By Guest Blogger:
Dr Sujata Gandhi
MD, DNB, FRCA(UK)
Note: This information is based on Dr Sujata’s structured training in India and UK as well as her long experience of 27 years in this field. The knowledge comes from worldwide authentic sources. She has very kindly shared about analgesia in labor. Over to Dr Sujata Gandhi.
I will give you some idea about the pain of labour and giving birth, and what can be done to make it less painful. The people who are looking after you i.e your anaesthetist, obstetrician or nurses will give you more information about the types of pain relief and resources that are available in your own hospital.
WHAT WILL LABOUR FEEL LIKE?
While you are pregnant, you may occasionally feel your uterus (womb) tightening from time to time. When you go into labour, this tightening feeling becomes frequent, regular and much stronger. It feels like period pain in the beginning and usually becomes more painful when you set in to labour.
Different women experience labour pains in different ways. Usually, your first labour will be the longest. If medication is used to start labour or speed up your labour, your contractions may be more painful. Most women use a range of ways to cope with labour pain.
PREPARING FOR LABOUR
Having knowledge on pain relief before you become full term will help you understand what will happen in labour and may help you to feel less anxious. You should check with your doctor i.e. obstetrician about what is available to reduce the pain. It may be helpful to look round to find out what facilities they have.
Here is some information about the main methods of pain relief available.
1. SELF HELP METHODS
You can play music to help you feel more relaxed.
It is important to talk to your birth partner about your concerns and how they can help you to focus during the birth. Breathing calmly may increase the amount of oxygen supplied to your muscles, and makes the pain less intense. Also, because you are focusing on your breathing, you are likely to be less distracted by the pain. You may find that having a massage while you are in labour can be very comforting and reassuring.
2. USING A BATHTUB DURING LABOUR
It has been shown that if you sit in water bath tub in initial stages of labour you will find it reduces the pain.
3. TRANSCUTANEOUS ELECTRICAL NERVE STIMULATION (TENS)
A gentle electrical current is passed through four flat pads stuck to your back. This creates a tingling feeling. You can control the strength of the current yourself. It is known to help at the beginning of labour, particularly for backache. TENS machines have no known harmful effects on your baby. Your physiotherapist can help you with TENS
Entonox is a gas made up of 50% nitrous oxide and 50% oxygen. Ask the anaesthetist if they can give itthrough anaesthetic machine. You breathe Entonox through a mask or mouthpiece. It is simple and quick to act, and wears off in minutes. It does not harm your baby and it gives you extra oxygen, which may be good for you and your baby. It will not take the pain away completely, but it may help. You can use it at any time during labour. To get the best effect it is important to get the timing right. You should start breathing Entonox as soon as you feel a contraction coming on, so you will get the full effect when the pain is at its worst. You should not use it between contractions or for long periods as this can make you feel dizzy and tingly.
Opioids are strong painkillers. They include painkillers such as pethidine, as well as diamorphine. They can be injected into a large muscle in your arm or leg.
The pain relief is often limited. You will start to feel the effects after about half an hour and they may last a few hours. Opioids are less effective at easing pain in labour than Entonox.
Side effects of opioids: They may make you feel sleepy or nauseous, but you can get anti-sickness medication to stop this. They may slow down your breathing. If this happens, you may be given oxygen through a face mask. They may also affect baby’s breathing or make your baby drowsy,
6. EPIDURALS AND SPINALS
Epidurals and spinals are the most complicated method of pain relief and are carried out by an anaesthetist. An anaesthetist is a doctor who is specially trained to provide pain relief and drugs that make you go to sleep.
Epidurals and spinals are the most effective method of pain relief and considered gold standard.
An epidural may take 40 minutes to give pain relief (including the time it takes to put in the epidural catheter and for the painkillers to start working). An epidural should not make you feel drowsy or sick. It hardly has any effect on your baby.
Having an epidural marginally increases the chance that your obstetrician will need to use a ventouse (a suction cap on your baby’s head) or forceps to deliver your baby.
WHAT DOES AN EPIDURAL INVOLVE?
First, a cannula (a fine plastic tube) will be put in a vein in your hand or arm, and a drip started to give you intravenous fluid.
Then you will be asked to curl up on side of bed or sit up bending forwards. Then your anaesthetist will clean your back with an antiseptic.
Your anaesthetist will inject local anaesthetic into your skin, so that putting in the epidural does not hurt.
The epidural catheter is put into your back near your nerves in the spine. Your anaesthetist has to be careful to avoid puncturing the bag of fluid that surrounds your spinal cord, as this may give you a headache afterwards.
It is important to keep still while the anaesthetist is putting in the epidural, but after the epidural catheter is fixed in place with tape you will be free to move. Once the epidural catheter is placed, you will be given painkillers through it. It usually takes about 20 minutes to set up the epidural and 20 minutes for it to give pain relief. While the epidural is starting to work, your blood pressure is checked regularly. During labour, you can have extra doses of painkillers through the epidural catheter either as a quick injection (a top up) or a slow, steady flow using a pump.
The aim of the epidural is to take away the pain of contractions. Usually, the epidural also completely takes away the pain when your baby is delivered
After an epidural your sensations below waist are decreased so you may find it difficult to walk around.
WHEN CAN I DECIDE I WANT AN EPIDURAL
You don’t have to decide in advance . You can take the decision after experiencing the labor pains,you may decide it is unbearable and go for epidural. Of course you must indicate to your obstetrician that you would want to exercise the option of going for an epidural if you so feel.
WHAT IF I NEED AN OPERATION AFTER HAVING EPIDURAL?
If you need a Caesarean section, the epidural is often used instead of a general anaesthetic. A strong local anaesthetic is injected into your epidural catheter to make the lower half of your body very numb for the operation. This is safer than a general anaesthetic for you and your baby.
Every medical procedure has side effects. However these side effects can be minimised if a safe and experienced anaesthetist looks after you. Always discuss benefits and risks of epidurals with your anaesthetist in antenatal period. You may have to make special appointment to meet your anaesthetist. That is the time when you get our facts right.
Spinal anesthetic is the preferred choice of anaesthesia for caesarean section. Spinal anesthetic has a track record on excellent pain relief. It is very safe for you and your baby. Pain relief during caesarean section is entirely a separate topic by itself. Hence it is not covered in details here.
I wish all the best and hope you have safe sailing through your labour pain and it is a satisfactory experience for you.