Pain relief options in labour

[New2020]

I've been educating myself on the various pain relief options and curious to know what other mums/ mums to be opted for..

What are your pain relief preferences and what was your thinking?

I'm not sure but I was thinking starting with gas and air but concerned that too much will make me feel sick and out of it which I really would hate. If it gets really bad then an epidural though I am concerned that contractions can slow and may result in assisted birth :(...

I ruled out opiate injections as it crosses the placenta to baby

What did you plan for?

@SockQueen thanks..I think I'd feel better just understanding the options and having an idea of what I'd be ok with and what I definitely don't want based on the effect it will have

No point planning. Zero. You can't know what will happen or how you will react to it. I wanted an epidural. Ended up with nothing as was too far along by the time I got to hospital. It was ok if a bit shocking. Pain was bearable.

I think it’s a healthy attitude to go into birth with an idea of what you would like and equally prepared to go with the flow. Until you are in labour you won’t know how you will feel at the time. The midwives are used to women with all different views and ways forward and in my experience are very supportive

oh, and stop talking about "pain threshold" too. It's bollocks.
All births are different, and a varying "pain threshold" isn't the reason I had one birth with no pain relief and another with every intervention going. There are so many more factors in the mix.

It's hardly a case of "ooh this hurts, now let me think what pain relief I fancy." It's more about using the right tools in the situation you're presented with.

@devonmum8 I think ideally nobody wants to take drugs if they don't need it..I wish I could go completely drug free but I don't think it would be realistic for me!

With an epidural how would you go to the loo if legs are numb? Do you get a catheter?

My experience was similar to Devonmums.

I did a water birth course, bought the oils, downloaded the hypobirthing aps.

My baby was back to back, and it took me 24 hours to get to 3cm. I was begging for an epidural, I had pethidine too so I could get some sleep. Plus gas and air/ tens etc. I just couldn’t handle the pain, it was very painful before I even got to 1cm!

Still had an amazing birth though, pushed her out in 20 mins (after being on drip for ages as I wasn’t dilating). Minor tear. Epidurals can make a otherwise traumatic birth very calm. I can honestly say I loved the second part of my labour!

Next time if I have a more normal labour and it’s short, I would like to just have a water birth with gas and air. But honestly, I hate it went women boast about drug free labour. You get no medals!

I wanted ALL the drugs. In the end I got none (Well half a dose of paracetamol 12 hours before) as it all progressed to fast. It hurt but it was over fast. Try not to plan too much as things have a habit of changing

Yes you get a catheter which they put in about the epi so you don’t feel it or anything.

I got a button which I pressed when I needed a top up, and could still move my legs etc.

In the gentlest possible way, it's not useful to talk about what you definitely don't want based on the effect it will have

I said that stuff before DC1's birth. I now realise I had no clue whatsoever what I might want after two days of back to back labour, with no gaps between contractions. What I would've ideally liked would've been a gun to shoot myself in the head and end what was, essentially, a world of agony with no let up. Sounds dramatic but it was honestly that bad. My prior ideas about diamorphine seemed laughably naive.

But then three years later I had an easy peasy birth with not even paracetamol, where drugs weren't even mentioned, as I just sort of popped DD out without it becoming an issue.

It's not like you go into hospital and get a menu to pick from (well, you might if you go private, but not in a standard NHS hospital). Different solutions are presented depending on the situation at hand.

Had an epidural with my first. Was fine but it meant going onto the ward, which was horrible. Hated gas and air. With my second I got a Tens machine and it's hands down the best pain relief there is. Or rather it's not even pain relief, it's just a fantastic distraction that cuts the visceral fear of pain. I had it all the way through both subsequent labours and needed no pain relief at all. Also, take your midwifes advice and take some paracetamol when contractions start. I thought they were full of it, but it does actually help if your Labour is straightforward.
It's worth bearing in mind that epidurals can also cross the placenta and apparently also contain opiates. Not that I cared at the time, lol!

I would say, clue yourself up with us much knowledge as possible, but when the time comes it might all go out of the window lol
My DD was breech and I'd planned for a natural birth but in reality I ended up with a spinal so try and read up as much as possible but be prepared to go with the flow.

@new2020 I didn't plan that at all and I didn't want a water birth!! But when they offered it I just said yes lol

As a PP said just be open to anything and don't plan too much x

@chubbyhotchoc I think it's important to know the options/ risks/ benefits/ alternatives and what you'd like and not like to make decisions on the day easier. That's what I mean by planning...it's obviously dependant on how things go and not set in stone

@New2020 I don’t know why she just decided. She said she didn’t feel like I was coping with the pain so was going to give me the shot, I’d already said no several times when she asked before so she just gave it to me. I was only 21 and didn’t realise I had choices in a lot of it, I was told I was having an induction, No choices offered. I just thought you had to do what they said. Sounds really silly now but it ended up being an incredibly stressful experience. 9 years later I’m doing it again a lot more knowledgeable about my choices

I planned to an epidural and no opiates.

I had gas and air and 1 shot Pethidine (no time for epidural).

MW recommended the Pethidine and explained why at the time. It’s good to be well informed but also open to change

I m pregnant with my first, my midwife has suggested it's good to have an idea of what I'd prefer in an ideal scenario but to be open minded.

So I've written that i'd prefer just paracetamol and gas and air, as I feel awful when I've had codeine in the past and if i have pethidine or diamorphine i wont feel like myself (i don't want my ability to make decisions in an emergency to be massively impeded and I'm also asthmatic which has a very slight increased risk as being affected with those drugs if i've understood correctly).

I have put down what I want to happen in worst case scenario if I need a section under General anaesthetic that i'd like them to explain any procedures baby or I need until I wake up so he can make the best decisions for us at the time.

@Oneandabean that's really frustrating and scary I'm sorry you had that experience. Not silly at all! I'm 35 and have found myself not very knowledgeable in some areas and accepting what I'm told where naturally I'd challenge

First birth: (twins) lovely lovely gas and air followed by an epidural

Second birth: nothing it was too fast and breech

Third birth: cesarean so epidural

My "birth plan" was start with water (if possible) and gas and air and then I am open to suggestions.

My only instructions for my partner was to encourage any options that kept me calm and to ask why they were suggesting any interventions etc.

In the end it was in the instructions for my partner that came in the most useful. We were at home and I was starting to struggle to cope. I was hesitant about calling in to get checked again as we hadn't been home long since I was last checked. He was right though, I arrived fully dilated and ready to start pushing.

Rather than thinking about how you want your birth to go think about how you would like to feel and make sure that your birthing partner is clued up on your triggers for extra pain relief and what questions you would want to ask when offered interventions.

Yes you have a catheter to go to the loo. But don't worry about that because by that stage you'll probably have pooed and weed on the midwife and you won't even care.

Had pethidine with my first and absolutely hated it. It was good for the pain but I had hallucinations and vomited. Also sure that's what made my DS come out drowsy and not breathing properly (sorry not intending to scare anyone.)
Had G&A with my DD. Didn't make me feel sick at all, just a bit spaced but like others said it quickly wears off.
Tens machine did sweet FA for me with either.
Expecting number 3 and hoping to have similar to my DD - however I know that's not guaranteed. I'm open minded about epidural.

Super scientist is right about the most important thing is your partner being clued up.

A student dr was left in charge of me at one point and my epidural was running out. My dh had to make him get someone more senior for it to be topped up.

As everyone else says you can't plan, even knowing the options doesn't really help as you won't care or remember during labour. Every situation is different and you will be seeking guidance on what is best from your midwife plus asking for all the drugs if it's that kind of a birth.

Yeah, are tens machines and actual joke. What do they even do. I forgot I had one before the gas and air and epidural in my first birth!

I approached my first labour with an aversion to opiates and epidural (because of increased risk of additional intervention) but I wasn't going to rule anything out! In the end, my labour progressed quickly and the pain never felt intense enough to need any pain relief at all. I did lose the plot right at the end, but G&A made me feel really spaced out and out of control, so I ditched it.

My advice would be not to take anything off the table but to physically prepare for the birth - learn about the different stages, optimal positions, breathing technique. Labour is such an unknown quantity - best to be prepared, hope for the best but accept that it might not go the way you think! Good luck!

I had both of mine with an early epidural because I hate pain and I just don't believe all the magic thinking out there about "good pain" (I am an anaesthetist). Both were pleasant labours, even though both had to be induced for different reasons. All very calm, the second time around was actually completely pain free as my contractions were only mild cramp-like when I got the epidural (being second time around I was expecting it to escalate quickly and didn't want to take any chances). I read a book and then snoozed for a bit. Pushed each DC out within 15min when the time came, despite DC1 being massive.

Lots of people, including health professionals, confuse correlation and causation: the labours that get an epidural are typically longer, but because you can't do a classic randomised controlled trial, it's just pointing to a correlation, and not that epidurals necessarily cause a prolonged labour. In other words, no study out there can tell you whether a labour was going to be longer /require intervention anyway, because of known or unknown maternal and/or fetal factors ... rather than specifically because the woman had an epidural (which many ask for/get because it's not progressing well already). My own reasoning was that if I "won the lottery" for one of those, I'd rather have my intervention with adequate pain relief already on board, rather than get all the way to fully dilated only to then to have to get something in my back (not exactly an easy task at that point) or a GA in a hurry.

As the doctor who does them, I would advise not to wait until the last minute to request it if you decide you want one. We usually cover multiple locations so often cannot attend immediately on request as labour epidural placement is not an emergency and we might be tied up in one, especially after hours. With last minute urgent calls, by the time we get there, the woman is often fully dilated - by then it's usually too late (unless there are issues with the pushing) as by the time we'd get it in and established, the baby would be out.

And nope, I don't have any financial incentive in "advertising" epidurals! We don't get paid per epidural (in a public health service - I can't speak for those countries which have extensive private provisions), so if you don't want/need one, that's great, it's an easier shift as far as I'm concerned.

As others have said, consider everything, discount nothing, go with the flow on the day. Good luck!