Please visit my Hypnobirthing page to see how you may be able to have a drug free and pain free birth. Hypnobirthing is absolutely what I promote. The information below is general information on pain relief options for anyone who is not planning to hypnobirth.
Pain should never be viewed as a normal process of labour and birth. Pain is caused by the fear/tension/pain cycle and it doesn’t have to be this way. The uterus contracts and stretches, but if you do not fear the process of labour and birth, and just go with the flow of your birthing body, your body will not become tense and you won’t experience the intense pain that society and the media portray birth to be.
Some women labour and birth completely drug free with ease, as do our sister creatures in nature; and others require the maximum analgesia available. Most women will avoid drugs/medications throughout their pregnancy because of the effect on their developing baby; but then will then go on and give permission for their birthing bodies to be pumped full of narcotic opioid analgesia during their birthing phase. This can have detrimental effects on breastfeeding in the early postnatal stage. You’re not the only one who wants the best for baby but then gets themselves into the fear/tension/pain cycle, giving into the smorgasboard of drugs on offer. Many other women experience this too.
Please have a read of the available pain relief options and go with whatever feels right for you at the time, after all it is your labour and birth and you must be well informed and comfortable with the choice that you have made both for yourself and your baby.
I do urge you to reject what society and the media portray birth to be. Nature does not intend birth to be like that. Pregnancy, labour and birth are normal natural functions of a woman’s body. From time to time we all doubt our own unique abilities, but please let me tell you that women’s bodies are made to birth babies in comfort and joy. If our sister creatures in nature can experience this, if other women can experience this, then so can you. Please visit my HypnoBirthing page for more information. Just click on the link at the top of this page.
Sterile water injections for the relief of back pain in labour
Some women experience back pain in labour. This is often from the position of the baby and is often referred to as “back labour”. This back pain may contine through the normal resting phase of a contraction and be severe enough to influence plans and decisions about pain relief options.
Sterile water injections (SWI) are an effective method for the relief of back pain in labour. The procedure involves a small amount of sterile water (0.1 ml – 0.2 ml) injected under the skin at four locations on the lower back (sacrum). See picture above.
The injections do cause a brief but very intense stinging sensation, that lasts for about 30 seconds and then wears off completely. As the stinging sensation eases, relief from the back pain is felt. To distract from the stinging sensation, the injections are usually given during a contraction by two midwives at the same time. Women benefit from support and encouragement from their support team as the injections are being given.
SWI provide effective pain relief for up to 85% of women who experience back pain in labour. The effect can last for up to two hours.
Advantages of SWI’S
* There is often an immediate effect
* No effect on the mother’s state of consciousness
* No effect on baby
* No limit to mobility
* Does not adversely effect the progress of labour
* A simple procedure that can be given by your midwife (check if your hospital offers this)
* Can be repeated as required
SWI are an excellent alternative for relief of back pain in labour. SWI will not provide pain relief from the pain felt by some labouring women due to them being in the fear/tension/pain cycle, once the back pain is alleviated, these women may then be more able to cope with their labour. As the back and pelvic muscles relax following the relief of pain, this may assist with the progress of labour.
As sterile water is not a drug, and there are no known side effects for mother or baby, SWI may become the preferred choice for the relief of back pain in labour for many women.
Source: Mater Mothers’ Private Hospital
NITROUS OXIDE AND OXYGEN (N2O&O2)
Nitrous Oxide mixed with Oxygen is the most commonly used form of pain relief used during labour. The gas is inhaled via a mouthpiece (see above picture) .
The gas mixture is most effective when it is used from before the start of a contraction right through to the end of the contraction. So it can be a bit tricky to get the timing right. If you start inhaling once you have the contraction, you may not achieve the desired result. The gas is only administered when you inhale on the mouthpiece, so you are totally in control at all time. Once your contraction is finished, remove the mouthpiece and breathe normally. Rest between contractions. You may feel lightheaded from the nitrous oxide which is otherwise known as laughing gas, but this sensation goes as soon as you start to breathe normally without the gas.
Nitrous Oxide does not harm your baby in any way so is a popular choice. Gas will not completely take the labour pain away but relaxes you and takes the sharp edge of any pain you have. Can be used in conjunction with a pethidine injection.
PETHIDINE (DEMYROL IN USA)
Pethidine is a narcotic drug which is commonly used in labour to relieve pain. Pethidine is an intralmuscuar injection and is usually given in the thigh or buttock. It will take around 20 minutes to start taking effect and may last for 3 – 4 hours. Pethidine is usually not given until contractions are strong and well established. Pethidine can make you feel nauseous, so another drug called an antiemetic is given in the same injection as the pethidine. Pethidine is usually only given twice during a labour. Pethidine does cross the placenta to the baby, and if given too close to the birth, the baby may have breathing difficulties. If the baby is very non responsive, a drug may need to be given to the baby to reverse the effects of pethidine but this would be very rare. It is usual to have a vaginal examination to assess the progress of labour before this injection is given. If your cervix is almost fully dilated (opened up), then it will be too late to give pethidine as this is when the baby may be affected if given to close to birth.
Pethidine can reduce your pain but does not completely take all the pain away. It can be used in conjunction with nitrous oxide and oxygen inhalation. Pethidine may relax you and relieve some anxiety and tension allowing you to rest and relax between contractions.
An epidural is a very invasive procedure and should be a last choice as a cascade of medical intervention will follow. An injection of local anaesthetic is first given into the lower back to numb the area. Then the epidural catheter is inserted in the epidural space which surrounds the spinal cord. This numbs the nerves from the top of the uterus downwards. An epidural anaesthetic must be administered by a specialist doctor called an anaesthtist. The epidural drugs will cross the placenta and be passed on to baby.
Prior to having an epidural inserted, you will need to have an intravenous infusion (a drip) inserted into either your hand or arm to ensure adequate fluids. An epidural also causes your blood pressure to drop, so the intravenous fluids will help to bring your blood pressure up.
To have an epidural anaesthetic inserted, you will either need to be curled up on your side or sitting on the edge of the bed with your back arched outwards like a cat. Your position will be the choice of the anaesthetic doctor conducting the proceedure. Local anaesthetic is first injected to numb the skin over the area where the epidural will be inserted. You will feel some pushing on your back as the epidural needle is inserted. A thin plastic tubing called a catheter will be threaded through the needle into the epidural space. The needle is then removed, leaving just the plastic catheter in place. The catheter will then be secured to your back with tape and will be removed once your baby has been born. The epidural line will then be connected to a flask of narcotic analgesia as prescribed by the anaesthetic doctor.
It can take 5 – 10 minutes for the anaesthetic to take effect. A top up dose can be given if pain is not alleviated or increases. An alternative to the top up dose is to have an infusion running. This is where a narcotic drug runs at a prescribed rate via an electronic pump to ensure the correct dosage is administered. It still runs via the epidural catheter in your back.
Whilst an epidural should completely eliminate pain from the uterus down, it doesn’t always work 100% effectively. Often you can have an uneven pain block where you can still feel pain on one side or at different places. Occasionally is might not give you any relief at all. Always keep in mind that an epidural anaesthetic is an extremely invasive proceedure, and is carried out under sterile conditions. In my opinion, an epidural medicalises the birth, by keeping you lying down in bed as you will have numb legs and be unable to stand. You also won’t know when you need to go to the toilet so you will need to have a urinary catheter inserted into your bladder so that your urine can drain into a bag. You may or may not be able to feel your contractions. If you do feel them, they shouldn’t be painful but should be more of a sensation that you feel. Your baby will be continuously monitored on the CTG machine. You will most likely need to be instructed and coached to push your baby out as you won’t be able to feel when you should be pushing. There is also a small risk of permanent nerve damage and another risk of developing an epidural headache which can be quite severe. An epidural also increases the need for having an instrumental birth (forceps or a suction cup on baby’s head), and therefore usually an episiotimy (a surgical cut made into the vulva to widen the opening of the birth canal). And lastly, remember that the narcotic drugs used do cross the placenta and are passed on to your baby which interferes with breast feeding.
On the more positive side, it is usually quite effective and will allow you to relax. Eliminates the need for any other anaestetic to be administered for other proceedures such as a forceps birth or stitching if an episiotomy is cut. The choice ultimately has to be decided by the woman in labour.
The tens machine stands for Transcutaneous Electrical Nerve Stimulation. This is a researched, safe and easy method of pain relief for labour. It has been used since the 1960’s with no adverse side effects in Australian and European hospitals. The tens machine can be used alone for a drug free birth, allowing you to stay mobile and in control of your birth. Used in conjunction with the natural birthing process, this will help to reduce medical intervention. The tens machine can also be used in conjunction with any other pain relief method you desire, which allows you maximum choice.
The tens machine works by releasing the body’s natural pain killers called endorphins and blocks out messages of pain which are relayed to the brain.
The tens machine feels like a pleasant tingling sensation on your skin. It has self adhesive electrode pads, fixed you your lower back. Then just swithch it on and turn it up until you start to feel tingling. You can turn up the boost button to increase the intensity of the signal with contractions.
The tens machine sends a signal to the brain via the nerves to block out the pain signals from the uterus.
Tens machines are usually available from physiotherapists, perhaps at your local hospital or pharmacy or click on this link to learn more. https://www.labourtens.com.au