Labor pain relief options

[northernnomad]

Doing my birth plan this week and had thought I was pretty decided on epidural but wanted to get feedback from personal experiences first. Did anyone manage with other combinations or with nothing at all?

Also, where there other things that anyone feels helped them get through the experience?

I wasn't able to move around in my labour and my pain was mostly in my back - my lovely midwife gave me a hot wheat pillow for my back - it was heaven. I had an epidural much later on, but I can't rave enough about it. I didn't get it with second child as apparently they were like gold dust on the delivery ward - if I'd known that I would have taken my own.

I wanted as little pain relief / intervention as possible and I got lucky and managed it. You really do need to remember that it is just the luck of the draw and every body and every birth is different. Also it's a bit difficult to compare different methods until you've been through it a few times! Have a plan but be prepared to change it.

Do try to keep mobile for as long as possible, and find distractions for early labour. I loved the water birth I had with my first, and judging from 2nd (too fast for anything at all) it did help. Not sure if g&a did, other than by spacing me out on top of an all-nighter, but I gather from here that I didn't have the faintest idea how to use it.
Do make sure you stay hydrated as well, being spaced out and distracted I didn't and my midwife was absent as often as not (be prepared for that in case you 'drop' as wonderful saying has it, on a busy night). Next day I was drinking every little bit -they ration it would you believe - that I could get hold of so they were worrying if I was diabetic!
Good luck!

I've had 4 and I can't have epidural or any spiral anaesthetic due my medical history so for me it was heating pads and positions. Heating pads and hot water bottles were the magic for me through my four. I always advice taking multiples and extras as my click-n-heat for my fourth birth died early on though my midwife did end up making me a makeshift one somehow (it was on my lower back and it was too nice of a relief to actually bother looking). Also showers with hot water on my lower back. In terms of positioning, when I needed to lay down, it did so on my side or bunched up blankets when at home to be on my front. For sitting up, on the edge of the bed drapped over my parter on a chair next to the bed was great especially with my fourth, or on a gym ball laying my upper half on the bed., For the pushing stage, up on all fours, pressing my head into something soft but firm as I felt the need to push (back of a large chair with 2, side of a duvan with 3, and the top of the hospital bed that had the top end tilted up was 4) was for me the best way to cope and push (even better when someone else could hold the heating pad on back or pubic bone depending on where baby was pressing most).

I had pethidine first.
The had early epidural, before I had significant pain. Then I watched DVDs on my laptop right thought the contractions,until I suddenly knew it was time to push, as I felt like doing a big poo.
I could feel enough to know when to push, but it wasn't that painful. Had a small episiotomy (obviously couldn't feel it) but no need for ventouse etc.
Job done.

Thoroughly recommend it. I am very afraid of pain. I had very little and a pleasant birth.

Baby 1 was back to back, and nothing worked except epidural. The pain was indescribable, and I haven't felt anything since (every midwife who has read my notes was amazed I gave birth naturally too). I was lucky and had an especially good amtheasiologist and I could feel my contractions and still push.

Planned for an epidural second time round, but he arrived 20 minutes after I got into delivery and it was a walk in the park compared to baby 1.

So my advice is, don't get too het up or too fixed on what you want. Do what's right for you and remember, birth may go beautifully, or change rapidly. Run with it and be open minded. Just look after yourself and baby. And, birth is the easy bit!

Best of luck with baby.

I would suggest giving yourself time to practice positions for active birth and breathing/ visualisation to help with the contractions (I never got round to it with no 3) make sure your birthing partner can massage your back effectively (counterpressure was the only thing that helped for me) try gas and air when you need it (it may make you throw up but then you could find you throw up a lot anyway) and prepare to 'escalate' to an epidural if you need it. Epidurals have their risks- you may need more intervention in the second stage, it may prevent you moving, I had an odd non-feeling patch of my thigh for about the next decade, so if you can manage without, it's probably best. My db had an epidural for a minor op which developed into an agonising abscess. On the other hand if you need that extra pain relief, you need it.
Go with it! You may have a 3 hr labour and barely need pain relief, you may have a long and painful labour, you may need induction. I think (in hindsight) you should train for it like any other physical challenge rather than plan.

I think that waiting to see what kind of labour you have and how long it takes is a good idea. I managed using the bath and hhypnobirthing the first time around and was fine, but then it was a relatively short first labour (8 or 9 hours). I'm going to aim for the same management this time around but obviously I may well reassess if it's a longer or harder labour. The benefit of no pain meds is that my baby came out very alert and ready to feed, I think we had an easier time of breast feeding because of that.

"Epidurals have their risks- you may need more intervention in the second stage"

With things like epidurals, it is not clear if the slightly increased risk of intervention in the second stage is because of the epidural itself or because labours that would have been more complicated anyway and require more intervention are more painful so women are more likely to have had epidurals.

The thing (as others have said and as it sounds like you are doing) is to keep an open mind and see how it goes on the day.

All we have is a lot of anecdote about our own deliveries! (DC1 - home birth, no analgesia - real problems with BFing that took weeks to sort, DC3 - induction & epidural - knew what she was doing in terms of BFing within minutes of being born!)

I had gas and air which was brilliant. One time I forgot to blow it back out and threw up as a result, but the rest of the time, breathing fully in and out, it didn't make me nauseous at all (I still had pregnancy nausea during labour, but luckily labour is quite a good distraction from it!)

However, I was induced (waters broken then drip about 4 hours later), and I felt I would need more help to get to the end. I tried pethidine but I didn't like it. It just made me groggy and didn't help with the pain at all. So in the end I had an epidural which was great. Despite getting a dural puncture, which was not ideal, and it only working on one side to start with, I would still do it again. Even only working on one side I felt as if the pain was 90pc gone, and when they topped up they managed to get both sides which gave me a totally pain free couple of hours.

I also had a mobile epidural which was great, so I could still walk around. And right at the end they didn't top up, so I could feel my contractions well enough to push: but I just started on the gas and air again and that combined with the left over epidural was still pretty close to pain free.

The whole thing was physically harder but much less painful than I expected.

Top tip: gas and air makes you VERY dry, so get your birth partner to give you plenty of water or ice between contractions and make sure to take a lip salve with you!!

One piece of advice: if you think you're going to want pain relief in the early stages that doesn't make you high (i.e. you want to swerve g&a and pethidine) then think carefully about taking paracetamol because the next option up from paracetamol in terms of strength is co-codamol or co-dydramol, both of which contain paracetamol, so you can't take them on top of paracetamol. Not a problem if you get offered straight morphine. It's just worth to check what's going to be available.

My 1st baby gas and air and pethidene and he was back to back ! 2nd epidural . And I am planning on an epidural for this one . I enjoyed labour when I had the epidural and I could remember it all and was a lot calmer . Its a personal choice and good luck .

I'm another one who had massive relief from TENS, as well as taking a bath before that. But you definitely have to be in control of the TENS yourself. The moment when I had mislaid the controls for a second and was a tiny bit late turning the TENS up when a new contraction started, was agony!

I was also upright the whole time, in the early stages standing up and swinging my hips, hanging on the door or DH, later on kneeling in front of the bed and leaning over it.

Did it three times without any other pain relief.

I was very open to what I was going to have with my first I just thought ill see how I go, gas and air did nothing for me it just made me feel sick and I kept heaving. I had Pethidine the pain relief for me was short lived it wore after 40 mins and after 12 hours I was begging for a epidural they have me it as I had to have an emergency c section anyway. I wasn't dilating so just felt like the pain was for nothing I maybe could of taken it a bit more if I was getting somewhere. 37 weeks with my second and having another csection but if I was doing it naturally I'm 90% sure id need epidural x

1st:

Paracetamol for the first couple of days and baths (baths helped a little), Morphine when on the drip (did nothing for me), followed by epidural (the one that's also on a drip and taped in place down your back). Couldn't move for an hour after the EMCS, legs swelled up, felt a bit groggy (not sure why)

2nd:
Paracetamol for the first couple of days, baths (didn't help a jot - lying on my back just made it worse), blessed pethidine (had been having regular contractions for a week at this point, and just needed an uninterrupted hour of sleep - I'd heard bad things, but it just made all the pain recede for a bit), G&A (despite not being in labour according to the rules), then I just had the small, one-shot spinal for my EMCS which I preferred because it wore of very quickly, I felt fine (well, as fine as you can do) virtually straight after, and had no lingering effects unlike my previous epidural.

I think you need to go with what feels right at the time, just make sure that they know if you're in pain so you can be given the options.

I had no pain relief during the birth of my DS and was lucky enough to have him in a birthing centre.

I had a lavender bath followed by massage on my lower back from the MW (who was essentially by birthing partner) and then lots of rocking on a birthing ball.

I did try G&A but it made me feel sick and so I stopped.

I think it's more about keeping your head, not panicking and knowing that your body was made for this.

Did anyone find that G&A made their contractions more intense?

I had G&A but it made me feel very out of control. I couldn't do without it, especially towards the end, but as it made me feel 'out of it', I couldn't do the things that I had hoped to do, like squatting or staying mobile. I just wanted to go to sleep!

If I had to do it again, I'm not sure if I would use G&A, but I will definitely need some form of pain relief. TENS seemed pretty useless to me (and annoying!).

What are the downsides to an epidural?

I think next time I might go for one. I was intensely afraid for about 2 weeks after the birth, I think the birth had haunted me a little. I remember DP wanting to pop out after the birth to get some coffee, and I wouldn't let him leave!

I'd highly recommend a yoga birthing class with your birth partner. I stayed at home till 8cm dilated just using the breathing and relaxation exercises with my second, then gna at hospital due to baby being back to back. Otherwise would have popped out as soon as we got there I reckon.

Didn't even bother with a birth plan second time as no one read it first time. I really didn't want pethidine unless a last resort and got it twice- hated it and still cannot remember a lot if what happened, baby became distressed, was touch and go when he was finally born. (He's a healthy four year old now thou ).

Good luck with whatever you decide, just be prepared to be flexible, all women and all births are different. I think it's one thing you can't really plan that much for.

StepDoor, here is a leaflet from Obstetric Anaesthetists about the pros and cons of epidurals.

www.labourpains.com/UI/Content/Content.aspx?ID=161

Curiously, I hated G&A with DS and loved it with DD. The only thing I won't consider is pethidine. If I need opioid analgesia, I want diamorphine!

My labour was 4 days, mostly at home, went in 4 times as contractions teetered between 15 mins and 4 mins apart for the 4 days.

I did hypnobirthing classes and used a tens machine, had the occasional paracetamol and warm showers and went in the birthing pool a bit on one of the times. When not in the pool or shower I had the tens machine on. A couple of times when I went in I had co-coda mol - more to help me get a rest. I did have local anaesthetic when ds was crowning as they could see I would tear.The g&a was hooked up wrong so I didn't get any till it was stitches time.

Ds was back to back so am glad I didn't have an epidural (which I asked for when I went in last time despite not wanting one initially - I was shattered and worried I wouldn't cope - but they didn't think is was far enough along (didn't even do an internal) 2 hours later I asked them to check as I thought I was def getting there and was 10cm so too late for epidural thankfully - I think it was because I wasn't screaming in pain - one of them actually said - you'll know when you are as you'll sound like the ladies out there (as could hear screaming in other rooms) - I think if I had had an epidural I would have ended up with intervention as he was back to back all the way out.

Ps the hypnobirthing is really relaxation and visualisation techniques - helps to stay calm, coupled with breathing, movement and positions and she taught my dfiance massage techniques and what to expect as well as how to help me with breathing etc - I felt it added positively to my birth experience.

I had a big fat epidural and it was bloody marvellous.

With DS1 I had cocodomol, pethadine and then gas and air. I was stuck on my back with continuous monitoring with rapid contractions, meconium in the waters & a traumatic delivery.

With DS2 I've just had the most amazing, healing birth experience :) My pain relief this time was: natal hypnotherapy, TENS & a doula - DS2 was 9lb 15oz! Labour was just under 6 hours from first contraction, TENS & breathing exercises / visualisation at home, got to hospital (consultant led due to previous complications) within 2 hrs & was 6cm. I had asked in my birth plan not to be offered pain relief as g & a made me so disorientated & pethadine did nothing, I didn't want an epidural due to SPD and a water birth wasn't available - knowing I could ask for pain relief if I wanted to helped me to manage without it, if that makes sense! Contractions were always manageable with the TENS, breathing techniques and being active, pushing was more intense but I was off my back (unlike my first birth) so able to get into a good position and felt in control, everything paused for a minute or two just as he was crowning and that made me panic a little (but doing 'horse lips' - blowing raspberries with the out breath - slowed my breathing and got him out with a graze & a couple of stitches). The whole atmosphere was amazing, so calm, and I felt awesome! Recovery was so fast too.

I know no pain relief isn't what many people would choose, but after last time it really helped me to cope to be able to think clearly and let my body take over. It was what was right for me. (Reading Ina May Gaskin's Guide to Childbirth helped me too)

I used Hypnobirthing and it as been such an amazing experience that I trained to become a Hypnobirthing teacher.
There is a whole lot of social folklore around birth, most of which actually makes things more complicated than they are. Nature makes a whole baby from a tiny little egg and didn't figure out an exit strategy? No other physiological function is painful: unless it is done in a wrong way.
I strongly advice to look into a Hypnobirthing course, or at least a book, research about gentle birth and how your body is actually more than prepared to give birth. Re-assess all your assumptions about pain and do work to release fear. You will not regret it.
Be gentle to yourself. Be gentle to your baby. Prepare a gentle birth.
And whatever you choose, make sure you make an informed choice.
Best of luck
Cecilia
www.hypnobirthingnw3.com