Pain Relief Choices In Labour
By Roseanne Hickey, RN, BN, MSc(N), IBCLC
on March 07, 2007
Ways To Keep As Comfortable As Possible
Breathing and relaxation techniques are an essential part of preparing for labour. It's important to be familiar with the techniques - even if you are sure that you want to use additional methods of pain relief (analgesia).
Breathing & Relaxation Techniques:
- Will help you cope with early labour discomforts at home.
- May delay your admission to the hospital.
- Are essential if your other, preferred labour coping methods are delayed or become unavailable.
When thinking ahead about your labour, it is a good idea to be aware of your choices for pain relief. You may be asked in prenatal class about your preferences for pain relief using a 10-point scale, with one being 'I want to avoid all pain relief options,' and 10 being 'I want my epidural at my last prenatal appointment!' Most women, especially first-time moms, sit somewhere in the middle.
The events of labour have been likened to being dealt a hand of cards: it can be unpredictable. Your circumstances may require you or lead you to change your mind as your labour progresses, so it is important to be flexible.
For example, you may really want an epidural early along, but when you arrive at the hospital you may be almost ready to give birth. (Lucky you!) Conversely, you may have wished to avoid medications, then have a very long labour and need pain relief for rest and recharging. Since these options are not available at every facility, remember to ask your caregiver or prenatal teacher what options are available at your hospital.
A warm shower can be taken at home or in the hospital and can be soothing for the back and belly. You may want to have a non-slip stool or chair for your comfort and safety. Some centres have baths and whirlpools in the labour area.
Studies have shown that women who use tub therapy report higher comfort levels and have less need for pain relief. (Remember that partners should bring swim wear if they want to be close by!)
Transcutaneous Electrical Nerve Stimulation (TENS)
TENS works by delivering nerve stimuli to the surface of your belly and back, which interferes with transmission of deeper pain impulses, including those from the uterus. Electrodes are taped on specific locations on your back, and the stimuli are given using a small, hand-held machine (about the size of a deck of cards).
TENS therapy must be arranged ahead of time through the physiotherapy department of your hospital or private supplier. You operate the device yourself. While most units are easy to use, you will need to be familiar with the unit and placement of the electrode pads. That's why it's a good idea to practice using the unit ahead of time.
Nitrous Oxide/Entonox ('Laughing Gas')
You may be familiar with this pain relief option from the dental office. The nitrous oxide gas is inhaled through a mask. It provides short-term pain relief. You hold the mask yourself and with the onset of each contraction, breathe very deeply. Women report a feeling of well-being and report coping better with their contractions.
Nitrous oxide is often used for rapid labours when delivery is soon expected. (This option may not be available in all hospitals).
Narcotics are sometimes given to women in early labour to provide pain relief and rest. This is usually given in the form of an injection, and less often, through an intravenous medication (examples are nubaine, morphine and fentanyl).
Women say that narcotics 'take the edge off' the pain but do not eliminate it. Since the medicine can cross over to the baby and can slow down the baby's breathing after delivery, the timing of administering these drugs is very important. Should this occur, medicine will be given directly to the baby to reverse the effect.
An epidural provides pain relief by freezing the nerves that bring pain sensation from the uterus. This is done by administering a small amount of medicine (local anaesthetic and narcotic) into the epidural space. This medicine is given through a tube that is inserted into the lower back.
You will be asked to sit or lie on your side and curl up. For your comfort, local anaesthetic is placed in the skin and soft tissue in the lower back and a needle is inserted. The needle is removed and the tube stays in place so you can receive medicine as long as you need it.
Most women have complete pain relief with an epidural. The down side is that the loss of sensation restricts mobility and increases the likelihood of having to have bladder catheterizations. Some women have a temporary drop in their blood pressure and a transient slow-down in contractions.
Years ago, epidurals were associated with higher rates of forceps use and caesarean sections. These days, the combination of medicines and techniques allows for greater control of your muscles while providing very good pain relief.
For example, you may have heard of the 'walking epidural.' This is actually a combined spinal-epidural (CSE). The first amount of medicine is placed into the spinal space, which makes it work very quickly. The CSE provides analgesia for one to three hours and is usually used when labour is moving along quickly. Most women have good muscle control in their legs and can move about as they wish.
Should your labour last longer than about three hours, you can receive your medicine through the epidural tube. When you have an epidural or spinal and the time comes for pushing (second stage), pushing is not encouraged until you feel the urge to bear down.
Some women worry that epidurals are dangerous. While there is a one in 250 chance of a severe headache after an epidural, serious side-effects are extremely rare. If you have had certain kinds of back surgery or back deformities, such as curvature of the spine, you may not be able to have an epidural. If you are concerned, ask your practitioner during your pregnancy. When considering any of the options above, ask your caregiver questions you may have or voice your concerns.
Roseanne Hickey works at Sunnybrook and Women's College Health Sciences Centre as a nurse in labour and delivery and has taught prenatal classes for many years.
Published in March 2007
By Roseanne Hickey, RN, BN, MSc(N), IBCLC|
March 07, 2007