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Working with labour pain
You may be coming to the end of your pregnancy and beginning to think about when
you go into labour and how you will cope with labour pain. How you deal with labour
pain can influence your birth experience, so this leaflet aims to help you make choices
when the time comes.
why is labour painful?
Pain is an important part of having a baby. It helps you to know labour
has begun so that you can find a ‘safe’‛ place to give birth. Pain also
gives you information about how your labour is progressing so that you
can feel in control of your labour/birth experience. The pain you will
experience during labour and birth is special because it is one of the
only times in your life when feeling pain means that your body is working
effectively. The natural pain-killers your body makes help you and your
baby prepare for life after birth.
However, as the pain of labour and birth can be difficult and tiring, this
leaflet aims to provide you with information on ways you can work with
this pain and make use of your body’s own coping mechanisms. Pain
relief during the experience of childbirth should be YOUR choice,
whether or not you decide to have it, or which method you would like to
try.
Your midwife is there to help you give birth safely and to offer support.
She will aim to stay with you for the majority of your labour, to provide
help and encouragement.
Having a positive approach to labour will help you to feel in control of the natural
process of childbirth. Labour pain is a ‘positive pain’, so as each contraction passes,
try to imagine being another step nearer to that special moment when your baby
arrives. Feel strong by focusing upon the body’s natural ability to give birth. Breathing
techniques, visualisation (closing your eyes and picturing a pleasant scene or image)
working with the pain and listening to calming music will help you to feel relaxed and
stay in control.
positive thinking
Good support is vital when you are giving birth; it may even help ease labour pain.
Research has shown that with good support during labour women stay more
relaxed, making childbirth a much more positive experience. Good support may
mean you can stay at home longer, and reduce the need for pain relieving drugs.
WHO CAN SUPPORT ME?
Most women want to be supported by someone they know, usually it‛s their partner,
mum, sister, friend, or doula. Birth partners can help by rubbing your back, holding
your hand, breathing with you, getting you a drink, or helping you to change position.
Just someone being there is enough for some women. Support may also be
emotional encouragement and understanding or a combination of both. It is
important that both you and your birth partner talk about what you want from your
birth experience.
support
Although many women think that they should be lying on a bed while
they are in labour, research shows that a more upright position is
probably better. You can do this by walking around, using a birthing
ball, squatting, kneeling or sitting upright. Ask your midwife for a
birthing ball, though you may have to use you own.
‘All fours’ is a good position for relieving pressure and pain from your
back. You can get in this position by using mats on the floor, or by
kneeling over the back of your delivery bed. Remaining upright and
mobile during the first stage of labour can reduce the need for pain
relieving drugs and shorten labour. Movement will help, so walk
around the house or around the room if you’re in hospital. During the
pushing stage of labour upright positions encourage your pelvis to
open wider, allowing your baby to move down the birth canal more
easily and quickly. Lying on your back can intensify the pain and
reduce the flow of oxygen to your baby, so when possible remain in an
upright position and ask for support from a partner or your midwife to
help you get comfortable.
Remember!
Labour pain means your body is healthy and working properly!
what position should i be in?
Remember!
Try and make yourself comfortable and try to remain in control, as staying positive makes
you feel more relaxed. An upright position, and/or using a rocking chair may help your
labour to progress. Lying on the bed throughout your labour intensifies the pain, and may
slow down your labour.
Although lying on the bed throughout your labour intensifies the pain, and may slow
your labour, women find lying down useful at some stages. If you feel tired and you
want to lie down, it is better to lie on your side rather than flat on your back.
Most importantly listen to your body, try to adopt positions that encourage the
contractions rather than trying to make them go away.
rest when you want to!
hot or cold remedies and massage
It has long been known that the use of heat and cold can relax tense muscles. Cold is
particularly good for low back pain, which is common in labour. Hot compresses on
the back, lower abdomen, groin or perineum are good muscle relaxants and a warm
shower, or being wrapped in a warm blanket, can also help.
Research has found that massage and touch are helpful not only for pain relief but
also to make you feel better. Massage and touch improve your comfort level and
ability to cope with the pain. You and your birthing partner can practise before labour
begins so that when you start to have contractions you know exactly what to do. Your
midwife will show you what to do if you ask her.
A warm bath or shower can help relax your body and ease your labour pain. It can also
make your labour shorter. Water can give you the feeling of ’being in control’; something
a lot of women say is important to them. The water will support your body and let you
change your position more easily. Research has shown that using water to relieve your
pain reduces the need for drugs and the need for an assisted birth, such as forceps or
ventouse. It also helps soften the perineum.
Whilst you are having a warm bath it is an ideal opportunity for your birth partner to give
you a massage.
Birthing pools, when available, can be used for labour and you can stay in the pool for
the birth of your baby if you want to. Ask your midwife for more details!
using water
aromatherapyAromatherapy is the use of natural plant extracts which create a feeling of well being,
relieving anxiety and fear. Aromatic oils can be used through massage, inhalation or
compression, and have been linked with a reduction in the need for other, more intrusive
methods of pain relief.
Some aromatherapy oils are not suitable for use in pregnancy, and a qualified therapist must
always be contacted when considering this method for pain management. If you are
considering aromatherapy, you must discuss this with your midwife.
hypnotherapy
Is a way of preparing for childbirth through using relaxation techniques, such as breathing
and visualisation exercises. You may attend sessions with a specially trained Hypnobirthing
Natal Therapy practitioner, or you can purchase DVDs and CDs which help you learn the
techniques for when labour begins. Ask your midwife for more details, or check out these
websites:
Natal Hypnotherapy: http://www.natalhypnotherapy.co.uk
Hyponobirthing: http://www.hypnobirthing.com
tens TENS (Transcutaneous Electrical Nerve Stimulation) works via gentle impulses that are
passed through four pads stuck to your back. You may control the strength of the impulses
to produce a tingling feeling in your back. These machines can be hired from baby retail
outlets, or the internet.
There are no known harmful effects to the baby. TENS is not recommended for use by
women who suffer from epilepsy, have a pacemaker or are in the bath. The effects of
TENS are more beneficial if begun in the early stages of labour, allowing the electrical
current to be increased as the contractions become stronger. It is most important that the
pads (electrodes) are placed correctly on your back for you to get the best benefit. Ask
your midwife to help you.
Also known as ‘gas and air’, Entonox is a mixture of nitrous oxide and oxygen in equal
proportion which is inhaled through a mouth piece or mask, depending on your
preference. Steady breaths are taken from the start of each contraction; the effects can
be felt within thirty to forty seconds and last for a short period of time. There are no long
term effects to you or your baby. It is important that the Entonox is used correctly to gain
maximum benefit. Your midwife will show you how to use it to get the best effect, then
the control is yours. When you first start using Entonox you may experience a slight
dizzy, light headed sickly feeling. Entonox can be used throughout labour and, if
required, right up until the baby is born.
entonox
Remember: you don’t have to be on a bed to use Entonox, you can walk round or even be in a
pool!
pethidine
Pethidine (and similar medicines) is an injection usually given into one of the muscles in
your bottom. It is a form of pain relief for women who want to take the edge off their pain.
It is very similar to Morphine and is often given with an anti-sickness drug (usually a
medicine called Metoclopramide). If given in early labour, Pethidine may help you to relax
and may even help you sleep. However, if given before labour is established it can slow
contractions down. If Pethidine is requested it can usually be prescribed by your midwife,
so you don’t have to wait too long. Once administered Pethidine begins to work within 15-
20 minutes and can last around 2 hours, depending on the dose given. Pethidine can be
used with Entonox.
Pethidine has some side effects and can make some people feel sick, sleepy, dizzy, light
headed or out of control. If given near to the time of birth, your baby may be sleepy and
slow to start breathing.
epidural
Epidurals are a way of experiencing a pain free labour with few reported effects on your baby. An
epidural uses pain relieving drugs to block the nerves from your uterus (womb), surrounding
muscles and back which transmit the pain experienced in labour.
A fine catheter (tube) is inserted into your lower back through a small hollow needle under local
anaesthetic (you will have to stay very still whilst this is carried out). The needle is removed and the
catheter is then secured to your back using a sticky dressing and pain relieving drugs are given
through it.
As this procedure takes some time to perform and the painkillers which are given take some time to
work, it may take up to 30 minutes before the epidural pain relief is fully effective.
An epidural, should you want one, is put in place by an Anaesthetist (a doctor who is specially
trained in providing epidural pain relief). It is possible that when you decide you would like an
epidural, the Anaesthetist may be busy elsewhere, so there may be a delay in him/her being able to
come to you.
You may want to discuss epidurals with your midwife early in labour if you think you might. want
one, and the Anaesthetist will talk to you before putting the epidural in place to make sure there are
no reasons why an epidural would be unsuitable for you (e.g. if you had blood clotting problems)
and to answer any questions you may have. Occasionally this may mean blood tests are necessary
before it is safe for you to have an epidural.
epidural (cont)
Some people are worried about developing backache after having an epidural. Research shows that
epidurals do not increase the risk of backache, and serious complications are rare.
There are some circumstances, where epidurals may be particularly useful in helping with the birth of
your baby and may be recommended by your midwife or obstetrician, for instance: pre- eclampsia,
twins, breech position or some medical conditions. But it is always up to you whether you want to
have an epidural or not.
Although epidurals are usually a safe and effective form of pain relief, there are some disadvantages
and potential side effects you need to be aware of:
Not every epidural is effective. Sometimes it is impossible to put the epidural in the right place.
Sometimes it works only partly. You may have a ‘window’ of pain (an area where you can still
feel the pain of your contractions). It is occasionally possible to help with this type of pain by
changing the drugs put in your epidural or changing your position when top-ups are given. If this
does not work the epidural can be removed and a new one put in. If you prefer you can also
combine the epidural with Entonox.
Epidurals can cause your blood pressure to drop although this is less common with modern low-
dose epidurals. You will need to be monitored after each top-up and you will need to have a drip
in place, so that you can be given fluids if necessary. A drop in blood pressure is more likely if
you lie flat on your back with an epidural, so you should avoid this position.
Having an epidural can slow down your labour and increase the chance of you needing a drug to
increase contractions. Epidurals may increase the need for an assisted delivery such as forceps
or ventouse.
We hope this booklet helps you to make an informed choice about your pain relief in
labour.
Remember: Being prepared, supported and informed will help you during the birth of
your baby.
Thanks to parents and midwives for use of their photos, and to East Lancashire Hospitals NHS Trust for permission to
adapt their information leaflet ‘Working with Pain’.
Acknowledgements to MIDIRS Informed Choice Leaflets.
Made by Sheena Byrom
Adapted 2014