Pain Relief In Labour

Epidural and More

It is natural to worry about the pain associated with childbirth. Thankfully, there are many options for pain relief, both medical and non-medical. In my experience, an epidural is by far the most effective pain management option. However, I always respect your wishes if you prefer a less invasive method.

Childbirth: pain relief options


The one thing most people worry about when it comes to vaginal birth is pain.

You may already know what you want to do regarding pain relief. Very commonly, women decide in advance that they want an epidural. Alternatively, many women are very reluctant to consider an epidural. They would prefer either no pain relief or other pain relief options.

I am happy for you to choose to use the pain relief that you prefer. That said, women commonly underestimate the intensity of the pain and their capacity to cope with it. When faced with reality, many are disappointed that they did not manage pain as well as they expected. They are often hard on themselves if they make a late decision to have an epidural.

Pain relief options can be broadly categorised into two groups: options that help a little bit, and options that are truly useful. In the truly useful group is an epidural — everything else falls into the other category.
Childbirth: pain relief options |Dr Chris Nichols

Epidural for pain relief


Epidural is the most invasive form of pain relief but by far the most effective.

An anaesthetist will introduce a fine plastic catheter into the epidural space. It is taped in place so that medication can be fed into the site as required. This provides good pain control throughout the labour.

The pain nerves are very small, and the anaesthetic medicine gets into these nerves very easily. The motor and sensory nerves that control movement and sensation in the lower body are much bigger. Hence, the anesthetic medicine enters much more slowly, and therefore control of limb and bladder function is not affected. The exceptions are if the labour is long, or if stronger doses of medication are required.

Side effects of epidural


Side effects of an epidural include blood pressure drop, spinal tap, patchy blocks, and epidural site infection:

Blood pressure drop

Most commonly, it drops blood pressure. Therefore, an intravenous line is routine. If the blood pressure drops it can acutely stress the baby, but this is usually easy to correct.

Spinal headaches

If the epidural needle goes a little too deep it can enter spinal fluid. This is done deliberately with a combined spinal and epidural, commonly employed for elective caesarean section.

The spinal needle is very fine, unlike the epidural needle that produces a bigger hole. This can potentially lead to long-term spinal headaches. It is the most common serious problem, occurring once in every several hundred epidurals.

Patchy block

The tip of the catheter may sometimes lean more to one side than the other. If so, it will work more on one side than the other, producing a patchy block. Stronger doses of medicine, potentially leading to increased numbness and leg weakness, or repositioning of the catheter, will usually correct this problem.

Epidural site infection

Epidural site infection can be serious but is very uncommon. Superficial infection is more common and not important.

Epidurals will not upset the progress of the labour. Caesarean section is no more common with epidural as without. It may slow the pushing stage, and therefore vacuum-assisted deliveries are a little more common.

Labour pain treatment options Perth

Other methods to treat pain


Narcotic pain medicines

Narcotic pain medicines such as morphine are not commonly used. If they must be used, they are best used early, as they can cause sedation in the baby. This can make it slow to establish breathing after birth.

Nitrous Oxide

Nitrous Oxide, or “laughing gas” is about as effective as narcotic medication. The advantage is that the effects of nitrous oxide will wear off in a couple of breaths. This means it is rapidly removed from the system. However, this method is often tiresome to use for a prolonged period of time.

Non-medicine

Non-medicine options can be appealing for that reason, but they are poor options. A bath in warm water is very soothing and has appeal for women not in labour. However, the intensity of labour often leads to women being disappointed by this option.

TENS

A transcutaneous electrical nerve stimulation (TENS) machine is a great non-medical pain relief option — in theory. The thought is that swamping nerve pathways around pain nerves will block the pain signals from being perceived by the brain. Great in theory, and useful in some situations in other parts of the body, but for labour, most women are disappointed.

Hypnotism

Hypnotism has been used infrequently for decades to relieve pain. A lot of preparation work is required by the hypnotist in advance of the labour and hypnosis. But again, this method frequently disappoints.

No pain relief

Lastly, I have seen many women who manage vaginal delivery with no pain relief at all. Pain is a very individual thing and some women do cope very well. These women are likely younger and therefore their labour is quicker. Typically, the babies are also smaller, and it is often not the first labour.

How Dr Chris Nichols can help you


I am happy to talk to you about pain relief options in labour. You may certainly choose your preferred method but, that said, many women find that their plan does not translate into reality. Ultimately, it is your choice, and I can only guide with the best of my experience and training.
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Pain Relief In Labour |Dr Chris Nichols

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Dr Chris Nichols Obstetrician - Gynaecologist - Fertility Specialist Perth

Dr Chris Nichols

MBBS FRANZCOG
I deliver babies at SJOG Murdoch Hospital and have gynaecology theatre lists at both Murdoch and South Perth Hospital. With the help of Fertility Specialists of WA, I established the first fertility clinic south of the river, Fertility Specialists South, located in Applecross.
Elaine McCann Practice Midwife

Elaine McCann

Practice Midwife
I have been a midwife for over 30 years and worked with Dr Chris Nichols for more than 20 years, initially on the maternity unit at SJOG Murdoch Hospital where I still work as a clinical midwife part time and more recently as his practice midwife.
Ruth McCloskey Practice Nurse

Margaret Browne

Practice Secretary
I have known and worked as a practice secretary with Dr Chris Nichols for over 20 years at SJOG Murdoch Hospital. It is an enjoyable workplace and our aim is to provide a professional and caring experience for our patients.
Ruth McCloskey Practice Nurse

Ruth McCloskey

Practice Nurse
As a practice nurse I have worked at several hospitals and clinics around Perth including SJOG Murdoch Hospital. I enjoy assisting Dr Nichols with minor procedures in the rooms.