find out more...

Aromatherapy - The power of essential oils as relaxants and stimulants is well-known. Various oils may be used to ease labour discomforts either burned in a vaporiser or directly applied to the body through massage. Find out more...

Massage - Massage can be of great help in helping deal with early labour pains, not least because of the sense of support and intimacy from your birthing partner giving the massage, but also because of the oils that can be used. Find out more...

Homeopathy - Some doctors in the UK dismiss homeopathy out of hand as 'quack medicine' others see it as highly complementary to traditional medicines. It can be used alone or in combination with other pain relief options. Find out more...

Acupuncture & reflexology - Acupuncture is becoming increasingly well respected in medical circles and works in a similar way to the TENS machine. Pressure is applied to different acupuncture points in order to block the transmission of pain. Advanced acupucture using needles can only be administered by a trained acupuncturist. Find out more...

Availability & expectations
It's important to be aware that exactly what pain relief options are open to you on the day will depend on where you choose to give birth. For example, an epidural requires the presence of an anaesthetist and so isn't an option for home births or most birthing centres, but is usually available at hospitals. Conversely a birthing pool or other alternative therapies may not be available in all hospitals, but birthing pools are common in birthing centres and can be bought or hired for home use. Likewise gas and air and TENS machines, though popular, aren't necessarily available on all labour wards, although TENS machines can easily be hired if one isn't available where you choose to give birth.

So, if you have your mind set on a certain form of pain relief, do check that it's available to you when you visit potential birthing places.

Whether you want to try and manage with only 'natural' pain relief or you're keen to sign up straight away for an epidural, it's worth remembering that women can have very different responses to the varying treatments and therapies: what's one woman's pain relief holy grail can leave another woman cold. It's a good idea to think about the options in advance and have preferences, but do try to keep a reasonably open mind in case your chosen methods don't provide the relief you expected, or in case they're not suitable for use as your labour progresses.

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Discuss this story

That's a look at the main options for mums-to-be, but it'd be great to hear about your experiences with the different forms of relief on offer, whatever you used. If you have general observations on pain relief in labour then here's the place, if you want to add your experiences with specific medicines or therapies then please do comment in forum threads at the bottom of the specific articles.

Looking forward to hearing abour your experiences and opinions!

Posted: 13/02/2006 at 16:20

i found tens really good with my first baby, you just need to make sure that it sure that it stays on at all time and stays sucure. else it stops working.

good luck.

Posted: 20/02/2006 at 17:02

I agree, I thought TENS was great for pain relief but you do need to get it on early otherwise it's more of an annoyance.

Posted: 21/02/2006 at 15:44

I had gas and air but I just found it was a distraction. It's weird, because my mum had all three of us on gas and air at home! And my sister really found it good and didn't need anything else.
I liked TENS for the contractions etc but then I ended up having an epidural as well. At first I felt like I was giving in to pain relief, but my labour had been long and I needed to be able to rest. It didn't completely cut out the last stage pains, but it did let me rest a bit and get the strength to stay the course!

Posted: 23/03/2006 at 15:11

I also had a tens m/c which was good but my pains got quite bad and started using gas and air which I found helped (but it did make me feel and be sick) then after 11 hrs or so I had pethadin (which was great as I actually got a little bit of sleep during the day. My midwife saw me throughout the day and in the end she said I should have an epidural as she agreed it would be better for me. Unfortunately the doctor was really busy that night and I had to wait ages for it to be fitted but once it was the relief was fantastic. I could still feel what was going on but without the pain and I'm glad I had it. I hadn't set out to have all of it but sometimes thats just how it works out. My daughter was then born at 1.15am (after waiting for over 26 hrs to appear). The best bit was that I could sleep afterwards!! Hope this helps and hasn't put you off!

Posted: 23/03/2006 at 19:35

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