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November 20, 2017

What will happen when you have your baby? Do you plan to have dimmed lights and scented oils, soothing music and a birthing pool? PENNY MURRAY delivers the choices you'll face on the big day

There is a range of gadgets and drugs available to help with labour, each with benefits and drawbacks. While relatively low-tech aids such as gas and air or TENS machines can be used even during home births, medical ‘interventions’ such as epidurals (which block pain entirely) require a hospital anaesthetist. Antenatal classes and midwives will explain the options and their associated risks, but it can be hard to decide what you’ll need when you don’t know what labour will feel like.

For many expectant mothers, the choice about pain relief isn’t about what might go wrong, but the kind of birth they want to have. Some women want an active labour, moving around and delivering in an upright position or in a pool, which the tubes and monitors accompanying an epidural would prevent. For others, blocking pain is the priority.

Whether you want to go drug-free or block it all out, there are many ways to help cope with the pain: 

Go hands on

Massage eases pain and tension and it can be especially welcome in soothing your lower back, to warm up chilly feet or just provide distraction during labour. You may want a rub down with oil, perhaps feather-light strokes make you feel better, or you may not want to be touched at all – it’s worth practising all of these with your birth partner ahead of time. Acupressure and reflexology can also strengthen contractions and relieve labour pains. Different points perform different functions, so talk to an acupressure specialist or your midwife before labour begins for advice about where to press and when.

Two paracetamol and a distraction

As low-tech as it sounds, this is common advice for women in the first stage of labour experimenting infrequent contractions and crampy, period-like pain. Now's the time to go for a (short) walk, bake biscuits or check out comedy clips on Youtube - after all, laughter is a medicine like no other. 

Make a splash

You don’t need to be planning a water birth to reap the benefits of bathing. While you’re still at home, a soak in the bath can soothe that sore back and pouring a jugful of water over your belly during contractions can take the edge off during those early stages. At a cosy 36-37ºC, birthing pools are more spacious than domestic baths, though it’s wise to get out every couple of hours to cool down and walk around.

Hypno help

Hypnobirthing works on the premise that fear leads to tension and then pain, which leads to more tension and pain, so the more relaxed and in control of anxieties you are, the easier your birth experience will be. Research backs up the benefits: hypnobirthers tend to have shorter labours, more comfortable deliveries, need less pain relief and have fewer caesareans. Partners also feel more involved and better able to support you. Ideally, you both need to practise the self-hypnosis, breathing and visualisation techniques daily from your first trimester, or at least from 35 weeks. 

Take TENS

A TENS (transcutaneous electrical nerve stimulation) machine sends electrical pulses to sticky pads on either side of your spine, blocking pain messages and boosting endorphins – the body’s natural painkiller. Maternity TENS have special programmes for different stages of labour, plus a boost button for contractions. It takes an hour or so to feel the full effect, but many women swear by TENS during labour (though they aren’t suitable if you have epilepsy, a pacemaker or heart problems). These battery-operated devices can also be used from 37 weeks to help with back pain. 

It's a gas

A mix of nitrous oxide and oxygen, and often referred to by its brand name Entonox, gas and air is the speediest of pain relievers when the going gets tough. It takes 15-30 seconds for a lungful to reach peak effect and that lasts for about a minute. As well as being fast acting, gas and air is powerful: equivalent to a 15mg injection of morphine, but there are no needles, no lingering residues and few side effects (some may experience vomiting). And the beauty of gas and air is that you can take or leave it, and then take it again if you feel you need more.

The drugs 

Midwives can administer pethidine and morphine by injection. These don’t block pain entirely, but help you relax. They’re often accompanied by anti-nausea medicine. They also cross the placenta, meaning the baby feels the effects too, so aren’t usually given within two hours of the birth. Pethidine can make newborns drowsy, affecting the crucial first feeds. Remifentanil also crosses the placenta but wears off more quickly, so can be used up until birth. An anaesthetist inserts a drip and you control the dose. Many find it more effective than pethidine, but the drip  restricts movement.

Block it all out

An epidural is highly effective, but must be performed by an anaesthetist. A tube is inserted via a needle between two vertebrae in your spine and painkillers are fed through it, blocking messages from the nerves in your lower body. It takes about 10 minutes to set up and 10-15 to work, with top ups added by your midwife every two hours as necessary. You’ll be attached to a drip (epidurals lower blood pressure), a monitor around your belly and possibly a catheter, restricting you to the bed. Studies have found epidurals can slow labour, increasing the likelihood of an instrumental delivery – but are generally considered safe.  


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