Maternity Information Leaflet Pain Management During Labour Version 2
Pain Management during Labour How will I know when labour starts? During your pregnancy you may notice your uterus (womb) tightening. These contractions are known as ‘Braxton Hicks’ and they are painless. When your labour starts, these tightenings will become regular and much stronger, causing a sensation that may feel like strong period pains that get more painful as labour progresses. Preparing for labour Understanding what happens in labour can help reduce stress and anxiety. We strongly recommend that you attend antenatal classes where midwives will discuss positioning, relaxation and breathing techniques as well as the options that are available in our maternity unit. Please ask your midwife for details of the classes. Pain management techniques You might want to consider alternative methods of labour management such as acupuncture, reflexology, hypnosis and aromatherapy. If any of these interest you please contact a qualified practitioner for advice. A supportive birthing partner can help by rubbing your back and for more information about this please attend our antenatal physiotherapy classes. This is not something you have to decide before you go into labour but it does help if you give it some consideration before the time comes.
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Options available For managing your labour, there are drugs and natural methods, or a combination of both. Not all methods are available at home or in the birth centre. Here are the main options: 1.
Transcutaneous Electrical Nerve Stimulation (TENS)
TENS is transcutaneous electrical nerve stimulation. A TENS machine is a small battery-powered box with wires attached to four pads that stick to your lower back. It sends small electrical pulses that block the pain messages to your brain. Some women find that it helps them to cope with contractions or back pain in early labour. What’s good about it? You can move around while using it You can use it with other forms of pain relief You control it, so you can increase or decrease the level of pain relief according to your needs • It’s drug-free and doesn’t have any known side effects • • •
What’s not so good? You can’t use it in the bath or in a birthing pool You must begin to use it in early labour for maximum effectiveness • Not effective for all women • •
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2.
Water
Soaking in a deep, warm bath can be very soothing. Both our hospitals have birthing pools, and you can either give birth in the water or just use it for comfort. If you're giving birth at home, you can hire or buy a birthing pool. What’s good about it? It helps with pain relief and can make you feel relaxed You can move around more easily and be upright when you give birth • It's drug-free • •
What’s not so good? • It may not give you enough pain relief • Can’t use with TENS, injections, epidural 3.
Alternative Methods
This includes reflexology, acupuncture, hypnobirthing, use of essential oils etc. Please see a qualified practitioner for further information on using these. Hypnobirthing is available locally. This is an established and well recognised antenatal education programme with a focus on natural birth. It uses the power of positive language to combine easy to learn methods of deep relaxation, breathing techniques, visualisation and affirmative positive thinking. This reduces anxiety, stress, fatigue, fear and pain which helps to achieve a calm and gentle birth. Please ask your midwife and see our Trust Hypnobirthing leaflet if this interests you.
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4.
Gas and Air (Entonox)
You breathe in entonox through a mouthpiece or mask at the start of each contraction. Many women find that it reduces the intensity of the contraction. What’s good about it? •
It doesn’t affect your baby
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You can control how much you use
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It gives you something to focus on. Many women find that concentrating on breathing in the gas and air at the right time can distract from the contractions
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You can use it at a homebirth or hospital birth and with other pain management options, such as TENS or water
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Can used any time during labour
What’s not so good? •
It can make you feel sick and light-headed
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It’s a mild painkiller, so it might not be strong enough
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5.
Keeping Comfortable
Get as comfortable as possible during labour. •
Wear something loose and cool
Tight, restrictive clothing, especially around your bump can make you more uncomfortable •
Keep moving
Your position can make a difference. Try kneeling, walking around, and rocking back and forwards. •
Learn how to relax and stay calm
Breathe deeply. You could think:’re’ as you breathe in, 'lax' as you breathe out. Keep your shoulders down rather than hunched up. •
Have a partner, friend or relative to support you during labour
If you don't have anyone, don't worry, your midwife will give you all the support you need. •
Have a bath
Warm water can help you to relax, and it makes the contractions seem less painful. You won't be able to get into water if you've had an epidural, or within 2 - 4 hours of having pethidine or diamorphine.
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•
Use a V-shaped pillow or a birthing ball
This can help you to get comfortable during labour, and can ease backache. A V-shaped pillow will also be useful afterwards when you need to get into a good position for breastfeeding. 6.
Injections
These are injections of drugs, such as pethidine or diamorphine, directly into the muscle in your thigh or bottom. An intramuscular injection takes about 20 minutes to work, and lasts for between two and four hours. What’s good about them? • • •
They can help you to cope better and relax They are available on the labour ward and birth centre You may be able to sleep between contractions
What’s not so good? •
They can make you feel sick, 'woozy' and forgetful
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If the drugs haven't worn off towards the end of labour, pushing can be difficult. You might prefer to ask for half a dose initially to see how it works for you
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Can cause nausea / vomiting, so usually given with an antisickness injection
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If pethidine or diamorphine are given too close to delivery, it may affect the baby's breathing. If this happens, an antidote will be given.
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7.
Epidural
This is a special type of local anaesthetic that's injected through a very small tube inserted into your lower back. It takes about 20 minutes to set up an epidural, and another 10 -15 minutes for it to work. An epidural numbs the nerves that carry pain signals from the birth canal to the brain. You will have a drip to run fluid into a vein in your arm. What's good about it? • • • •
It offers total pain relief for most women It works quickly It can be topped up when needed Patient controlled epidural analgesia is used at our hospitals so you control when the drug is given by pressing a button.
What's not so good? •
• • • • • •
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An anaesthetist has to give you the epidural, so it's not available at a home birth, and you may have to wait to get one in hospital It can't be given on the birth centre Some women still feel pain in one spot or down one side It may make your legs heavy, depending on the type of epidural that you have Your blood pressure may drop. This is rare, as the drip in your arm will help to maintain good blood pressure Your baby's heartbeat may need constant monitoring You're more likely to need an assisted delivery with forceps or ventouse (a suction cap to help the baby out) as you may not be able to feel when to push You probably won't be able to move around for an hour or two after the birth
About one in 100 women get a headache after an epidural. If this happens to you, it can be treated • Your back might be a bit sore for a day or two, but epidurals don't cause long-term backache •
Assisted delivery or caesarean operation For most women an epidural can continue to be used if your baby needs help to be delivered such as forceps or ventouse; and instead of a general anaesthetic if you need to have a caesarean section. This is because stronger anaesthetic and other pain relieving drugs can be given into the epidural tube without the need for anything else. This is safer for you and your baby than a general anaesthetic. If you have any questions about any of the options within this leaflet, please ask your midwife.
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Please use this page to write down any questions you may wish to discuss with your midwife or doctor:
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Further Information and Useful Websites •
National Institute for Clinical Excellence 11 Strand London WC2N 5HR www.nice.org.uk
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Royal College of Obstetricians and Gynaecologists www.rcog.org.uk
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Royal College of Midwives - Normal Birth Campaign. www.rcm.org.uk
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Further Information NHS Choices Website — www.nhs.uk National Institute for Clinical Excellence — www.nice.org.uk
Contact details: St Richard’s Hospital, Spitalfield Lane, Chichester, West Sussex, PO19 6SE Labour ward: Antenatal Clinic:
01243 831433 01243 788122 ext. 2871
Worthing Hospital, Lyndhurst Road, Worthing West Sussex, BN11 2DH Labour Ward: Antenatal Clinic:
01903 285138 01903 205111 ext. 84371
We are committed to making our publications as accessible as possible. If you need this document in an alternative format, for example, large print, Braille or a language other than English, please contact the Communications Office by: email:
[email protected] Or by calling 01903 205 111 ext 84038. www.westernsussexhospitals.nhs.uk Department: Maternity Issue date: January 2014 Review date: November 2016 Author: Joint Obstetric Guideline Group
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