Labour and birth

Braxton Hicks | Bringing on labour | Membrane sweep and induction | First stage of labour | Transition and second stage of labour | Third stage of labour | Natural pain relief | Breathing during labour | Birth partners | Water births | Forceps and ventouse | Caesareans | Recovery after a c-section

Pain relief during labour

Epidurals | Mobile epidurals | Gas and air | Pethidine | Meptazinol | Spinal block | Combined spinal epidural

Epidurals

Whether it's your first or your fifth baby, you can't know how you'll cope with the pain of the contractions until labour is well on its way. So, even if you're intending to give birth without any medical form of pain relief, it's still worth knowing what your options are beforehand, and what each involves, in case your birth plan ends up getting shredded by a more tricky labour and birth than you anticipated.

An epidural is a combination of anaesthetic and pain-killing drugs being injected into your lower back just outside the dura - the tough sack that surrounds the spinal cord - to numb the lower abdomen.

What does having an epidural involve?

An epidural is done by an anaesthetist who first numbs the area using a local anaesthetic before inserting a hollow needle with a shaped point.

Once the needle is correctly situated, a fine tube is passed through it and then the needle is removed, leaving the tube in place. (Described, this all sounds rather terrifying, but chances are that if you're asking for one, you won't actually care that much when all this happens... just that it happens NOW.)

The anaesthetist then injects the anaesthetic into your back, via the tube. It can take several attempts to site an epidural, but once it's there additional doses can be administered with minimum fuss. More than 90% of women find it completely blocks the pain of contractions.

On paper, there's nothing to stop you having an epidural at any stage of your labour, but that doesn't mean you can successfully scream for one as your baby's crowning. Most mums who opt for an epidural do so during the active phase of the first stage of labour, when you're about 5-6cm dilated and the contractions are becoming increasingly hard work.

If you're in the later stages of transition and only 1-2cm off being fully dilated, you might find your midwife encourages you to grit your teeth and keep going. This is because you're not far away from giving birth and epidurals can slow the process down.

Unlike opiates, an epidural offers total pain relief without the 'high' - so you'll still know exactly what's going on. If you're labour is long and exhausting, it offers you the chance to get your breath back before it's time to start pushing. An epidural can also help if you've got high blood pressure.

What are the downsides of an epidural?

During labour there are quite a few:

• You may go numb right the way down to your feet and be unable to stand
• Regardless of whether you can stand or not, a lot of hospitals make you stay in bed once you've had one, which puts an end to any mobility and is not the best position to labour in
• It may not work completely, in which case you may end up numb down only one side of your body or still have partial sensation in your abdomen
• It can make you feel sick, shivery, dizzy or itchy
• Your baby will need continuous monitoring throughout, and you will have to have your blood pressure checked frequently
• It may slow your labour down, especially the second stage of labour when you have to start pushing, because it can be very difficult to know if you're pushing correctly
• It increases your chances of needing a Synotocinon [Pitocin] drip to speed your labour up
• It increases the risk of your baby moving into the wrong position to be born without assistance
• It increases your chances of needing an assisted delivery using forceps or ventouse
• It can cause your blood pressure to drop, which can reduce your baby's oxygen supply, so as a precaution you'll have a cannula (a small, hollow tube), sited in the back of your hand or arm connected to a drip so that, in an emergency, a drip can be administered quickly
• You might not know if you need a wee - in which case you'll have a catheter inserted into your bladder to drain urine automatically
• It increases your chances of running a fever during labour
• There is an extremely slight risk you will experience breathing difficulties, infection or nerve injury
• All the tubes and monitoring - added to the fact you're partially paralysed - can make you feel like you are no longer in control of your body or your labour
• You can't have one if you're having a home birth

Not all hospitals offer epidurals around the clock - so check whether yours does and, if it doesn't, try to give birth during 'anaesthetist hours'.

And after the birth:

• You might have difficultly doing a wee afterwards
• If the spinal cord membrane sheath is accidently punctured, you can suffer a whopping headache (caused by cerebro-spinal fluid leaking out once the needle is removed) that can sometimes persist for several weeks
• You might find you have a sore back where the tube was sited

"I wanted everything under the sun first time round, from about the time of my positive pregnancy test. I was the only person in my touchyfeely antenatal group saying, 'Yep, epidural, that's the one for me'. It didn't work very well - only on one side. But given that I was in labour for two and a half days, or something vile like that, I came out of the hospital saying 'Bloody hell, I could never do that without drugs'." Motherinferior

What is a mobile epidural?

Mobile epidurals are administered in the same way as a traditional epidural, the main difference is you're injected with a slightly different, lower dosage of drugs.

The upside of a mobile epidural is that you retain some feeling in your legs, so you may be able to move about a bit - although how much depends on how you react to the drugs. You may still need help - and you definitely won't be running any marathons.

It's worth remembering:

• Not all hospitals offer mobile epidurals (ask beforehand if yours does)
• There is still an increased risk of a longer labour and the need for a assisted delivery, although the risk is less than that associated with a traditional epidural
• As with traditional epidurals, you may find you get very itchy or have trouble passing urine

"I had an epidural, but it left some painful spots and I think it helped slow down an already slow labour (though it's impossible to know for sure). Everything stalled and I ended up with a caesarean." snowleopard

About a third of women who gave birth in an NHS hospital between 2006-07 had an epidural, general or spinal anaesthetic (NHS Maternity Statistics, England: 2006-07).

Epidurals aren't the only form of pain relief available during labour. Other options include:

What does gas and air (Entonox) do?

Remember the laughing gas you used to get at the dentist? Well, Entonox is a mild painkiller made up of a 50/50 mix of nitrous oxide (laughing gas) and oxygen. Most hospitals have it available in their delivery suites and you simply breathe it in through a mouthpiece or mask placed over your nose, usually immediately you feel a contraction starting.

It will make you feel a bit woozy - at which point you should stop using it until you next feel the need - but this only lasts a few seconds. Some mums find it makes their contractions less painful, others find it does very little.

Plus points are:

• It's easy to use - just breathe in deeply
• You control how much you have and, if it works for you, you can have as much as you like
• It doesn't harm your baby - in fact the oxygen in it is good for your baby
• It doesn't hang around in your system
• You can keep sucking for all your worth even when you're in a birthing pool

The downsides are that it makes some people feel nauseous and it dries your mouth out, so make sure you have little sips of water or suck ice chips in between tokes.

"I used gas and air. It was bloody marvellous. I had Mr Men hallucinations through my contractions, with the figure morphing from Mr Messy in between to Mr Sneeze at the peak. Bizarre!" TheFallenMadonna

"I hated gas and air; it made me unable to concentrate on contractions, so I gave it up after about 15 minutes." phdlife

"I planned to have nothing more than gas and air (I was still clutching the mouthpiece long after my daughter was born) but after transition I began begging the midwife for a caesarean. When she told me it was too late, I turned to my husband and loudly declared, 'I hate that bitch'." puzzlerocks

What are pethidine and diamorphine?

Strong, very effective pain-relievers, these opiates are usually delivered via an injection into your buttock or thigh. They work very quickly - within about ten minutes - last a few hours and can give you a real 'high' (hence the fact they're often given to surgical patients postoperatively).

But there is a downside: they can make you feel sick, drowsy and dizzy, and, more important, they may also affect your baby, making him or her sleepy and/or reducing his or her ability to breathe after birth. The latter may need urgent treatment.

Because of this crossover, it's recommended you only use diamorphine in early labour, because its effects lasts longer, whereas pethidine can be used slightly later into the first stage of labour, as it's shorter acting and less likely to affect your baby.

"TENS and gas and air did nothing for me. I had two shots of pethidine which were lovely and helped me rest, but they refused me any more. Eventually, after 42 hours of back-to-back labour and only 3cm dilated, I was literally paralysed with pain and absolutely exhausted, so I had an epidural. It stopped the pain but my whole legs had pins and needles. I eventually ended up with a ventouse delivery and episiotomy as my son's heartbeat was dipping." MegBusset

"I had gas and air and pethidine (which was bliss) during the early stages, but found the pushing stage easier to cope with without pain relief. It just felt as though my body had a job to do and was getting on with it." Tatties

"I had pethidine: I think it made my daughter very sleepy and reluctant to latch on." Elk

What is meptazinol (Meptid)?

Although also delivered via injection, meptazinol is a bog-standard analgesic rather than a potentially addictive opiate such as pethidine or diamorphine. It has the same swift pain-killing effect but can also make you feel sick and dizzy.

The plus is that it's far less likely to affect your baby and so can be used late into the first stage of labour. It is less commonly available than pethidine.

"I had pethidine with my first daughter, which was great. With my second, it was a different health authority and they only had diamorphine. It worked as pain relief, but I hallucinated, started to feel paranoid and had a couple of major panic attacks. It was horrible." annmar

What is a spinal block?

This is a one-off injection of an anaesthetic (sometimes mixed with a pain-killing narcotic) directly into your spinal fluid.

A spinal block completely numbs you from the waist down but wears off over a few hours. It's not usually used in labour itself, but is sometimes used for forceps and c-section deliveries.

Potential downsides are that you:

• Can only have the one injection
• May be immobile and confined to bed
• Can still get shivery, sick or itchy
• May find it hard to wee
• May get a bad headache

"I had a spinal when my consultant announced 'hmm, it will have to be forceps and you're going to need a big episiotomy'. Having it was horrendous, but once it was done it was great. After being in very painful labour for 36 hours having the midwife say: 'I'll let you know when you are having a contraction so you know when to push' was like a dream come true." WhereTheWildThingsWere

What is a combined spinal epidural (CSE)?

A CSE is similar to an epidural in that you receive a combination of painkiller and anaesthetic, the difference is in how these are administered.

First up, you'll have a spinal injection of a fast-acting opiate painkiller such as fentanyl. Meanwhile, an epidural catheter (tube) will be sited in the usual way - but you won't be given any anaesthetic via the tube until the effect of the painkiller starts to wear off (usually in an hour or two).

CSE is particularly suited for use in late, rapidly progressing labours as relief is virtually instantaneous (yippee).

Unlike a spinal, it can be topped up when the initial spinal injection wears off. Plus, until you have the epidural anaesthetic, you'll be able to walk around. The cons are similar to those associated with mobile epidurals.

"I wrote on my birth plan that I didn't want any pain relief unless absolutely necessary. Ha... I started off with a TENS machine that was soon ripped off as every time I tried to get on the bed the wires came out and gave me an electric shock. I ended up with gas and air, pethidine and an epidural that was topped up 3 or 4 times..." TheArmadillo

Braxton Hicks | Bringing on labour | Membrane sweep and induction | First stage of labour | Transition and second stage of labour | Third stage of labour | Natural pain relief | Breathing during labour | Birth partners | Water births | Forceps and ventouse | Caesareans | Recovery after a c-section