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.
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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.
How long labour is painful 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.
Other Techniques:
These refer to those methods of pain relief that involve application of drugs.
Nitrous Oxide
Gas This gas, commonly known as "laughing gas", is 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 your nor your baby's bodies, it is safe. However, the gas may make you feel
light-headed, drowsy or nauseated, 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 nauseated or drowsy and reduce the mother's
cooperation in pushing. In addition, these drugs cross the placenta to the baby
and make it drowsy and depress its breathing after it is born. If this happens,
an "antidote" can be given to your baby to reverse these side effects.
Epidural Analgesia
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 and the tube in place,
local anaesthetics is then injected to provide pain relief. This normally takes
about 10 minutes to perform and another 10 to 15 minutes for the drugs to work.
Each dose may last for about 2 hours before it is necessary to inject more drugs
down the plastic tube. Alternatively, a continuous slow infusion of local anaesthetics
is sometimes used.
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 anaesthetics 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 should an urgent Caesarean
section or assisted delivery be required. It may also be used to provide post operative
pain management. Epidural analgesia is particularly valuable when labour is long
and difficult.
Combined Spinal Epidural Analgesia (CSE)
Combined spinal epidural analgesia resembles the epidural analgesia procedure described
earlier. However, after putting the needle in your back and before placing the plastic
tube, your anaesthesiologist will insert another finer needle through the first
needle to puncture the dura (the tough membrane around your spinal cord) for injection
of a small amount of anaesthetics. After that, this needle will be removed and the
plastic tube will be put in the epidural space as described earlier.
One of the major advantages of combined spinal epidural analgesia is that it is
one of the better and quicker ways to relieve your pain and you can still maintain
your mobility.
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 just be possible, but the equipment is designed to prevent
this from happening.
Will an epidural (or combined spinal epidural) hurt my spinal cord?
- The procedure is performed by well trained anaesthesiologists at your lower lumbar
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.
But apart from some tenderness for a day or two from the needle, this has been shown
to be no more likely after an epidural.
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 and can be cured by special treatment if required.
People have told me that epidural will prolong labour, is that true?
- There is no definite answer to this question. With lower concentration of drugs,
modern obstetrical epidural anaesthesia may shorten the 1st stage of labour, but
may sometimes prolong the 2nd stage of labour.
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 during the 1st stage of labour. However, your obstetrician
or anaesthesiologist will be able to help you to determine when is the best time
for administration.
