Obstetrician Perth | Pain relief in labour
Pain Relief In Labour
Epidural and MoreChildbirth: 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.
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
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.
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
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