Pain Relief During Labour: Best Ways To Manage Labour Pain

“What did you use for pain relief during labour?”, “Which method of pain relief works best?” are some commonly asked questions by expectant mums on theAsianparent app. 

In fact, so many mums have confessed that they are afraid of giving birth because labour pain scares them. Fear of labour pain is one of the reasons some women wouldn’t go for natural delivery.

As expected, labour pain also emerged tops in our poll on “What do you fear most during your pregnancy”!

In this article, we discuss various methods of pain relief during labour, and their pros and cons, so you can have a pleasant and stress-free delivery.

Pain relief during labour: Pharmacological methods

Tolerance to pain varies among individuals, and so does the effectiveness of the various pain relief methods. 

Here are some commonly used methods of pain relief during labour.

Etonox or Nitrous Oxide Gas

Etonox is commonly known as “laughing gas”, and is a mixture of nitrous oxide and oxygen. 

You breathe this gas in just as a contraction begins, using a mask or mouthpiece, which you hold yourself. It works best if you take slow, deep breaths as soon as a contraction begins, so maximum effect is achieved at the peak of contraction. It takes about 20 to 30 seconds for the gas to be effective.

Pros:

• It is readily available.
• This gas is insoluble in the bloodstream, and there are no harmful side effects for you or the baby.
• This method is easy to use and the mum-to-be can control it herself.

Cons:

• It might not be effective for strong pain, so you may need to use other pain relief methods as well.
• It may make you feel drowsy, sick, lightheaded, and unable to concentrate.
• It might make your mouth feel dry (in that case, sipping water or sucking ice cubes will help).

Drugs like Pethidine

Pethidine, Diamorphine and similar drugs can be given as injections for pain relief.

Pethidine is more commonly used, and it is a strong painkiller drug which can be injected into the thigh or buttock to reduce labour pain. Each injection takes about 20 minutes to work and provides two to four hours of pain relief.

However, there are some constraints in this method of pain relief. It cannot be given too close to the time of delivery, as it can cause drowsiness and breathing problems in the baby. This injection should be used least 4 hours before delivery and only when the cervix is < 6 cm dilated. 

Pros:

• These drugs are stronger than laughing gas, and can help reduce the severity of pain.
• They can help the mother to relax and sleep.

Cons:

• These drugs may cause drowsiness and nausea in the mother.
• They might reduce the mother’s cooperation in pushing.
• These drugs cross the placenta to the baby and might make him or her drowsy. This might affect breastfeeding after delivery. 
• They may also affect the baby’s breathing after birth. If this happens, an antidote has to be administered to the baby to reverse the side effects.
• If you’re having a water birth, you won’t be able to use the birthing pool for at least 2 hours after you’ve had an injection.

Epidural

An epidural is a local anaesthetic that is injected into the spine and numbs the nerves that carry the pain impulses from the birth canal to the brain.

An anaesthetist is the only person who can give an epidural, so you can only have an epidural if you are in a labour ward.Your doctor will ask for your signed consent before administering an epidural.

If you choose to have an epidural, your blood pressure will be checked more often, and you will be put on a drip. Your contractions and baby’s heartbeat will also be continuously monitored.

Pros

• It is more effective at pain relief than laughing gas or pethidine.
• It is helpful for women who are having a long or particularly painful labour.
• It can be started at any time.
•  It allows you to be pain-free and fully awake during labour.
• It is not linked to a longer first stage of labour or an increased chance of having a caesarean section.

Cons

• You may not be able to move around as much after you’ve had a few top-ups.
• You can only take an epidural in the labour ward in hospital, because it needs to be given by an anaesthetist.
• Epidurals are linked to a longer second stage of labour and an increased chance of an assisted birth (like vacuum/forceps delivery). If you can no longer feel your contractions, the nurse/midwife will have to tell you when to push.
• You will need to be monitored more closely in labour.
• There can be side effects and complications, including ​​loss of feeling and muscle weakness, nausea, shivering, low blood pressure, moderate backache, loss of bladder control, itchy skin, feeling sick, headaches, infection, breathing difficulty, and nerve damage.
• In extremely rare cases (1 in 50,000–100,000), an epidural can cause paralysis. 

Non-pharmacological (drug-free) methods of pain relief during labour 

Some mums might prefer alternative drug-free treatment for pain relief such as acupuncture, aromatherapy, massage and reflexology. Their efficiency is not scientifically proven though.

It’s important to discuss this with your doctor or midwife before you go into labour. Also make sure that the practitioner is properly trained and experienced.

Some other non-pharmacological methods of pain relief during labour include:

TENS Machine

TENS stands for transcutaneous electrical nerve stimulation. A TENS machine sends out tiny electrical impulses to block pain signals sent from your body to your brain. It also stimulates the body to produce more of its own natural painkillers, called endorphins. 

TENS is seen to be more effective during the early stages, when many women experience lower back pain.It has not been shown to be effective during the active phase of labour, when contractions get longer, stronger and more frequent.

There are no known side effects of TENS machines for either mother or baby, but do check with your doctor.

Pros:

• A TENS machine doesn’t affect your baby.
• You can control it yourself.
• You can use other pain relief at the same time.

Cons:

• If you only start using a TENS machine when you’re in established labour, it will not be effective.
• It may not work for all women. You may need other pain relief methods as well.
• You can’t use it in a birthing pool, bath or shower as there is a danger of electrocution.

Having a water birth

Some women find that being in water is more relaxing and makes the contractions less painful. Check with your doctor about water birth options.The water will be kept at a comfortable temperature (not above 37.5°C), and your temperature will be monitored.

Do note that if you prefer water birth, you will not be able to use a TENS machine. Neither will you be able to have any drugs for pain relief, such as pethidine or an epidural.

Other tips for pain relief during labour:

• Breathing and relaxation techniques work well and are completely safe. Slow rhythmic breathing  will help you get into a relaxed state and cope better with labour pain.
• Taking a warm bath or shower can help in the early stages of labour.
• Keep moving. Your position can make a difference, so try kneeling, walking around, or rocking backwards and forwards.
• Ask your husband to hold your hand, or massage you. Although it’s totally okay if you don’t want to be touched at all.

(Source: NHS, Singhealth, Healthhub)

Also READ: What happens to your body after giving birth: The first hour, day, week and year