HealthAgenda

Pregnancy & Birth

Your pain relief options during labour

How to manage the pain while giving birth, from natural painkillers to epidurals.

Lucy E Cousins
July 2018

Labour is one of the most momentous and memorable events that women can experience, and knowing the pain relief options ahead of time may help you feel better prepared for childbirth.

Preparing your mindset

With a child born every minute and 43 seconds in Australia, it’s little wonder that birthing stories are a common topic for new mums. However, according to midwife Edwina Sharrock from Birth Beat, women shouldn’t put too much credence in other people’s experiences.

“The conversation we have in Australia as a society is that birth is something to be feared, when actually we need to be educated about the physiological process instead,” she explains.

Obstetrician and gynecologist Dr Reawyn Teirney at the Royal Hospital for Women, Sydney agrees.

“We know that the more stressed you are, the more pain you’ll experience. So it’s important to have a really good idea of what you might expect during labour, and how relaxation techniques can help.” 

In fact, a small study shows that women who have a lot better understanding and knowledge around labour have a much more positive labour experience.

There are prenatal courses that expectant parents can do to prepare for labour.

Natural pain relief

During the early stages of labour, there are some non-invasive complementary therapies that can be used for initial pain relief.

Although complementary therapies have had few large-scale medical trials, a 2016 study found that patients who used certain therapies had a significantly reduced epidural use and caesarean sections.

The therapies included in the study were acupressure, visualisation, relaxation, breathing techniques, massage, yoga poses and facilitated partner support, where birthing partners help to calm the mum-to-be’s stress levels.

Sharrock also believes the most effective pain relief for early labour can be done at home.

“There are a lot of strategies you can do prior to going to hospital,” she says. “One combination I recommend is heat (including baths and showers), massage and movement, which are evidence-based natural pain relief options that, in conjunction with breathing techniques, actually [can help].”

Medical pain relief

Once labour has progressed, and if you’ve requested medical pain relief, there are several options available, depending on whether you’re at a hospital or birthing centre.

Nitrous oxide

Generally the first medical pain relief after paracetamol is nitrous oxide, known as laughing gas, which contains a mixture of nitrogen and oxygen. You inhale it during contractions, so can control how much you have and how often.

“Nitrous oxide acts pretty quickly and can take the edge off the pain,” explains Dr Teirney. “However, it can make you feel drowsy and a little bit confused. It doesn’t affect your baby in a negative way.”

Injections

The next level of pain relief available may be a pethidine injection, which takes about 20–30 minutes to take effect. It can be given every 4 hours, and lasts 2–4 hours. Diamorphine is another pain relief injection sometimes used.

“Pethidine is quite good at helping with pain,” says Dr Teirney. “You’ll definitely feel relaxed but you can feel pretty drowsy afterwards and it can make your baby feel sleepy too. We don’t administer it if we think the baby will be born soon.”

That’s because when administered too close to delivery – or when dosed repeatedly – pethidine can also affect your baby’s breathing, however this effect can be reversed by an injection given to your baby.

Epidural

An epidural, which numbs you from the waist down, delivers long-lasting, reliable and effective pain relief.

An epidural is given via a needle into the epidural space near the spinal cord and while it does come with some risks, the procedure is generally seen as very safe.

Often fluids are given to avoid a drop in blood pressure and some women lose feeling in their bladder, meaning a catheter is required. The epidural takes about 20 minutes to set up, usually by an anaesthetist, and another 20 minutes to take effect. When it starts to wear off, you can have top-ups that last between 1 and 2 hours.

Women who have epidurals have a higher rate of assisted birth, where the baby is delivered with the help of medical instruments, such as forceps or a vacuum.

If you have a caesarean section, the most common type of pain relief is a spinal anaesthetic, which blocks the pain from your chest down.

When it comes to planning your pain relief, talk to your healthcare team to find out which methods are recommended and available at your chosen birthing centre or hospital.

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