Pain Relief in Labour

These are approaches that use positive thinking and an understanding of the labour and birth processes to help women feel in more control of a given situation. There are distinct strategies that can be used including:

• Visualization, meditation.
• Positive affirmations (e.g. my body is strong and is working well for me).
• Conscious relaxation of tense muscles.
• Breathing techniques.
• Non-focused awareness (i.e. notice what you see, hear, feel, smell without holding on to any of them).
• Vocalizing, sounding or repeating a mantra.
• Hypnosis; state of deep physical relaxation, is thought to inhibit the bodies stress response and promote a positive approach to the pain of uterine contractions.

It is important to note that the majority of these techniques require pre-labour preparation, tuition and practice before they can be used effectively as a form of pain relief during labour. Some of these techniques are taught at the antenatal classes that are run in the hospital, but most are available through private classes e.g. yoga classes and hypnobirthing.

A TENS is a hand-held battery powered device that transmits electrical impulses through four electrodes (or pads) placed on the lower back. You are able to set the intensity of the electrical impulses at a level which will then reduce your awareness of your contractions.

TENS works by blocking the nerve pathways that carry pain messages to your brain and also stimulates the production of natural pain relieving substances (endorphins) in the body.

TENS works best when used in the early stages of labour. It may not be as useful once labour becomes fully established. Most women say that they would use it again in labour.

Advantages
• TENS may offer immediate relief.
• It is self administered so it increases sense of personal control.
• It may allow you to postpone or avoid the use of epidural analgesia.
• You can move around in labour with it.
• It has no known adverse effects.

Disadvantages
• TENS may not be strong enough to help you cope with extreme labour pains.
• TENS cannot be used if you choose immersion in water during labour.
• You need to rent a TENS machine before your expected due date, usually about 38 weeks, and to receive instruction on its use including the correct placement of the electrodes.

Please contact the Parentcraft Department on (091) 544210 for information.

This is a mixture of oxygen and nitrous oxide gases that you inhale/breath in through a facemask or mouthpiece. Research suggests that women find entonox useful.

Advantages
• It is available instantly.
• It can be used whenever you decide you need it. You are in control and give the gas to yourself.
• It works within 30 – 40 seconds but has no lasting effect. Once you stop using it the effects wear off rapidly.
• It can be used throughout labour without effecting contractions or the progress of your labour.
• It has no known ill effects on the health or well being of the baby.

Disadvantages
• It does not lessen the pain of the contractions, but just helps to relax you.
• It is sometimes difficult to get the timing right. If you start inhaling the entonox too late in relation to the contractions, it may not be fully effective by the time the contraction is at its strongest. This may improve with practice and your midwife will advise you on how best to use it.
• Some women may notice some unhelpful side effects. These include feeling sick, drowsy, dizzy or lightheaded. Therefore it may limit how much you may move around during labour.
• It may make your mouth dry, so ask for a drink in between contractions.
• It can affect your ability to remember events around your labour and the baby’s birth.

Pethidine is a drug which is given as an injection into your thigh or buttock.
Research has shown that it is much less effective than an epidural at relieving pain in labour.

Advantages
• It can be given within 5 minutes of asking for it. It usually works within approximately 20 minutes and the effects tend to last for at least a couple of hours.
• Providing you are having regular and strong contractions (in established labour) it should not slow down contractions or progress in labour
• It can help you to relax which may allow you to rest. This may also help labour progress more quickly.

Disadvantages
• It may make you feel sick or “woozy” (you will be given a drug at the same time which prevents sickness)
• It may make you feel light-headed, which may prevent you from moving around during labour.
• If given too close to the time of birth, it may also make the baby sleepy and effect their breathing (your baby may need an injection to reverse this effect).
• The baby may be sleepy in the first few days and it may make breastfeeding harder to establish.

The labour ward is equipped with a large and deep bath which may be used for immersion in water during labour (one bath available on a first come – first served basis). Women who have used water for their labour have said that it maximizes their feelings of control and they feel more satisfied with their birth experience.

Advantages
• It can help you to relax and cope better with the pain of labour.
• It is safe and effective.
• It reduces your need for other pain relieving drugs.
• The buoyancy of the water allows for ease of mobility during labour.

Disadvantages
• There are certain circumstances where it may not be appropriate for woman to use the bath in labour (your midwife will advise you).
• Immersion in water may slow labour if you enter the bath before your labour is established, or if you stay in for more than one or two hours.

N.B. Water immersion may be used for pain relief in labour only. Birthing in water is not currently facilitated in the maternity unit in UHG.

Continuous one-to-one support from an experienced birth professional has been shown to reduce women’s need for pain relief in labour, increase their chances of having a normal birth and increase their level of satisfaction with their birthing experience. It is the policy in University
Hospital Galway to provide women with one-to-one care from a midwife throughout labour. Midwives are experienced in providing emotional support as well as  monitoring mothers’ and babies’ conditions in labour.

Women may also choose to hire the services of a Doula. This is a private arrangement between the woman and the Doula. A doula is a woman who has been trained to provide a continuous presence and emotional support for women during labour. They may also be trained to provide pain-relieving or coping methods that are non drug based, for example massage and touch, positive thinking and relaxation techniques.

Comfort measures are a number of different approaches that can help you to cope with the pain of labour these may include; the application of hot compresses or ice-packs, using complimentary therapies, adopting different positions in labour, the use of massage or touch and the use of comfort aids such as bean bags or birthing balls.

Many women find these measures effective in easing pain, helping aid relaxation and giving a sense of well being with no, or very little, potential to do harm. Most of these measures are taught as part of the hospital run antenatal classes and your labour ward Midwife will support and advise you.

Acupuncture involves the use of hair fine needles to stimulate lines of energy (called channels) flowing beneath the skin. Acupuncture in labour has been shown to reduce the need for pethidine and epidurals. Acupuncture may also induce relaxation. However, it is an invasive procedure and is not suitable for everyone. It must be administered by a trained professional. Acupuncture services are not available in the hospital and must be arranged privately.

This is an alternative to acupuncture and involves the application of pressure with fingers or small beads on various acupuncture points. The use of acupressure has been found to decrease labour pain and may be effective in shortening the length of the first stage of labour. Acupressure or shiatsu services are not available in the hospital and must be arranged privately.

If you have any questions regarding any of the information in this booklet, please discuss with your midwife, obstetrician or the midwives of the Parentcraft department on 091 544210.