Give me all the drugs! A guide to labour pain relief choices
Pain Relief vs Natural Birth
When preparing for birth, most women’s first instincts are to find out all they can about natural birth and not really consider labour pain relief. We have done it for millions of years, after all, and the excitement that Hypnobirthing and homebirths generate, helps us expect that we should be able to birth quite naturally without help.
I personally believe that with the right birth preparation and support, most women should be able to achieve a natural birth, sadly, I don’t think most women are offered the right kind of preparation and certainly not the optimal support to achieve an unassisted birth (one with no interventions).
When you look at UK statistics in 2010–11 (the most recent available), a whopping 58.2% of births had some sort of medical intervention. This counts anything from using gas & air to full caesarean.
And in 2012–13, 63.4% of births required some form of labour pain relief (not including gas & air), showing that the likelihood of needing to be informed is quite high!
While statistics on specific pain relief options use are harder to find, it is clear that epidural rates are as high as 33%. Unless you dig deeper into these statistics you don’t get the full story, but it is certainly clear that many women choose or need labour pain relief or some kind of intervention.
In my experience as an Active Birth antenatal teacher, and through my yoga classes with pregnant and postnatal mums, I have heard time and again how women have opted for labour pain relief and birth interventions they really know very little about, and, as a result, suffered unexpected consequences.
In an ideal world, we would have an hour for every midwife visit, and all our possible choices, decisions and risks would be outlined in detail, well in advance. In reality, these visits are 10 minutes in the UK. Other countries not under a midwife-led system may not even have this – and the onus is on us to understand what we are being told, what it means for our own personal circumstances, and how it could impact pregnancy, labour and birth in both positive and negative ways.
I fully support aiming for a natural birth, however, I also know it can be very harmful to end up having unplanned interventions and the implications that go along with them.
My aim is that all women go into labour with full information about the labour pain relief choices available to them. I also want them to have a good understanding of the most common birth interventions.
So that if their birth includes these (either through planning or not), that they understand what is going to happen to them, and what further implications might be of that choice or procedure.
Labour Pain Relief Choices
Here is a summary of all the labour pain relief choices, with links to further articles that go into a little more detail. Read more about common birth interventions here…
TENS stands for Transcutaneous Electrical Nerve Stimulation.
You attach sticky pads to your skin and the electrical current is sent through your body from one set of pads to the other.
The electric current stimulates the nerves under the skin and helps to reduce the pain and intensity of contractions.
During a contraction, you increase the frequency and switch on the pain relief part of the TENS – stimulating the nerve signals to the brain and stopping the pain signals from getting through.
When the contraction has finished, you switch back to the low-level current. You can’t use it in water, but there are no known side effects so it is a very popular choice.
KEY BENEFITS: no side effects on mother or baby, easy to start and stop, the mother has full control.
KEY RISKS: Not everyone finds it helpful, incorrect use can reduce efficacy, can’t be used in water.
I have wrote an more in depth post about using a TENS machine in labour here…
Gas & Air (Entonox)
This is a gas that is comprised of 50% nitrous oxide and 50% oxygen that is inhaled during contractions to relieve pain.
You breathe through a demand valve via a plastic nozzle to inhale the gas and exhale air. It takes about 30 seconds to take effect and wears off within 60 seconds of stopping inhaling it. You can either stop inhaling in between contractions or use it continuously.
It acts to dull the sensations of labour, but doesn’t take them away completely. Many people describe it more as taking the edge off the pain to make it manageable.
It can be stopped at any time with no lasting effects – within 60 seconds the effects have gone completely. It does cross the placenta but has no known side effects on the baby so it is considered a very safe method of labour pain relief.
In some people, it can cause nausea or sickness and a feeling of dizziness or really woozy.
KEY BENEFITS: mother in full control, no side effects to mother or baby, easy to start and stop, can be used in water.
KEY RISKS: can make some people feel sick or dizzy, sometimes further pain relief is needed.
Intradermal Water Injections
These are injections of sterile water just under the skin in the back to help relieve severe back pain in labour (usually as a result of a posterior (back-to-back) baby).
It is thought to slow down or block the signals from the back and uterus up to the brain through nerves in the skin, although it is not very well understood.
The initial injection feels like a wasp sting and can be painful, which is why they try to administer two injections simultaneously by two members of staff.
This initial sting rapidly ceases and women report to have relief from back pain fairly quickly, lasting up to 120 minutes.
There are no real side effects and has no affect on the baby, so is considered very safe, if painful to administer.
KEY RISKS: usual risk associated with injection, painful to administer.
KEY BENEFITS: no affect to mother or baby, can be used multiple times.
In my book, Helping Birth: Your guide to pain relief choices and interventions in labour and childbirth with real stories, I go into great detail about all labour pain relief choices and common birth interventions. I use the BRAIN framework (Benefits, Risks, Alternatives, Implications, Nothing) to look at each option's pro's and cons, to help you understand which choices are right for you and your baby.
I discuss what each option is, what it feels like and what happens, discuss the risks and benefits, and give advice as to what you can do to minimise complications if you choose these drugs or procedures.
There is an insight to help you understand risks and statistics around birth, and also things that may happen to you or your baby such as continuous monitoring, and immediate cord clamping.
Each of the 25 chapters has women's real-life stories and experiences to enhance your understanding of what it is really like to experience these labour pain relief choices or birth interventions.
Buy the book for £10 on Amazon (free delivery in the UK).
Opioid-based pain relief (Diamorphine or Meptazimole)
They are all morphine-based drugs administered for labour pain relief by changing the nerve receptors in your brain.
The drug doesn’t take away the pain but affects your consciousness and how you experience the pain – it sedates you.
Diamorphine is basically heroin, an opiate made from morphine derived from the Poppy is a synthetic opioid that was developed in 1939 for medical use. Meptazimole (or Meptid tends to have a shorter onset but also wears off more quickly.
They are effectively sedatives and can make you feel quite drowsy, but allow you to rest and relax, helping time to pass more quickly. It does not take away the pain of labour, but works on your endorphin receptors in the brain, changing the way you experience it.
There are quite a lot of doubts as to how effective it is as a pain relief option, with some women reporting that it made no difference to the pain but made them feel they were out of control.
Some women find it gives them just enough relief to get them through a few more hours, or to get some rest.
You can’t use it once you are 10cm dilated, or near transition or the active stage of labour as it can have a detrimental effect on your baby at birth and can take many hours to clear from your system.
There are many side effects of these drugs so further research is highly recommended.
KEY BENEFITS: Can change your perception of pain, can have repeat doses.
KEY RISKS: has effect on mother and baby, once taken you have to wait for it to wear off, doesn’t remove pain.
This is an injection of a local anaesthetic drug around your lumbar spine region.
The anaesthetic is injected into the space in between the vertebra of your spine and spinal fluid (known as the epidural area) in order to numb the nerves in the lower half of the body and reduce or remove pain from the area.
In fact, ‘epidural’ refers to the place in the body in which the drugs are administered rather than the drug itself.
The drugs used in an epidural come under the category of local anaesthetics such as Bupivacaine, Chloroprocaine, or Lidocaine, and can be combined with some narcotics, such as Epinephrine, Fentanyl, Morphine, or Clonidine to enhance the anaesthetic affect.
The specific drugs and combination of drugs will vary across hospitals so it is best to check with your midwife or maternity unit as to the exact combination they use.
The difference between a spinal block and an epidural is that the spinal block is one injection to administer a single dose of the drug(s), and an epidural is an injection to place a very thin catheter into the epidural space and remains in place so the drug can be administered continuously for as long as required.
Once the drugs kick in you will not be able to move properly or feel pain from around the waist down. Again this would be restricted if you were nearly fully dilated as it takes time for the drugs to kick in anyway.
An epidural also has a long list of side effects and further research on this option is definitely recommended.
There are also quite a few implications of having an epidural, namely that you are lying on your back which is physiologically the worst position for birth, so the likelihood of needing further interventions are quite high (ie, forceps or a caesarean).
KEY BENEFITS: completely removes pain, allows rest and recuperation.
KEY RISKS: long list of side-effects, can feel disconnected to body and birth, makes further intervention much more likely.
Read more about common birth interventions here…
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For further research about these labour pain relief options go to: https://www.nhs.uk/conditions/pregnancy-and-baby/pain-relief-labour/
Statistics taken from: Birth Choice UK Professional’, https://www.birthchoiceuk.com/Professionals/index.html
Winter, J., ‘Hospital Episode Statistics: NHS Maternity Statistics – England, 2013–14’, Hospital Episode Statistics Analysis, Health and Social Care Information Centre, https://content.digital.nhs.uk/catalogue/PUB16725/nhs-mate-eng-2013-14-summ-repo-rep.pdf, 2015
Walsh, D., ‘Pain and epidural use in normal childbirth’, Evidence Based Midwifery, Royal College of Midwives, https://www.rcm.org.uk/learning-and-career/learning-and-research/ebm-articles/pain-and-epidural-use-in-normal-childbirth, 2009
Entonox: A cylinder of Entonox with a demand valve nozzle (bottom of image). Credit : By Owain Davies (Own work) [CC BY 3.0 (https://creativecommons.org/licenses/by/3.0)], via Wikimedia Commons.
Epidural: An epidural is administered by an anaesthetist. Credit: MrArifnajafov [GFDL (https://www.gnu.org/copyleft/fdl.html) or CC BY 3.0 (https://creativecommons.org/licenses/by/3.0)], via Wikimedia Commons