TENS
This stands for transcutaneous electrical nerve stimulation and is offered at some hospitals. In others you may need to hire a machine. It lessens the pain for many, but not all, women.
There are no known side-effects for either you or the baby and you can move around while using it. Electrodes are taped on to your back and connected by wires to a small battery-powered stimulator known as an ‘obstetric pulsar’. You hold the pulsar and can give yourself small, safe amounts of current.
It is believed that TENS works by stimulating the body to increase production of its own natural painkillers, called endorphins. It also reduces the number of pain signals that are sent to the brain by the spinal cord. If you’re interested in TENS you should learn how to use it in the earlier months of your pregnancy. Ask your midwife or physiotherapist.
Injections
Another form of pain relief is the intramuscular injection of a pain-relieving drug, usually pethidine. It takes about 20 minutes to work and the effects last between two and four hours. It will help you to relax and some women find that this lessens the pain. However, it can make some women feel very ‘woozy’, sick and forgetful. If it hasn’t worn off when you need to push, it can make it difficult. You might prefer to ask for half a dose initially to see how it works for you. If pethidine is given too close to the time of delivery, it may affect the baby’s breathing, but if it does an antidote will be given.
Epidural anaesthesia
An epidural is a special type of local anaesthetic. It numbs the nerves which carry the feelings of pain from the birth canal to the brain. So, for most women, an epidural gives complete pain relief.
An epidural is given by an anaesthetist so, if you think you might want one, check with your midwife beforehand (perhaps when you’re discussing your birth plan) about whether an anaesthetist is always available at your hospital.
While you lie on your side, anaesthetic is injected into the space between the bones in your spine through a very thin tube. It takes about 20 minutes to get the tube set up and then another 15 to 20 minutes for it to work. The anaesthetic can then be pumped in continuously or topped up when necessary.
An epidural can be very helpful for those women who are having a long or particularly painful labour or who are becoming very distressed. It takes the pain of labour away for most women and you won’t feel so tired afterwards. But there are disadvantages:
- your legs may feel heavy and that sometimes makes women feel rather helpless and unable to get into a comfortable position;
- you may find it difficult to pass water and a small tube called a catheter may need to be put into your bladder to help you;
- you will need to have a drip on your arm to give you fluids and help maintain adequate blood pressure;
- you won’t be able to get out of bed during labour and for several hours afterwards;
- your contractions and the baby’s heart will need to be monitored by a machine. This means having a belt round your abdomen and possibly a clip attached to your baby’s head.
- if you can no longer feel your contractions, the midwife will have to tell you when to push rather than you doing it naturally – sometimes less anaesthetic is given at the end so that the effect of the epidural wears off and you can push the baby out more effectively;
- some women get backache for some time after having an epidural.
In some hospitals, a mobile or ‘walking’ epidural is available. The anaesthetist gives a different combination of drugs which allows you to move your legs whilst still providing effective pain relief. Ask if this is available in your hospital.
If you don’t want any of these kinds of pain relief, you are free to say so. And if you decide you do want pain relief, ask for it as soon as you feel you need it, without waiting for it to be offered.
Alternative methods of pain relief
Some mothers want to avoid the above methods of pain relief and choose acupuncture, aromatherapy, homeopathy, hypnosis, massage and reflexology. If you would like to use any of these methods, it’s important to let the hospital know beforehand. Discuss the matter with the midwife or doctor. And make sure that the practitioner you use is properly trained and experienced. For advice, contact the Institute for Complementary Medicine.
What you can do for yourself
Fear makes pain worse and everyone feels frightened of what they don’t understand or can’t control. So learning about labour from antenatal classes, from your doctor or midwife, and from books like this, is an important first step.
- Learning to relax helps you to remain calmer and birth classes can teach ways of breathing that may help with contractions.
- Your position can also make a difference. Some women like to kneel, walk around or rock backwards and forwards. Some like to be massaged, but others hate to be touched.
- Feeling in control of what is happening to you is important. You are working with the midwife and she with you, so don’t hesitate to ask questions or to ask for anything you want at any time.
- Having a partner, friend or relative you can ‘lean on’, and who can support you during labour certainly helps. It has been shown to reduce the need for pain relief. But if you don’t have anyone, don’t worry – your midwife will give you the support you need.
- And finally, no one can tell you what your labour will feel like in advance. Even if you think you would prefer not to have any pain relief, keep an open mind. In some instances, it could help to make your labour more enjoyable and fulfilling.
Coping at the beginning
At night, try getting comfortable and relaxed and perhaps dozing off to sleep. A warm bath or shower may help you to relax. During the day, keep upright and gently active. This helps the baby to move down into the pelvis and the cervix to dilate. It’s important to have something light to eat to give you energy, as labour, particularly a first one, may last 12 to 15 hours from the early stages to delivery.
Information provided by Health Promotion England
