As pregnancy progresses in the third timester, many women turn their thoughts, and often worries, to the concept of labour. If you have had babies before, you may already know what to expect. You may even have a birth plan. But the most important thing to remember and to focus on, is that labour and birth is aimed at getting your baby into this world in the safest way possible. It is important that you understand all of your options and that you can make informed choices about pain relief as well as other options that may be provided to you during delivery.
Labour contractions feel different for every woman. They are generally described as tightening pains around the bump and back as well as a feeling of fullness in the pelvis. Contractions typically last for 10 to 40 seconds and at the beginning occur every 20 to 30 minutes. As your labour gets going, your contractions will get stronger, longer and closer together. In established labour, you should expect to get 3-4 contractions within a 10 minute period.
There are many options for pain relief; you may be ok with none, one, or even try them all at various stages of labour. Remember that it is perfectly ok to labour with no pain relief at all, or opt for the maximum pain relief if it helps you to manage with your contractions, and get to the second stage of labour when you are fully dilated and can commence pushing. The most common options for pain relief, also known as analgesia, are described below:
Breathing techniques and positioning
You will learn these techniques if you attend an NCT class. Lying on your back can make your contractions slower and more painful. Movement, such as rocking, swaying and leaning forwards, maximises your body’s ability to give birth as it helps ease your baby along the birth canal. You can continue with these techniques throughout labour, although once you commence pushing once you are fully dilated, your midwife or doctor may ask you to use the more traditional position on your back with your legs bent. This may be due to a need for monitoring of the baby, or if the head is in an unusual position.
A TENS machine transmits mild electrical impulses to pads on your back. These block pain signals and help your body to produce endorphins. This method may be particularly useful in the early stages of labour and can be used at home without need for doctors. Some women may not like the sensation and the pads may have to be removed if the baby needs extra monitoring during labour.
Gas and Air (entonox)
Entonox is a colourless, odourless gas made up of half nitrous oxide and half oxygen. It is breathed in through a mouthpiece and acts quickly when inhaled, so can be used as soon as a contraction starts for the duration of the contraction. It is the same ‘laughing’ gas you get at the dentist, but in labour you may not feel so much like laughing! The benefits are that it can be controlled easily as the gas wears off as soon as you stop using it and doesn’t cause any harm to the baby. Most birth centres and all labour wards will have it available, and there is no need for additional monitoring.
Some women find the gas makes them quite light-headed but you usually get used to that. It can be used throughout the first stage of labour, but in the second stage all of your breath needs to be focused on pushing so you cannot be breathing in and out of the mouthpiece.
Opiods such as pethidine
Opiods are strong painkillers that are usually given by injection into the thigh. They can be extremely effective at relieving pain, and have not been shown to slow the progress of labour. They are also useful to help you to relax if you are struggling to cope, and even allow you to get some rest. A particular drawback however is that opioids do pass across the placenta to the baby. The effect usually lasts around 4 hours, so if your baby is delivered before that time they may come out a bit drowsy although that effect will wear off eventually.
5. Epidural/ Spinal anaesthetic
Epidural analgesia is a local anaesthetic injected into the space between two vertebra in your back. It usually removes all pain and most feeling from the waist down. The anaesthetist will leave behind a tube which can be used to top up the epidural medication as it wears off. Most women find that they feel no pain when the epidural is working well, although there may be a sensation of feeling the contractions. This allows you to rest while the contractions continue, and prevent you from feeling too exhausted too early. The anaesthetist or midwife will usually insert a catheter (a small tube) into your bladder because it is difficult to pass urine once the epidural is working.
As you cannot use feel your legs, you cannot mobilise easily so there is a slight risk of labour slowing down. If this happens, doctors may decide to give you a hormone drip to get the contractions happening again.
It is important to note that an epidural can only be given on a consultant-led birthing unit so if this is something you may want, mention this early on. In addition, as you cannot feel the contractions very well, there is a slightly increased risk of needing an instrumental delivery (forceps/ ventouse) to help get the baby out.