Expecting a baby is definitely one of the most joyful experiences in your life, so it is important that the labour and delivery are safe and pleasant.
Tolerance to labour pain varies among individuals, but it is best for you to be open-minded to all pain relief methods.
Your active participation in planning your childbirth, together with the help of your obstetrician, the anaesthesiologist, midwife and your partner, will let you experience a comfortable and rewarding labour.
What Is Labour Pain All About?
1st stage of labour
During this stage, uterine contractions occur at regular intervals. These are accompanied by dilatation of your cervix to allow your baby's head to pass into the birth canal. Pain is felt in your lower abdomen and sometimes in your back.
2nd stage of labour
During this stage, contractions continue. In addition, a bearing-down sensation or pressure helps you to push your baby's head down the birth canal, stretching the muscles and tissues of the vagina.
The 3rd stage of labour involves expulsion of the placenta.
All these sensations are conveyed through the nerves to your spine, when messages are transmitted to the brain which releases the pain signal to your body.
The duration of labour and severity of labour pain, is difficult, if not impossible, to predict. The range is from a few hours to 12 hours or more, but it is important to realise that prolonged pain and stressful labour is undesirable for both yourself and your baby. Resorting to pain relief methods during labour is not an indication of failure, but is a means of having a pleasant birth to which every mother-to-be is entitled.
What Can I Do To Relieve My Labour Pain?
Different methods are available to relieve labour pain. Effectiveness varies among individuals, but it is helpful to familiarise yourself with the more common methods before you go into labour, so you will be able to come to a quick decision when necessary.
Breathing and Relaxation:
These refer to the breathing exercises and relaxation techniques which you will probably practise during your antenatal class. When labour starts and you begin to feel pain, concentrating on your breathing rate and breathing out loud will help you to relax.
With the help of your partner, your discomfort may also be relieved by gentle massage on your back. You may find this adequate in early labour, but many mothers may have to seek other methods of pain relief when contraction pain becomes more severe.
These refer to those methods of pain relief that involve application of drugs.
Entonox or Nitrous Oxide Gas
This gas, commonly known as "laughing gas", is nitrous oxide mixed with oxygen. To use this method, a mask or mouth piece draws gas from a machine beside the bed. You need to take deep and steady breaths before each contraction becomes painful as it takes about 20 to 30 seconds for the gas to be effective. Since the gas will neither build up in you nor your baby's body, it is safe. However, the gas may make you feel light-headed, drowsy or nauseous and not all mothers find this method of pain relief effective.
Injection of Drugs
Pain-relieving drugs such as Pethidine (which is the most commonly used) can be injected into the muscles to reduce your labour pain, but their efficacy varies among individuals. They tend to make some nauseous or drowsy and reduce the mother's cooperation in pushing. In addition, these drugs cross the placenta to the baby and make him or her drowsy, causing respiratory depression after birth. If this happens, an "antidote" medication can be given to your baby to reverse these side effects.
Analgesia means pain relief. The anaesthesiologist will place a very fine plastic tube into your epidural space by passing it through a needle which is inserted in your back at about waist level. After the needle is removed upon successful tube placement, local anaesthetic is then injected to provide pain relief. This normally takes about 15 minutes to perform and another 10 to 15 minutes for the drugs to work. Subsequently, a continuous slow infusion of local anaesthetic is administered through the tube to maintain the pain relief till delivery.
Epidural analgesia is the only method that is capable of providing pain relief in labour, and let you stay awake at all times. The local anaesthetic has the tendency to numb your legs but has minimal effect on your baby. With the help of your midwife or obstetrician, you should still be able to push during the 2nd stage of labour. The tube also allows administration of surgical anaesthesia if an urgent Caesarean section or assisted delivery is required. It may also be used to provide post-operative pain management. Epidural analgesia is particularly valuable when labour is long and difficult, such as in first-time mothers.
Combined Spinal Epidural Analgesia (CSE)
Combined spinal epidural analgesia resembles epidural analgesia procedure described earlier, but involves additional injection of local anaesthetics into the intrathecal space, just deep to the epidural space. This allows for a more rapid onset of pain relief and is beneficial for mothers in moderate to severe pain.
When In Doubt, Don't Hesitate To Ask
Can I have another injection of Pethidine after it wears off?
This can be done but it tends to accentuate the side-effects on the mother and the baby.
If I inhale too much gas, will I become unconscious?
Theoretically this may occur but only for a transient period. When you are drowsy, you will not be able to inhale more gas and hence, the drowsiness will wear off.
Will an epidural (or combined spinal epidural) hurt my spinal cord?
The procedure is performed by well trained anaesthesiologists at your lower back region, below the end of your spinal cord. Therefore, the chance of causing damage to it is very unlikely.
Will an epidural (or combined spinal epidural) cause any backache?
Backache is common after giving birth whether you have epidural analgesia or not. However, you may experience some tenderness over the injection site for a day or two, but this is self-limiting.
Will I get a headache after epidural or CSE?
Headache rarely results from an epidural. If this happens, it usually only lasts for a few days (occasionally up to a week) and can be cured by special treatment, if required.
People have told me that epidural will prolong labour, is that true?
With lower concentration of drugs, modern obstetric epidural anaesthesia can shorten the 1st stage of labour, and although it may sometimes prolong the 2nd stage of labour, the extended duration is not significant.
When will I regain sensation in my legs after an epidural block?
This depends on the type and concentration of local anaesthetics you have received. Usually after delivery, the plastic tube will be removed from your back, and sensation should return to normal within a few hours.
When should epidural analgesia start?
It can be started at any time as long as the mother is in active labour. However, your obstetrician or anaesthesiologist will be able to help you to determine when the best time for administration is.
This featured article is contributed by the Department of Women’s Anaesthesia, KK Women's and Children's Hospital. To read more please visit www.kkh.com.sg/HealthPedia.