7 expert ways to cope with labour pain
Wondering how you're going to bear up when labour kicks in? A midwifery expert explores the ways you can manage and relieve labour pain, from hypnobirthing to an epidural.
In recent years, giving birth as ‘naturally’ as possible has been the goal for most mums and midwives. On paper, it sounds great: women feeling in control, birthing their babies in a calm environment with minimal intervention.
However, the focus on idealised natural birth meant that some women who didn’t have one felt they’d failed. Last summer, the Royal College of Midwives acknowledged this, changing the language around their campaign for ‘normal’ birth.
While the options haven’t changed, there’s a new mindset and this can only be great news for mums-to-be. Women are being encouraged to look at all the birth options as a toolkit, educating themselves so they can make choices that are right for them.
From hypnobirthing to gas and air, we asked midwife Liz Halliday to take us on a tour of the pain management toolkit.
Natural pain relief: Hypnobirthing, water, warmth and massage
There are many non-medical techniques, starting with wheat bags that can relieve aching muscles in early labour. Massage can help you to get more comfortable and relaxed all the way through the process. Birthing pools can support the whole body and bring relief, while warm baths and showers can also help mind and body relax between contractions. The self-hypnosis and breathing techniques of hypnobirthing help labouring women focus on the moment, remain calm and feel in control.
When to use?
Most natural pain relief techniques can be used from early on in labour so you’ll probably start using them at home. In the run up to your due date, talk to your midwife about the ones that appeal to you and prepare.
'Hypnobirthing can be very effective. The earlier you can start in pregnancy the better. If you’re listening to a track-based programme, listen on a daily basis.
Don’t panic if you fall asleep during the tracks, you’ll actually be taking more in while you’re asleep!
Hypnobirthing has been portrayed as a way to not experience the sensations of labour but, actually, it helps women be focused. If it doesn’t work for you, that’s OK. Some people are just more suggestible than others. Immersion in water is gravity-defying, supports your bump, and you can get in and out.
Being in the pool, bath or shower can also create a small, safe space for women. Massage can be incredibly powerful, just holding a partner’s hand can reduce the chances of having an epidural.'
TENS stands for Transcutaneous Electrical Nerve Stimulation. Maternity TENS machines are small, battery-powered machines that deliver small pulses of electric current through four pads stuck onto the lower back. The pulses are thought to disrupt pain signals and TENS machines are used to help other conditions like arthritis, period pain and joint pain.
How do I get it?
Hospitals and birth centres don’t provide maternity TENS machines, so you’ll need to buy one for £50 - £60 or rent one for around £30 from retailers including Mothercare and Boots. Or ask around friends and mum groups, somebody may have one you can borrow!
'TENS is very individual not only to women but also to labours. Some find it works for one birth and not another. It’s always worth giving it a try.
The trick with the TENS is to put it on, on the lowest setting, as soon as you think something’s going on. Whether it’s a distraction or whether it’s working on the nerve impulse, I don’t know.
Having it positioned properly and using it from early, early labour, does seem to be effective for most people. And if it’s not annoying you, leave it on – it can feel like it’s having no effect until you take it off.'
Gas and air
Entonox, better known as gas and air and sometimes laughing gas, is half oxygen and half nitrous oxide. The colourless, odourless gas is inhaled through a mask or mouthpiece. While it won’t block out the sensation of contractions, it can make them more bearable. While some women love it, others hate the way it makes them feel.
How do I get it?
If you give birth in a hospital or birth centre, entonox will be plumbed into the wall, ready for you to use whenever you want. If you have a home birth, your midwife will usually bring a canister with her.
'I’d advise using the mouthpiece rather than the mask as I think the mask can make women feel sick - the smell is quite horrible. It’s not going to get rid of all the sensations of labour but can take the edge off.
Where it’s really effective is slowing the breathing down, as you can hear your breath whooshing through. That’s calming.
I love the fact that if you’re feeling dizzy, paranoid or sick or you don’t like the sensation, you can just stop. Put it down, take a few breaths and within 10 to 12 seconds, you feel normal. You can always give it another try later. It makes your mouth really dry so make sure you stay hydrated.'
Paracetamol is often recommend to help with early labour. Codeine is an opiate, from the same family as morphine and can also provide some relief in the earlier stages.
How do I get it?
Paracetamol is available over the counter so it’s worth having some on standby, although always run through your plans with your midwife and mention them to triage when you call the hospital. Codeine is usually administered once you’ve been admitted.
'The issue with codeine is the same as with the other opiates, they’re going to have a sleepy effect on both you and the baby. We have to be aware that if the baby’s born quite quickly, there may be side-effects. It doesn’t mean we shouldn’t do it, but we need to be mindful that baby could have some minor breathing difficulties at birth and need assistance.
Midwives are taught to tell women in very labour to take paracetamol, have a bath and go to bed but there’s been some debate lately that it has an anti-prostaglandin effect, which could slow down the dilation of the cervix.
I now steer clear of it. In early labour I’d rather see somebody having a bath, resting, doing some belly binding, eating chocolate and ice cream! All of the things you usually do with period cramping.'
Pethidine, diamorphine and meptid
Image: Thought Catalog
Pethidine is a synthetic opioid, as is meptid. Diamorphine is semi-synthetic opiate. They’re all usually administered by a midwife with an injection in the thigh. Pethidine passes through the placenta, as does diamorphine, so midwives try to avoid giving them towards the end of labour as they can affect babies’ breathing. Meptid doesn’t cross the placenta but isn’t as strong. Diamorphone can slow contractions and prolong labour.
How do I get it?
You can ask to move onto these drugs during labour if you feel you need help and are in hospital (some midwives will administer it at home but may are unwilling to due to the possible side-effects). Meptid isn’t available in all hospitals.
'The injections can be really useful for people having an induction of labour in the early stages of that induction, as it can bring on quite intense and painful sensations that aren’t actually doing a lot.
They can help relax the lady and help her get some rest. In my experience, it doesn’t seem to be as effective later on in established labour although there are some women who love it.
You’d usually have anti-sickness medication with the injection and expect to feel drowsy.'
Epidural and spinal block
'An epidural is a local anaesthetic delivered via a cannula between the small bones in the spine. The aim is to numb the midsection, sometimes retaining sensation in the legs and feet.
A thin tube running out of your spine will be taped over your shoulder. Some epidurals deliver continuous dose while others can be topped up when required. A spinal block is administered in a similar way but is a single injection and no cannula is left in. Spinals are only given in theatre, don’t last as long and can’t be topped up.'
How do I get it?
If you feel you may want an epidural, mention this to the midwife so she can contact the anaesthetist. Most hospitals only allow epidurals in obstruction-led units. Spinals are given for instrumental delivery, C-sections, repairing of tears/episiotomies and manual placenta removal.
The epidural goes into a different place in the spine from the spinal, which is why it takes a little longer to get in, but it does have the option of topping up. You can have a lighter epidural that will allow you to get up, maybe walk, get up on all fours. The spinal block takes effect very quickly and takes around four to six hours to wear off. A spinal is often used in an emergency to numb you up quickly – it’s very effective.