Pain relief

Pain Relief

YOUR body is perfectly capable of managing labour with its own hormones, breathing, relaxation, safe dark environment, eating, drinking and resting to keep the energy up, all enable the body to work to the best of its abilities.

BUT there will be those who are anxious about giving birth, and will feel safer knowing that “The Sweetie Counter” is available. That the drugs are accessible even if it is not what they envisioned when thinking about their birth options.

There is no right or wrong way to give birth – it’s whatever is right for YOU.  Any choices you make are right for you at that particular moment in time.  Understanding how the pain relief options available can interfere with the production of the hormones and thus have an impact on the labour and birth journey is very important.

The tools we learn when doing this course will help and support you and your baby,  until you are able to access other forms of pain relief if you choose to.
So what are your options:

  • Paracetamol
  • TENS
  • Water
  • Epdural
  • and the big one for me is BREATH!

Paracetamol

This might be an interest linking about Paracetamol Link

T.E.N.S

T.E.N.S stands for Transcutaneous Electrical Nerve Stimulation.
It is a small machine which generates pulses of electrical energy through 4 sticky pads (electrodes) attached to your back.

The electrical impulse – sensations that tingle encourage your body to produce Endorphins.  The endorphins are able to travel to the brain more quickly than the sensations of discomfort.
The TENS machine can be hired or bought and work if they are put on as soon as you are experiencing contractions.

As you press the button attached to the machine these then send messages to the brain that help it distort and lesson the pain signals due to the increasing levels of the endorphins.

Please make sure you have noted if you are using a TENS machine in labour in your birth wishes.  It will need to be removed if you are going into a birth pool.
Pop the sticky pads back on the plastic sheet so if YOU decide to get back out of the water the TENS can be reattached.


Here’s a great guide to using the TENS machine

A guide to drug free pain relief TENS machine

WARNING TO PARTNERS:
If your partner has been using her T.E.N.S machine throughout labour, the chances are, by the time the baby has been born, it will have been turned up very high.
DO NOT touch the underside of the pads until the machine has been turned off.
Her Endorphin levels will be sky high, yours won’t and those tiny little gadgets pack quite a punch.
I have been on the receiving end of these beauties … it certainly didn’t fling me from one side of the room to the other but I did have an interesting conversation with the dad who was adamant he had switched it off but had actually hit the BURST button!!! Hmm. the air was a little blue … to say the least … when I tried to remove it.
We did have a good chuckle about it when we were reflecting.  Especially as we were removing them in a bathroom that was lit by candles!

Liked Because:
No risks to mum or baby
Non-invasive
Mum remains in control
Can be used from very 1st contraction whether mum is at home or in hospital

Disliked Because:
Can take a bit of time to work effectively (hence the need to put it on early)
Cannot be used in water
Some women may find the pain-relief inadequate

Water

Pain Relief

YOUR body is perfectly capable of managing labour with its own hormones, breathing, relaxation, safe dark environment, eating, drinking and resting to keep the energy up, all enable the body to work to the best of its abilities.

BUT there will be those who are anxious about giving birth, and will feel safer knowing that “The Sweetie Counter” is available. That the drugs are accessible even if it is not what they envisioned when thinking about their birth options.

There is no right or wrong way to give birth – it’s whatever is right for YOU.  Any choices you make are right for you at that particular moment in time.  Understanding how the pain relief options available can interfere with the production of the hormones and thus have an impact on the labour and birth journey.

The tools we learn when doing this course will help and support you and your baby until you are able to access other forms of pain relief if you choose to.
So what are your options:

Paracetamol
TENS
Water
Gas & Air (Entonox)
Epidural and
YOUR breath

Paracetamol

This might be an interest linking about Paracetamol Link

T.E.N.S

T.E.N.S stands for Transcutaneous Electrical Nerve Stimulation. It is a small machine which generates pulses of electrical energy through 4 sticky pads (electrodes) attached to your back.

The electrical impulse – sensations that tingle encourage your body to produce Endorphins.  The endorphins are able to travel to the brain more quickly than the sensations of discomfort.
The TENS machine can be hired or bought and work if they are put on as soon as you are experiencing contractions.

As you press the button attached to the machine these then send messages to the brain that help it distort and lesson the pain signals due to the increasing levels of the endorphins.

Please make sure you have noted if you are using a TENS machine in labour in your birth wishes.  It will need to be removed if you are going into a birth pool.
Pop the sticky pads back on the plastic sheet so if YOU decide to get back out of the water the TENS can be reattached.

Here’s a great guide to using the TENS machine

A guide to drug free pain relief TENS machine

WARNING TO PARTNERS:
If your partner has been using her T.E.N.S machine throughout labour, the chances are, by the time the baby has been born, it will have been turned up very high.
DO NOT touch the underside of the pads until the machine has been turned off.
Her Endorphin levels will be sky high, yours won’t and those tiny little gadgets pack quite a punch.
I have been on the receiving end of these beauties … it certainly didn’t fling me from one side of the room to the other but I did have an interesting conversation with the dad who was adamant he had switched it off but had actually hit the BURST button!!! Hmm. the air was a little blue … to say the least … when I tried to remove it.
We did have a good chuckle about it when we were reflecting.  Especially as we were removing them in a bathroom that was lit by candles!

Liked Because:
No risks to mum or baby
Non-invasive
Mum remains in control
Can be used from very 1st contraction whether mum is at home or in hospital

Disliked Because:
Can take a bit of time to work effectively (hence the need to put it on early)
Cannot be used in water
Some women may find the pain-relief inadequate

Water

Ohh my goodness water is an amazingly, effective pain-management tool.
If this is your go to normally it MAY just be what you enjoy in labour.
Submerged in warm water can be the “Cadillac of pain relief”.  The best thing from “The Sweetie Counter.”

Either choosing to use the bath or the shower can be really beneficial in the early stages.  The flow of the warm water can help the body to produce endorphins.
Immersing yourself in a bath of water or a pool lit by candles or a set of fairy lights or even a pool with lights running under the liner.
This is an image from a clients birth set up with a birth pool.

Resting in the excited stage is beneficial.
Encourages the production of Endorphins and also Oxytocin.
Being in a pool where you are able to float and and feel like you are in a cocooned, safe space increases the production of oxytocin and this supports the baby and their journey through the birth canal.

Entering the pool at the right time – if contractions slow down then perhaps enjoy the relaxing experience and then reassess and have a mooch around in your own space …
if they start to increase in intensity great – if you are comfortable stay where you are.

Here are a couple of examples of birth in the pool … you may want them to not to chat so much
YOUR choice …

Another example of birth in the pool – this is so much more instinctive with gentle support …

If you would like to do more research on this check out the research of Michel Odent and Janet Balaskas who have written extensively on this.

Liked Because:

  • No risks to mum or baby.
  • Can reduce the length of labour.
  • Mum is less likely to need other forms of pain relief or intervention.
  • Mum will feel more buoyant and able to change positions more easily.
  • Can reduce the risks of tears to the perineum.
  • Leads to a more ‘hands-off’ birth as it is not so easy to touch the mother when she is in the pool.

Disliked Because:

  • Only recommended for low-risk births (although some delivery suites do have a birth pool option)
  • May not enjoy the sensation of being in the water It can be very warm in the pool

Gas and air (Entenox)

Gas and air is made up of 50% oxygen and 50% nitrous oxide.
At a home birth supplied in canisters and in a hospital setting usually piped Tinto the birth rooms.

Check that to is being offered with the current Entonox debate.

Inhaled through a mouthpiece – using it in a set way is much more beneficial then sucking on every breath – and feeling like you are away with the fairies … it gives you this feeling of floatiness is you feel drunk and away with the fairies you are taking too much of it! Please ask in class I will go through …

Early use in labour – negative effects can be felt
More advanced in labour – side effects aren’t felt as much.

Liked Because:
 No risks to mum or baby
Mum remains in control It can be used in any position and in conjunction with any other form of pain relief it is exhaled immediately so no lingering effects if mum decides she doesn’t like it.

Disliked Because:
Side effects can include

  • dizziness and nausea, similar to having one alcoholic beverage too many!
  • It can make mum very thirsty and her lips dry – use the straw in your pack and buy some lip balm!!
  • Can take a bit of practise to get it right
  • Only available once she gets to hospital (unless you are booked with the Homebirth team who will have portable bottles).

Opiates

Check your Trust – what do they offer?
Is this available only on Labour ward?  Is it an option for the Birth Centre or Home Births??
Opiates offered???  – depends on hospital – pethidine, meptid or diamorphine.
All are forms of opiates and they are given via intra-muscular injection.
They take about 20 minutes to work and act like a sedative, altering perception of pain and time, a bit like the gas and air, rather than an actual pain reliever.

Once administered please ask how l9ng each one lasts …. as this can have a knock on effect to your baby.
You may be able to have a couple of doses – how does that impact your labour?

Full disclosure – the opiates have some pretty major side effects (listed below) but they can work successfully, especially if the early/excitement phase has been long and the mother needs to rest. It can also help to relax her so successfully that if baby is in an awkward position, once the stomach muscles relax, it’s easier for the baby to turn. It’s also a big jump to go from gas and air to an epidural and this might provide a bit of down time before any decisions are made. Please don’t think this will stop you feeling the contractions – you are still very aware of them!!

Liked Because:

  • It can support the mother to rest between contractions
  • It can help a tense mother to relax letting her baby to move into a less awkward position
  • It can be administered by the midwife

Disliked Because:

  • It crosses the placenta, so if administered too close to the baby being born it can cause feeding and breathing difficulties
  • It can cause nausea and sickness (sometimes it is administered with an anti-emetic)
  • Mum cannot use the birth pool unless it has been 4 hours since the injection was given
  • If it causes mum to fall asleep in between contractions she might only wake again at the peak of the contraction and be unable to help herself cope with it
  • If mum doesn’t like it, there is nothing she can do about it until it has left her system

Epidural

The Holy Grail of anaesthesia = and if it works, takes away the pain completely – YAY
It does not take away the awareness of pressure in the vaginal space.  YAY

There are many side effects that you should be aware of …

  • it cuts off the body’s communication system and the catheter acts as a barrier
  • it blocks the production of labour hormones which will slow labour down and possibly lead to further intervention.Check with your Trust that they offer mobile epidurals or low dose epidurals because, in theory, the pain-relieving elements are there, but the complete numbing effect is not, so a woman is able to be more mobile.
  • I have had one client at Dudley PFI Hospital utilise a walking epidural.
    More women are likely to feel immobile.What may be an alternative is to choose the epidural and then nearer the time to lay off pressing the button so you become more aware of the pressure in the perineum and with support becoming more active in terms of birth position – U F O and off YOUR back. Perhaps draped over the back of the bed and sometimes evening being mobile at the side of the bed!

    The more the drug is topped up, the more like a traditional block it becomes and the mum-to-be becomes a ‘fall risk’ potentially causing injury to herself, her baby and maybe even the midwife who has to drag her back on to the bed!

    Midwives can be fairly uncomfortable about a woman becoming mobile with an epidural.  The lower dose and mobile epidurals have a higher concentration of opiates in their make-up, which we know crosses the placenta.

Liked Because:

  • It can provide total pain relief – unless sited wrong!
  • It can be topped up if necessary
  • It can support a very tired or frightened mother to rest
  • It lowers blood pressure (which is good if yours is high!)

Disliked Because:

  • It is a fairly complicated procedure and requires an anaesthetist to administer it.
    In other words, a mother can be desperate for one, but if there is no anaesthetist available there is no epidural. I recall a client who tole me that she was 8cms and the epidural was not possible.  She kept asking for her “F**king” epidural and then realised she wasn’t going to get it …
  • It might not work or may only provide a partial block.
  • It takes about 20 minutes to work.
  • It lowers blood pressure (which is not good if there’s nothing wrong with your blood pressure)
    To counteract this, a saline drip will be set up at the same time.
  • A skin infection can develop at the epidural site.
  • It can cause a fever in the mother.
  • A catheter is required because a woman is often unable to feel if she needs the toilet or take herself there once the epidural is set up.
  • It leads to an increased risk of assisted delivery because of the cascade of intervention and immobility of the mother.
  • An epidural also changes the shape of the pelvic floor, making it very hard for the baby to turn against it.
  • About 1% of women will suffer a dural tap (a leak in the spinal fluid) which can cause a severe and debilitating headache.
  • It can lead to spinal injury and paralysis and in some cases death (very rare according to Reynolds, F., 1989)

BREATH

Your breath is so powerful.  Durin the course you have learn a few breaths – some of these will feel very comfortable and others a little alien.

Attached is a document to help you remind yourself and to connect to them:
Breathing relaxations for pregnancy and birth