By Jenny Lord
There are no medals for completing the marathon that is labour and birth, nor does it affect what sort of Mother you are going to be! This post is designed to inform you about the different types of pain relief you may be offered or would like in labour, and the pros and cons of each. There are also lots of natural methods too, which we will cover next time, but here we are purely focusing on the drugs you can take in labour. We have also designed a useful Infographic at the bottom of this post, which you can save or pin as a quick reference guide. Share it with anyone you know who may benefit. Included below are the three main forms of pain relieving drugs available in labour in the UK.
Entonox (Gas and Air) in Labour
Also known as gas and air, or laughing gas, because it can make you laugh, but if you’re in the throes of labour, there’s nothing funny about the pain! It’s inhaled through a mouthpiece or a mask and is either piped in through the wall and won’t run out, or it’s in a canister, and will be changed when it is close to running out. Both the mouthpiece and the mask will have a valve in so you won’t rebreathe your own air and can keep the mouthpiece in or the mask on continuously.
How to use Entonox (Gas and Air) in Labour effectively
As soon as the contraction starts, start inhaling the gas in long deep breaths. Use relaxation methods if you can and let yourself float away. You will still feel the pain, but not as bad, and you should feel distanced from it. It also makes you feel a bit happy or ‘high,’ but the effect soon wears off. A lot of women, after using it for a while claim it has stopped working, but it is usually because the contractions are increasing in intensity, the body also builds up a mild tolerance to the effects, but if you take it away for a couple of contractions, you soon notice the difference.
Advantages of Entonox (Gas and Air) for Labour
It works quickly, because it’s inhaled and it also leaves the system quickly, so if you try it and don’t like it, as soon as you stop using it, it runs out very quickly. You also have complete control over it, the deeper and longer you breathe it, the more effective it is, or you can take smaller amounts. It can really help you relax and develop a breathing rhythm. There aren’t any known side effects to the baby and it can be used at home, in the hospital and in and out of the birth pool. You can get the giggles – that can be a positive or negative, depending on how you look at it!
Disadvantages of Entonox (Gas and Air) in Labour
It can make you feel nauseous and some people vomit. You may feel like the room is spinning, which makes you feel dizzy. Some women feel out of control, not with it and they don’t like that feeling. Although there are no known effects to the baby, the long term effects are unknown – it has been used for the last 50 years at least though, with no known complications.
Pethidine or other Opiates as pain relief in Labour
Pethidine is commonly given in the UK as a pain reliever in labour, it would usually be offered in the earlier stages of labour. Some care providers may use similar alternatives, such as Morphine, Diamorphine. They are all administered via an injection into a muscle, usually the thigh or buttock. It takes around 20 minutes to work. Sometimes and anti-emetic (anti-sickness) can be given at the same time.
Advantages of using Pethidine as pain relief for Labour
It has a sedative effect and it’s a relaxant, so it’s really good if you’re having a long early part of labour and are getting tired, but the pain is stopping you from resting. This relaxation effect can help indirectly to dilate the cervix. It works quite quickly, as it goes directly into the muscle rather than having to be digested. The pain relief you get is good, better than the Entonox – it doesn’t relieve it completely, but it does take a lot of it away.
Disadvantages of using Pethidine as pain relief for Labour
Once you have the injection, the effects can last up to 4 hours, so if you don’t like the effects, there isn’t anything you can do to reverse it. The drug can cause you to feel nauseous and you can vomit. Although it’s good for resting, it reduces your mobility which can slow labour down. Pethidine interferes with your natural endorphin production, which are the body’s natural pain relievers and important in the production of oxytocin (the labour hormone) and prolactin (the breastmilk production hormone). Any opiate will act as a respiratory (breathing) suppressant, which reduced oxygen to your body and baby. If you have Pethidine within approxmately 4 hours of having the baby then s/he may need to be resuscitated at birth, and may have trouble feeding at the breast or bottle. It does cross through the placenta and makes the baby sleepy, this is usually not a problem unless given too close to birth, so timing is important.
Epidural pain relief in Labour
An epidural involves a local anaesthetic injection (which stings going in like a bee sting) which numbs the area quickly. Then, a bigger needle can be inserted into the epidural space, not near the spinal cord. Once in the right place, a small tube is then inserted to administer the drugs and the needle is removed. Below is a short animation made by Bupa so you can visualize the process. The sticky tape we use is commonly bigger than that shown.
Advantages of getting an Epidural in Labour
It provides complete pain relief, you will still feel your legs, pressure and touch, but the pain of the contractions are gone. There is no drowsiness or mental effect from the drugs, as they are only affecting a specific area. The drugs used in an epidural lower your blood pressure, which can be beneficial if you have pre-eclampsia or pregnancy induced hypertension (high blood pressure).
Disadvantages of getting an Epidural in Labour
Your mobility is reduced, most likely you will be on a bed, there are more ‘mobile’ epidurals but they are not widely available and rely on mothers taking less of the drug and keeping a manageable level of sensation. This reduced mobility can slow labour down and increase your chance of intervention. The drop in blood pressure can work against you, as it reduces cardiac output and can mean less blood flow to the baby. It can raise your temperature, causing the unnecessary need for antibiotics as a precautionary measure. You will need to have an IV drip to counteract the risk of your blood pressure dropping too quickly – this also restricts your movement, and as it’s commonly sited in the hand and remains in for the immediate postnatal period, it can affect your ability to establish breastfeeding. As well as the slowing of labour, the reduced mobility and lack of feeling in the pelvic floor can increase the likelihood of needing an instrumental delivery (ventouse or forceps) or a c-section. You will need to have a urinary catheter fitted as you lose the sensation of needing to go (you won’t wet yourself) and your bladder could fill up dangerously. This comes out soon after the birth, but can cause it’s own problems, such as urinary retention (when you need to go but can’t) and urinary infection. Some women get itching and irritated skin from the epidural. If it isn’t sited properly it can have a lopsided effect or partial effect and may need to be topped up or re-sited. There is also a risk of puncturing the dura, which can lead to a severe headache after the birth which may need minor surgery to fix, mostly it heals on it’s own.
Here’s a handy Infographic you can save or pin on Pinterest to refer back to for future reference.