Your guide to pain relief in labour




Pregnancy is a joyful of period for most women. The birth of a baby is one of nature’s miracles that only a woman has ever had the privilege to experience. However, as the name implies labour at the end of nine months is a painful process. Most modern day pregnant women are concerned about how they would cope with labour pains and whether they would indeed be able to go through the long hours that labour entails.


Medicine has come a long way since Queen Victoria used chloroform for the birth of Prince Leopold. Now there are various methods available to women and a few these such as TENS, Laughing Gas, Acupuncture, Hypnotherapy and Epidurals are discussed below.

TENS

TENS stands for transcutaneous electrical nerve stimulation.
It is a gentle electrical current passed through four flat pads on your back. The TENS works by stimulating the body to increase production of its own natural painkillers called endorphins. They also interrupt the pain signal pathway sent through your spinal cord to your brain reducing the pain sensation. The TENS is most effective if used from early labour as it takes 30-40 mins to build up the endorphin levels and the electrical stimulation can be increased as the contractions become stronger. It is not very effective during the active phase of labour, when contractions get longer, stronger and more frequent. It's probably most effective during the early stages, when many women experience lower back pain.

Electrodes are taped on to your back and connected by wires to a small battery-powered stimulator. Holding this, you give yourself small, safe amounts of current through the electrodes. You can move around while you use TENS.

Pros

-You can keep moving and it won't directly interfere with your labour.
-You can use it for as long as you want.
-There are no lasting side-effects for you or your baby.
-It doesn't need an anaesthetist, doctor or midwife.
-It can be used at a home birth and in hospital.

Cons

-You’ll probably need someone to help you to position the pads.
-It may only help in the early stages of labour.
-It may have to be removed if your baby's heart has to be monitored electronically.
-It might make it more difficult for your birth partner to massage your back.
-The clinical evidence in support of TENS is lacking though many women say that it helped them.

Laughing Gas

Nitrous oxide (often called “laughing gas”), in combination with oxygen (50% of each gas), has been in use for two centuries as a simple anaesthetic agent. It has been used by women in labour since the 1930s. It is also called “gas and air”.

It is used by labouring women to help cope with labour pains. It won't remove all the pain, but it can help reduce it and make it more bearable. Many women like it because it's easy to use and they control it themselves.

You breathe in the gas and air through a mask or mouthpiece, which you hold yourself. The gas takes about 15-20 seconds to work, so you breathe it in just as a contraction begins. It works best if you take slow, deep breaths.

Pros

-You can control it and the effects wear off very quickly once you stop inhaling.
-It’s fast-acting (taking effect after 20 to 30 seconds).
-Your baby doesn't require extra monitoring while you're using it.
-You can use it in a birthing pool.

Cons

-It may make you feel sick and light-headed initially but the nausea usually passes.
-It can dry your mouth out if you use it for long periods.

-Keeping hold of the mask or mouthpiece may stop you from moving around and getting into a comfortable position.

-It can take a few contractions to get the hang of it so that it's effective at the peak of contractions.
-If used with pethidine or diamorphine, it may make you feel even drowsier.

There are no harmful side effects for you or the baby

Acupuncture and Hypnotherapy

Acupuncture, an important and ancient component of traditional Chinese medicine, is gradually being integrated with conventional medicine in the West.Acupuncture involves putting needles into points on your body to help reduce the pain. The therapist would need to be with you during your labour. Some studies suggest that women who used these therapies feel in control of their labour and use less medication to reduce pain.

Hypnosis has been used to reduce childbirth pain since the early 19th century. With the improvement in obstetric analgesia in the 1960s and later, the popularity of hypnosis declined. Today, the interest in hypnosis training to shorten labor and decrease childbirth pain is increasing among holistic practitioners and expectant parents.

Hypnosis can distract you from the pain. You can be trained to do the hypnosis yourself (self-hypnosis), which you will need to practice while you are pregnant. Otherwise, a hypnotherapist will have to be with you while you are in labour.

Epidural

An epidural is an injection given in the back to stop you feeling labour pains from your belly button downwards. It can be used during childbirth and during caesarean sections. It requires a doctor called an anaesthetist to administer it, unlike the other forms of pain relief discussed above. It also has to be monitored by the midwives and anaesthetists through out the length of labour.

It can provide very good pain relief, but about 1 in 8 women may need to use additional methods of pain relief. Some women may experience a headache after an epidural which can be treated.

Which method you opt for is a matter of personal choice. Some hospitals may not offer all forms of pain relief. So speak to your doctor about what choices you have.

Exercise through the pregnancy is an excellent way of preparing for labour. Yoga, meditation and breathing exercises have all been proven to help reduce the intensity of pain during labour.

The article has been authored by Dr Prathima Reddy MBBS, MRCOG (London), FRCOG (London), FACOG (USA), Director, Senior Obstetrician and Gynaecologist - Fortis La Femme Hospital, Richmond Road Bangalore.



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