Working with labour pain

You may be coming to the end of your pregnancy and beginning to think about when

you go into labour and how you will cope with labour pain. How you deal with labour

pain can influence your birth experience, so this leaflet aims to help you make choices

when the time comes.

why is labour painful?

Pain is an important part of having a baby. It helps you to know labour

has begun so that you can find a ‘safe’‛ place to give birth. Pain also

gives you information about how your labour is progressing so that you

can feel in control of your labour/birth experience. The pain you will

experience during labour and birth is special because it is one of the

only times in your life when feeling pain means that your body is working

effectively. The natural pain-killers your body makes help you and your

baby prepare for life after birth.

However, as the pain of labour and birth can be difficult and tiring, this

leaflet aims to provide you with information on ways you can work with

this pain and make use of your body’s own coping mechanisms. Pain

relief during the experience of childbirth should be YOUR choice,

whether or not you decide to have it, or which method you would like to

try.

Your midwife is there to help you give birth safely and to offer support.

She will aim to stay with you for the majority of your labour, to provide

help and encouragement.

Having a positive approach to labour will help you to feel in control of the natural

process of childbirth. Labour pain is a ‘positive pain’, so as each contraction passes,

try to imagine being another step nearer to that special moment when your baby

arrives. Feel strong by focusing upon the body’s natural ability to give birth. Breathing

techniques, visualisation (closing your eyes and picturing a pleasant scene or image)

working with the pain and listening to calming music will help you to feel relaxed and

stay in control.

positive thinking

Good support is vital when you are giving birth; it may even help ease labour pain.

Research has shown that with good support during labour women stay more

relaxed, making childbirth a much more positive experience. Good support may

mean you can stay at home longer, and reduce the need for pain relieving drugs.

WHO CAN SUPPORT ME?

Most women want to be supported by someone they know, usually it‛s their partner,

mum, sister, friend, or doula. Birth partners can help by rubbing your back, holding

your hand, breathing with you, getting you a drink, or helping you to change position.

Just someone being there is enough for some women. Support may also be

emotional encouragement and understanding or a combination of both. It is

important that both you and your birth partner talk about what you want from your

birth experience.

support

Although many women think that they should be lying on a bed while

they are in labour, research shows that a more upright position is

probably better. You can do this by walking around, using a birthing

ball, squatting, kneeling or sitting upright. Ask your midwife for a

birthing ball, though you may have to use you own.

‘All fours’ is a good position for relieving pressure and pain from your

back. You can get in this position by using mats on the floor, or by

kneeling over the back of your delivery bed. Remaining upright and

mobile during the first stage of labour can reduce the need for pain

relieving drugs and shorten labour. Movement will help, so walk

around the house or around the room if you’re in hospital. During the

pushing stage of labour upright positions encourage your pelvis to

open wider, allowing your baby to move down the birth canal more

easily and quickly. Lying on your back can intensify the pain and

reduce the flow of oxygen to your baby, so when possible remain in an

upright position and ask for support from a partner or your midwife to

help you get comfortable.

Remember!

Labour pain means your body is healthy and working properly!

what position should i be in?

Remember!

Try and make yourself comfortable and try to remain in control, as staying positive makes

you feel more relaxed. An upright position, and/or using a rocking chair may help your

labour to progress. Lying on the bed throughout your labour intensifies the pain, and may

slow down your labour.

Although lying on the bed throughout your labour intensifies the pain, and may slow

your labour, women find lying down useful at some stages. If you feel tired and you

want to lie down, it is better to lie on your side rather than flat on your back.

Most importantly listen to your body, try to adopt positions that encourage the

contractions rather than trying to make them go away.

rest when you want to!

hot or cold remedies and massage

It has long been known that the use of heat and cold can relax tense muscles. Cold is

particularly good for low back pain, which is common in labour. Hot compresses on

the back, lower abdomen, groin or perineum are good muscle relaxants and a warm

shower, or being wrapped in a warm blanket, can also help.

Research has found that massage and touch are helpful not only for pain relief but

also to make you feel better. Massage and touch improve your comfort level and

ability to cope with the pain. You and your birthing partner can practise before labour

begins so that when you start to have contractions you know exactly what to do. Your

midwife will show you what to do if you ask her.

A warm bath or shower can help relax your body and ease your labour pain. It can also

make your labour shorter. Water can give you the feeling of ’being in control’; something

a lot of women say is important to them. The water will support your body and let you

change your position more easily. Research has shown that using water to relieve your

pain reduces the need for drugs and the need for an assisted birth, such as forceps or

ventouse. It also helps soften the perineum.

Whilst you are having a warm bath it is an ideal opportunity for your birth partner to give

you a massage.

Birthing pools, when available, can be used for labour and you can stay in the pool for

the birth of your baby if you want to. Ask your midwife for more details!

using water

aromatherapyAromatherapy is the use of natural plant extracts which create a feeling of well being,

relieving anxiety and fear. Aromatic oils can be used through massage, inhalation or

compression, and have been linked with a reduction in the need for other, more intrusive

methods of pain relief.

Some aromatherapy oils are not suitable for use in pregnancy, and a qualified therapist must

always be contacted when considering this method for pain management. If you are

considering aromatherapy, you must discuss this with your midwife.

hypnotherapy

Is a way of preparing for childbirth through using relaxation techniques, such as breathing

and visualisation exercises. You may attend sessions with a specially trained Hypnobirthing

Natal Therapy practitioner, or you can purchase DVDs and CDs which help you learn the

techniques for when labour begins. Ask your midwife for more details, or check out these

websites:

Natal Hypnotherapy: http://www.natalhypnotherapy.co.uk

Hyponobirthing: http://www.hypnobirthing.com

tens TENS (Transcutaneous Electrical Nerve Stimulation) works via gentle impulses that are

passed through four pads stuck to your back. You may control the strength of the impulses

to produce a tingling feeling in your back. These machines can be hired from baby retail

outlets, or the internet.

There are no known harmful effects to the baby. TENS is not recommended for use by

women who suffer from epilepsy, have a pacemaker or are in the bath. The effects of

TENS are more beneficial if begun in the early stages of labour, allowing the electrical

current to be increased as the contractions become stronger. It is most important that the

pads (electrodes) are placed correctly on your back for you to get the best benefit. Ask

your midwife to help you.

Also known as ‘gas and air’, Entonox is a mixture of nitrous oxide and oxygen in equal

proportion which is inhaled through a mouth piece or mask, depending on your

preference. Steady breaths are taken from the start of each contraction; the effects can

be felt within thirty to forty seconds and last for a short period of time. There are no long

term effects to you or your baby. It is important that the Entonox is used correctly to gain

maximum benefit. Your midwife will show you how to use it to get the best effect, then

the control is yours. When you first start using Entonox you may experience a slight

dizzy, light headed sickly feeling. Entonox can be used throughout labour and, if

required, right up until the baby is born.

entonox

Remember: you don’t have to be on a bed to use Entonox, you can walk round or even be in a

pool!

pethidine

Pethidine (and similar medicines) is an injection usually given into one of the muscles in

your bottom. It is a form of pain relief for women who want to take the edge off their pain.

It is very similar to Morphine and is often given with an anti-sickness drug (usually a

medicine called Metoclopramide). If given in early labour, Pethidine may help you to relax

and may even help you sleep. However, if given before labour is established it can slow

contractions down. If Pethidine is requested it can usually be prescribed by your midwife,

so you don’t have to wait too long. Once administered Pethidine begins to work within 15-

20 minutes and can last around 2 hours, depending on the dose given. Pethidine can be

used with Entonox.

Pethidine has some side effects and can make some people feel sick, sleepy, dizzy, light

headed or out of control. If given near to the time of birth, your baby may be sleepy and

slow to start breathing.

epidural

Epidurals are a way of experiencing a pain free labour with few reported effects on your baby. An

epidural uses pain relieving drugs to block the nerves from your uterus (womb), surrounding

muscles and back which transmit the pain experienced in labour.

A fine catheter (tube) is inserted into your lower back through a small hollow needle under local

anaesthetic (you will have to stay very still whilst this is carried out). The needle is removed and the

catheter is then secured to your back using a sticky dressing and pain relieving drugs are given

through it.

As this procedure takes some time to perform and the painkillers which are given take some time to

work, it may take up to 30 minutes before the epidural pain relief is fully effective.

An epidural, should you want one, is put in place by an Anaesthetist (a doctor who is specially

trained in providing epidural pain relief). It is possible that when you decide you would like an

epidural, the Anaesthetist may be busy elsewhere, so there may be a delay in him/her being able to

come to you.

You may want to discuss epidurals with your midwife early in labour if you think you might. want

one, and the Anaesthetist will talk to you before putting the epidural in place to make sure there are

no reasons why an epidural would be unsuitable for you (e.g. if you had blood clotting problems)

and to answer any questions you may have. Occasionally this may mean blood tests are necessary

before it is safe for you to have an epidural.

epidural (cont)

Some people are worried about developing backache after having an epidural. Research shows that

epidurals do not increase the risk of backache, and serious complications are rare.

There are some circumstances, where epidurals may be particularly useful in helping with the birth of

your baby and may be recommended by your midwife or obstetrician, for instance: pre- eclampsia,

twins, breech position or some medical conditions. But it is always up to you whether you want to

have an epidural or not.

Although epidurals are usually a safe and effective form of pain relief, there are some disadvantages

and potential side effects you need to be aware of:

Not every epidural is effective. Sometimes it is impossible to put the epidural in the right place.

Sometimes it works only partly. You may have a ‘window’ of pain (an area where you can still

feel the pain of your contractions). It is occasionally possible to help with this type of pain by

changing the drugs put in your epidural or changing your position when top-ups are given. If this

does not work the epidural can be removed and a new one put in. If you prefer you can also

combine the epidural with Entonox.

Epidurals can cause your blood pressure to drop although this is less common with modern low-

dose epidurals. You will need to be monitored after each top-up and you will need to have a drip

in place, so that you can be given fluids if necessary. A drop in blood pressure is more likely if

you lie flat on your back with an epidural, so you should avoid this position.

Having an epidural can slow down your labour and increase the chance of you needing a drug to

increase contractions. Epidurals may increase the need for an assisted delivery such as forceps

or ventouse.

We hope this booklet helps you to make an informed choice about your pain relief in

labour.

Remember: Being prepared, supported and informed will help you during the birth of

your baby.

Thanks to parents and midwives for use of their photos, and to East Lancashire Hospitals NHS Trust for permission to

adapt their information leaflet ‘Working with Pain’.

Acknowledgements to MIDIRS Informed Choice Leaflets.

Made by Sheena Byrom

Adapted 2014