Baby due May and no idea about pain relief! Any advice please?

[Snoopy10]

Hi - I am due to have my first baby in May and I really don't know where to start regarding pain relief. I have read masses now and I am still none the wiser.

Some swear by epidurals while others list all the problems. Gas and air seems to be a placebo for actual relief and the reports on pethidine vary greatly. Not sure I can face floating in a tub although I know most reports are very positive (I have to be in hospital due to risk factors).

Any advice welcome before I chat to the midwife. I don't know what to ask or plan for. Thanks in advance.

Hello. Does your MW do antenatal classes? Worth asking!

Here's the NHS website. www.nhs.uk/conditions/pregnancy-and-baby/pages/pain-relief-labour.aspx#close

Basically theres pros and cons to everything.

See how you go on the day. You don't need to decide now. Know the pros and cons, and see whether you need anything. You may cope brilliantly and not feel the need. You may need everything going. No way of telling, so relax! :)

Just go with the flow on the day.

I had planned on natural birth with gas and air only, maybe a water birth. However, there were some complications ( I had a high heart rate ) so it was recommended I take diamorphine to try and bring it back down before the baby got into distress. It worked for about 2 hours then wore off! The doctor then recommended an epidural. Again I agreed. I do feel I done the right thing at the time but still wish I could have avoided the epidural. I didn't like not feeling the contractions, it was very strange! The epidural also didn't take away the terrible back pain I had which was disappointing. I ended up with emcs so would have needed an epidural anyway but will try my best to avoid one this time.

The labour ended up the exact opposite of what I had planned but I don't see think I had much options on the day.

Everyone has to make their own choices and what's for one isn't for another.

I would maybe suggest starting with gas and air and tens machine and take it from there. If you feel you need more, then don't be afraid to ask!

I wanted a water birth with only gas and air but baby was back-to-back and I couldn't cope with the pain. Ended up having diamorphine (don't recommend - for me I was just scared of it wearing off the whole time, and it didn't help much) and an epidural. You'll know on the day.

Hello OP

Just be aware when making your choice that only gas and air and pethadine, maybe diamorphine now will be readily available to you.

You can choose epidrual but when you get to hospital they may have other ideas.

Anethitist busy, ward full, and so on.

I don't think you can make decisions in advance really. Think of it as a sliding scale, where you start at one end and see where you end up.

Gas and air is massively personal. I am high as a kite on it and it's the best pharmaceutical pain relief I've found. Others say it is just a distraction. The great thing is that it is readily available and easy to try and see how you get on. That's why it is often the first option.

Pethidine. As you say, people have differing experiences. Only you can make the call whether to try it when the time comes. Some people don't want it and don't go near it (I didn't).

Epidural. Again, differing experiences. Whether you feel you need one may well depend how long labour has been, and how your baby is positioned. Things you won't know in advance. Don't pin your hopes on it as the single solution to pain - there may not be the right staff available, there may be a wait, etc.

Thank you so much for your replies. Mostlyconfused and Ch11 sorry to hear things didn't go as planned. Is it just me or is the process women go through, not just for the birth itself but before and after, massively underestimated in many circumstances?!
There is very little written expressing waiting and seeing how it goes - how to tell if you need more, what that should be and advance warning of what will be available on the day. There is lots of advice on writing a birth plan but all the evidence seems to show you can't plan at all! (Unless your body and baby goes along a natural, hypnosis induced serene delivery with no tearing or screaming and a perfect Apagr score! That is my current plan ; ) ) Penguin, I hope gas and air have the same effect on me.

I listed them all in the order I wanted to have them and decided I would be open-minded and have whatever I needed as there is no way of knowing how you will find it, what position baby will be in, how long labour will be etc.

I knew I didn't want an epidural because the thought of the needle frightened me more than the idea of pain. I also really liked the local birth centre and wanted to give birth there, which ruled out an epidural because they don't do them there.

I had a TENS machine at home which I found quite useful (though the pads kept falling off and needed taping to my back as I moved around a lot). I did lots of hippy-type things like reading positive birth stories whilst in early labour and visualization etc.

I planned to use gas and air as soon as I felt like I was really in pain. But when I got to the birth centre I went straight into the pool and never thought about pain relief again as the warm water was so effective. I had a quick and straightforward labour so it turned out that I just didn't need or want anything. You just can't know in advance so I think the best thing is to know what your options are, what order you would like to use them in and then avail yourself of what you need/can have at the time.

I think it is a difficult balance, because most classes don't want to panic women and increase their fear levels. But that can also translate into being less than realistic about common experiences for first time mothers.

On birth plans, it is true, you can't plan that much, especially with your first (I'm expecting my third and my birth plan has some quite specific stuff based on past experiences, like that because (unusually) I find internals very painful I want them to make sure that they give me gas and air for any internals, even if I'm not using it generally. I tend to be very 'distant' in labour and I might not think to ask even though I'm in pain). However, they can be valuable in a number of respects. For example, you can indicate whether you would like to use the pool if things are going well. Whether you would like pain relief to be pro-actively offered or wait until you ask. Whether you'd like delayed cord clamping and injected vitamin k for the baby.

I have experienced two very different labours - first one was long with drip, epidural, forceps, etc. Second was at home in the pool with literally no other pain relief (had gas and air and local anaesthetic for the stitches afterwards). For me, epidural wasn't a great experience, but it was right for the circumstances. I couldn't really know that until I saw how things were going. It's really hard to plan and read up on it in advance, because there are so very, very many variables. It's best to have loose ideas and then be guided by staff on the day.

Good luck. As I said, I'm doing it for the third time so it can't be that bad!

Does your hospital offer Remifentanil?

I had that with my second and it really was wonderful. They put a canula in your hand, and you have a little control. You press the button as the contraction starts and the machine releases a safe amount. You then can't release anymore for 2 minutes or so, so you can't overdose. But it really did work. I was a bit shaky and cold at the end during the "comedown" and they had to monitor my oxygen/breathing while taking it, but those were the only downsides. It didn't affect baby at all.

Unlike pethidine which did nothing at all when I had my first. And the MW told me its not really for pain, more to make you sleep between contractions.

I think you have to wait for the day to really know what you need. My waters broke and I went into spontaneous labour shortly after. At the start I was offered and took paracetamol which did nothing and then as things progressed I had codeine which was a bit better. When my contractions got to every 7 mins I went to the birthing suite and tried the pool but it just slowed things down. After around 12 hours I went on gas and air which is good but you need to use it properly- as soon as you feel a contraction coming-I was leaving it too late. 24 hours after my waters went I was still on every 7 mins so had to go on a drip to be induced. Contractions hit like a truck after a couple of hours and DS was born a few hours after that. I had diamorphine about half an hour before he was born. It doesn't stop pain just makes you sleep in between contractions.

I wish I'd known more about the time it takes to get relief and for it to take effect- for instance I wasn't coping very well on the drip and they had to get a doctor to prescribe the diamorphine, then mix it up and administer it then wait for it to work. I think that the doctor could have pre-written the prescription when I was put on the drip. I was very, very grateful for it at the time (!!) but it does make you incapable of making a decision so put after birth stuff, cord cutting etc in your birth plan. The diamorphine+entonox also made it hard for me to concentrate on what my midwife was telling me and I panicked a bit- it meant that I pushed him out all in one go(rather than delivering the head then the body)- It might have made a difference to tearing if I'd been a bit slower and more in control- next time I'd probably lay off the entonox at that point.
You'll be fine. Get informed- and get your birth partner informed- make a vague plan then be prepared to throw it out of the window!!! Good luck!

I know too many personally who went for an epidural and it only worked on half their body or not properly but they still couldn't move to push etc for it to be an option I would plan for. That said, I always shout for one at the very end (not that it matters because when you get to that point it means the baby is coming and you aren't getting an epidural.

I'd start with water and then see how you go, The warn water really helps with contractions unfortunately I have never had the opertunity to give birth in a pool but have labored there

I would say personally to see water as something that might be available or might not. For me with my first labour, it was something I was quite focused on. As it happened, my labour had been long and wasn't progressing too well, so they attempted to augment my labour with ARM, then my contractions stopped completely and I ended up on the drip. All this well before the 5cm that the hospital rules required before I was allowed in the pool. So I needed pain relief long before water was even theoretically on the menu.

And another friend found the pool was busy and 'no one was trained' to use the inflatable one they advertised so heavily as a back up.

Water is great, but in hospitals and MLUs, it isn't always readily available to you as a choice. It was, I would say, the biggest factor for me in my next one being a homebirth.

I know what you mean VeggySausage!! The very first words my baby heard were "I want an epidural!!"- obviously very closely followed by "but he's here now!"

Thank you so much to everyone for all your replies. Jelly that sounds like water really worked for you. I have heard a lot of good things.

Panda - will check out availability of Remifentanil at this afternoon's ante natal app.

NickyEds - thanks that story about calling for help after the baby was born made me laugh : )

Penguin - Sorry to hear your labour was so tough.
The pool being busy, and no one being trained, makes it sound like your friend was having her baby at a local leisure center : ) This is one of my concerns about a water birth, plus all the climbing in and out and not having any other pain control options if choosing this. I am hoping to cope alright and don't want to take too much medication, but I don't want to go in blind, wishing I had done my research.

It is very useful to hear that you have to play so much by ear. Out of interest I was wondering how many people experienced tearing or episotomies. How long does it take to repair? I am very nervous of 'birth injuries' as they call them, I read that 50% of women suffer these with long term consequences but I'm not sure how accurate this is. I expect things to be a bit rough after the birth but I am worried about long term effects. Any realistic reports on this would be greatly appreciated. If I start a thread asking this then it attracts a lot of horror stories ; / I would really like a realistic snapshot of what to expect. Thanks again for all your help.

"I read that 50% of women suffer these with long term consequences"
I am also scared but read (on a reputable site) that it was 50% of women who had one full stop. As in: 50% of women need some type of stitching or a cut and most of these are painful but do not have 'complications' as such. Not that it's 50% who have very serious complications.

Are any midwives/doulas able to clarify whether that's hopelessly optimistic?

Certainly seems to be the consensus among mums in my RL F&F: one I know needed help (she delivered an 11lb whopper) and about half had stitches, cuts, tears which healed normally between 1-2 months (including naturally born twins, 1st pg!). Interesting how conversational topics change once you're upduffed...

Well, it is amazing what you talk about once you've had the baby too...

I would say that I know very few first time mums who didn't need some sort of stitching. I am not an expert and don't have stats, but I wouldn't be surprised if 50% is the overall number, with a much higher figure amongst first timers. I only know a few people who didn't need stitches first time.

But the reality was that it wasn't that bad. I've had both - episiotomy for forceps first time and a tear second. Both were stitched fine and both healed fine. I didn't have problems sitting down or anything like that. I have had some minor pelvic floor issues (I have to cross my legs if I sneeze!) but those were probably related to the forceps and it is something I am working on, not something that impacts my day to day life.

On the pool, part of the problem was that, in the area I was in at the time, the only option was a CLU. They don't really have the mentality that a MLU have. My ideal scenario for a first would be a MLU on site with a CLU for an easy transfer if you needed more pain relief. Also bear in mind that, if you get in the pool, there is no law that says you can't say you want to get out and have an epidural!

I won't lie, my first labour was a bit shitty, but mostly because of the horrid locum midwife. The forceps, the episiotomy, the stitches, they were all fine. The registrar was lovely. It's funny, before my first I was worried about all the same things you were, but in the end all those bits were fine- what made it difficult for me was how long it was and the sleep deprivation.

all of my birth plans were very specific that I was NOT to be cut. I would prefer to tear as everything I read shows women heal better that way.

I have had 3 births of 9/9.7/10.1 births.. I only required stitches once.. and they had to consider whether it was worth it as only a tiny graze (2 stitches). I admit I was quite lucky but I do think if I had allowed myself to be cut when they realised how big my babies were.. I'd have probably been cut. So very happy I opted out.

penguins not sure if it's true but I've been told it's the pregnancy not the birth that generally fucks your pelvic floor

Veggy - I think that's generally true, but I think forceps do have recognised issues for pelvic floors, as opposed to normal vaginal or, oh goodness, forgotten the word, suction cup thingys.

I only had gas and air with all three, and second child was a water birth which definitely helped a lot as well, am pregnant with 4th, and also due in May, and am hoping for gas and air and water birth again, but you can really only see what happens on the day, as you just have no idea how you will cope until its all kicked off - good luck!!

didn't know that penguins, but makes sense..

feeling quite pleased to have dc3 in arms now and know I never have to worry about any of this again!

off to book vasectomy for dh

Thanks Penguin and Veggie - that's very reassuring (I'm not one of those who think they can breathe a baby out etc' just wanted to know that a tear isn't always the "end of the world" so to speak). :)

Oh, no, it totally isn't. I get that the thought of your genitals tearing is quite a scary thought in advance!! But honestly it was fine, really not that bad. I won't lie, you've squeezed a person out, the whole area is pretty swollen and sore whatever happens. But stitches were fine. The tear healed more easily than the episitomy, but neither was a big issue.

Hi, i had forceps and an episiotomy. The forceps were used in theatre under a spinal block and involved rotating dd, so quite major i think. I won't lie, it was pretty sore afterwards but 14 months on i don't seem to have any lasting issues - i can cough, run and sneeze without any problems.

i only had paracetamol and codeine as pain relief for contractions, because i didnt need anything else, although like someone else said upthread i found internals really painful.

then when it was clear dd wasn't coming out without help they went straight to a spinal block, in case i needed a c section. In hindsight this was a good thing as it meant i couldn't feel the forceps, stitches etc.

this is the exact opposite of what was on my birth plan. - i was going to have a waterbirth and/or gas and air...