Pregnancy App Article: "Epidurals and pain relief options during labour"

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Epidurals and pain relief options during labour
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The drugs do work
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Whether it’s your first or your fifth baby, you can’t really know how you’ll cope with the pain of contractions until labour is well on the way.

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 thoughtfully penned birth plan ends up getting shredded by a trickier-than-anticipated labour.

Epidural

An epidural is a combination of anaesthetic and pain-killing drugs, injected into your lower back to numb the lower abdomen.

It offers total pain relief without the ‘high’ of some other drugs - so you’ll still be bright and alert (well, up to a point).

If your labour is long and exhausting, it gives you the chance to get your breath back before it’s time to start pushing. However, it can mean you aren’t able to move around as much, unless you go for a ‘mobile’ (low dose) epidural.

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 women who opt for an epidural do so when they’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, your midwife might encourage you to grit your teeth and keep going. This is because you’re close to giving birth and epidurals can slow things down (and not because she’s a sadist, although you may disagree at this stage).

There are a few increased risks for both you and the baby, so read up on the details beforehand so you can make an informed decision in the heat of the moment (or get your birth partner to do so if you're a bit distracted).

Gas and air

Otherwise known as Entonox, a mild painkiller made up of a 50/50 mix of nitrous oxide (laughing gas) and oxygen - this is like the stuff you get at the dentist.

Most hospitals have it available in their delivery suites and you simply inhale it through a mouthpiece or mask placed over your nose - usually from the start of each contraction to its peak.

It can make you feel a bit woozy - at which point you should stop using it until your next contraction - but this only lasts a few seconds.

Whether or not gas and air actually helps with labour pains is up for debate. Some find it does very little, others find they would gladly sell their birth partner for his or her body weight in Entonox when the contractions ramp up.

It’s easy to use, you control how much you have (as much as you like, if it works) and it doesn’t harm you or your baby. In fact, the oxygen in it is good for your baby. Some find it makes them feel nauseous, and it can dry your mouth out, so take little sips of water or suck ice chips in between tokes (see, we told you this would be fun!).

Pethidine and diamorphine

These strong and very effective pain-relievers are usually delivered via an injection into your bottom or thigh. They work very quickly (within about 10 minutes), last a few hours and can give you a real ‘high’.

Alas, there is a downside: they can make you feel sick, drowsy and dizzy, and they can also affect your baby - making them 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 last longer. Pethidine can be used slightly later into the first stage of labour, as it’s shorter-acting and less likely to affect your baby.

Meptid (meptazinol)

A bog-standard analgesic, also delivered via injection - it has the same swift pain-killing effect but can also make you feel sick and dizzy.

The upside is it’s far less likely to affect your baby than pethidine or diamorphine, so can be used late into the first stage of labour. It’s less commonly available than pethidine.

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.

Combined spinal epidural (CSE)

Similar to an epidural, but you’re given the painkiller via spinal injection first; the anaesthetic comes later once 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.

Unlike a spinal block, 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 epidurals.

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I had gas and air and pethidine (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.
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Quote 2
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!
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Quote 3
I wanted everything under the sun first time round. I had an epidural, but it didn't work very well - only on one side. But given that I was in labour for two and a half days, I came out of the hospital saying 'bloody hell, I could never do that without drugs'.
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Quote 4
I 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. 
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Quote 5
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. I ended up with gas and air, pethidine and an epidural that was topped up three or four times.
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