As anaesthetists we don’t get the opportunity to meet most of the amazing women giving birth, as we are only involved in the care of a small proportion of mamma’s-to-be. Nevertheless, knowing how an anaesthetist can look after you and your baby can be really helpful in the lead up to your big day.
The most common role anaesthetists play on the labour ward is talking to women and their partners about different sorts of pain relief available in labour. This sometimes includes us performing an epidural during labour, but there are many other options and just like everything else to do with having a baby its all about finding the best fit for you and adapting to what happens during your baby’s birth! Talking to your anaesthetist and midwife on the labour ward or perhaps in advance in clinic will help you understand the various alternatives for pain relief but we can give you a whistle stop tour now!
Pain Relief Without Drugs
Anyone can learn to use self-help techniques during labour, such as breathing exercises, and this is a great place to start, particularly for the early stages of labour. Some women can find it tricky to relax during the birth process, so it’s a good idea to practice different techniques prior to the big day. There are many books, podcasts and courses out there, have a look and see what suits you best.
A massage can also be amazingly helpful – perhaps suggest that your partner puts in some practice during pregnancy! Birthing pools too can be fantastic in helping you relax and reduce discomfort you may experience- have a chat to your midwife about the practicalities of using these during labour. Most birth centres have dedicated rooms for water births but these are often limited in number, so don’t pin all your hopes on one being available. Ask early and you may be lucky!
Aromatherapy, hypnosis and acupuncture have been used for many years to help women in labour and there are plenty of trained professionals who offer these complementary therapies. It is worth noting, however, that they are not available nationwide and can be a bit expensive. Another option is that you can be trained to do hypnosis on yourself (self-hypnosis) and with a bit of practice can become a pro quickly. Why don’t you check out posts from Hollie De Cruz for more information on hypnobirthing as she is the real expert!?
Transcutaneous Electrical Nerve Stimulation or TENS involves a gentle current, the strength of which you control yourself, passing through special pads attached to your back. This creates a tingling sensation and can be helpful in reducing the pain felt during labour, especially at the beginning. If you hire a TENS machine, you can use this at home…. a real bonus! If you are interested in hiring one then check out Boots, Mothercare and local pharmacies or online companies – the list of options is extensive.
The theory behind how a TENS machine works is based on “the gate control theory of pain” which proposes that there is a gate between the brain and the spinal cord nerves. If the gate is open, pain messages get to the brain and if it’s closed they don’t. If you stimulate non-pain carrying nerves, for example via the TENS machine or by “rubbing it better”, the brain is “busy” dealing with these messages and cannot receive the slower, painful signals. In essence the brain is otherwise engaged and therefore the gate is closed. Although there is not much robust proof that TENS machines work, many people do find them very helpful. The advantage is that TENS is well tolerated and largely without side-effects. You can use it in combo with other forms of pain relief but you will need to whip the pads off if you opt for an epidural or water birth!
Good old Gas and Air
There are of course drugs to help you manage the pain in labour. These include gas and air (Entonox- a mixture of nitrous oxide and oxygen) which can be used throughout labour via a mouth piece and has a very short duration of action. It can make you feel a little spaced out and giggly but most people don’t seem to mind these side effects! You control the amount of Entonox you use but to get the best effect it is important to get the timing right. You should start breathing Entonox as soon as you feel a contraction coming on, so you will get the full effect when the pain is at its worst. You should try not to use it between contractions or for long periods as this can make you feel dizzy.
And if you open up the drug cupboard…
The other main drugs we use to reduce pain in labour are opioid drugs, which are essentially morphine-like drugs. Most commonly in the UK we use diamorphine or pethidine, which are injections that your midwife can give you during labour, normally into your arm or leg. Some women get great pain relief with these, some are a bit disappointed. Opioid drugs can also make you feel a bit sick and rarely can slow your breathing down. They have been used for many years so are safe, but using opioids during labour can make you baby more sleepy after its born or it might be a little bit slow to take its first breath, both things that we can deal with easily. Sometimes we can give these sort of drugs via a special pump that you control with a button called a PCA or patient controlled analgesia system. You can give yourself a dose and then the machine locks for a certain time interval (e.g. five minutes) so there’s no risk of accidentally overdosing yourself!
What we’re famous for…
One of our most favoured skills as obstetric anaesthetists is putting in epidurals. This deserves a whole post of its own. So check back soon for all the details surrounding this form of pain relief.