Pain Relief in Childbirth

Childbirth can be a painful experience for most, but not all women. Pain in childbirth develops gradually. It begins with irregular contractions that you can cope with, without support, and develops to contractions that come as waves of pain at regular and frequent intervals¹.

This leaflet tells you about some of the methods that can be used to help you cope with this pain.

The birth plan in your handheld records is there for you to make your wishes known and help in the discussions you have with your midwife.

Pain during childbirth is a different experience for each woman. The type of pain relief you choose may change during the progress of your labour and delivery.

Pain relief choices in our hospitals include:

• support in labour
• relaxation and physical methods
• water blisters (injections of sterile water which block the pain in your lower back)
• birthing pool
• Transcutaneous Electrical Nerve Stimulation (TENS)
• painkiller drugs (such as tablets or injections)
• Entonox (gas and air)
• Pudental block
• epidural analgesia

What is support in labour?

Support during your labour is most likely to be given by your family, family members, friends, a trained lay worker (for example, a member of the National Childbirth Trust) or your midwife.

Women who have someone with them during their labour have been shown to be more relaxed and may need less pain relief.

This approach has also been shown to have a positive effect on the outcome of labour².

What are relaxation and physical methods of pain relief?

These methods do not take the pain of the contractions away, but help you cope with your pain by using your body’s own natural endorphins (natural painkillers in your body)³.

What can I do to help myself cope with my pain?

Maternity staff encourage women to be as mobile as possible during labour. You may find it helpful to try a number of positions, for example:

• kneeling on “all fours”
• leaning against your partner
• standing up, leaning back against the wall
• using a table or high surface to lean against.

You may also find it helpful to rock backwards and forwards, or from side to side during a contraction. This can be done in any of the above positions. A leaflet “Positions for Labour” gives more information.

What can my birth support partner do to help me?

During this time, you may find it helpful for your support partner to:

• rub your back
• cool your face with a damp towel or flannel
• offer you sips of water or use a light water spray on your face
• give you emotional support and help you to think about your breathing
• play music you like. This can help you to relax.

What else can I do during the early stages of my labour?

The following may help while you are at home:

• choose the music you wish to listen to while you are in labour. Remember to bring it with you.

• stay at home for as long as possible, carry on as normal, as being in your own home helps you to relax

• telephone the unit where you have planned to have your baby if you want any advice.

How can I use breathing to help?

It is best to find a position you are comfortable with before your contractions start.

You need to think about keeping your breathing regular. Try to concentrate on something other than your pain³. Your midwife will explain breathing methods to you and help you to practice.

What are complementary therapies?

Many women do not wish to use painkilling drugs during their labour. Another option is to use complementary therapies. These are drug free methods of pain relief.

Some of the common complementary methods of pain relief are:

• bath and/or birthing pool
• Transcutaneous Electrical Nerve Stimulation (TENS)
• hypnosis or acupuncture

Bath and/or birthing pool

A warm bath can be relaxing at the beginning of your labour. Your midwife may advise you to try this¹.

A birthing pool is deeper than an ordinary bath and much larger to allow you to move around more easily. This helps you to get more relief and can make your labour more calming and comfortable.

If you are interested in having a water birth please ask your midwife for a copy of our information leaflet, ‘Water Birth’.

Transcutaneous Electrical Nerve Stimulation (TENS)

This is a drug-free method of pain relief, controlled by you and has not been shown to have a harmful effect on mothers or their babies⁴.

Pads (electrodes) are placed on your lower back and a small handheld device helps you to control the electrical impulses.  It will give you a tingling, buzzing feeling and works in 2 ways. It helps:

• your body release natural endorphins. These are hormones that help you relax

• to block the pain messages getting to your brain^1,3,4.

You will need to practice using a TENS machine before you go into labour so that you know the most comfortable position for the pads and to make sure you know how to use the machine.

It is best to start using your TENS machine when you are at home and as soon as your contractions start, as this helps build up your body’s endorphins.

As your labour gets stronger, you may need more pain relief than TENS alone can give. If you are interested in using TENS during your labour, you need to organise it well in advance. Your midwife will advise you about who provides them in your area.

You will have to pay for the use of this equipment.

Hypnosis or Acupuncture

There is some evidence that women using acupuncture or hypnosis may find them helpful⁵. If you are interested is using either of these methods, you need to organise it with a registered practitioner well in advance.

You will have to pay for this service.

What painkillers can I have to help me with my pain?

There are a number of different drugs you can have to help the pain.

Tablets

There are very few tablets you can take for pain relief in labour.

• Paracetamol. This is used to help relieve mild to moderate pain. You should always follow the instructions provided in the leaflet supplied with your tablets.

• Dihydrocodeine. You may be given 1 – 2 tablets every 4 – 6 hours up to a maximum of 8 tablets in a day by your midwife, as this is a stronger tablet. This drug can cause constipation if taken over a long period of time⁶.

Entonox (gas and Air)

This is a mixture of oxygen and nitrous oxide which can be used during labour to give you pain relief without making you sleepy⁶. It can be used safely with other forms of pain relief.

Do I have control?

Yes, you have total control on how you use gas and air as you take it by breathing through either a mouthpiece or mask. It is easy to learn how to use and your midwife will help you with this. It gives quick relief of your pain^1,4,6.

How does it work?

It does not take your pain away completely but helps you to cope with the pain. It is important to use gas and air from the start of a contraction so you can get the full effect of the pain relief. When the contraction finishes, you need to stop using the gas and air and breathe normally. The side effects can make you feel light-headed and nauseous (feeling sick)¹. Please tell your midwife if you have any breathing problems such as asthma. It is not harmful for you or your baby.

Painkilling drugs given by injection – What drugs can be given and what are the effects?

Pethidine and Diamorphine (Opiate drugs) can be given for moderate to severe pain relief⁶. They are given by injection into your bottom or thigh (top of your leg).

They can take up to 20 minutes before easing your pain, but you should then feel the benefit for 2 – 4 hours. They do not take the pain away completely if you are in strong labour, but you will find they help you to cope with the pain.

Pethidine is quick and short lasting, but is not as strong as Diamorphine^1,6. They can make you feel nauseous but you can be given other drugs to help with this.

Opioids may cause your baby to be slow to start breathing at birth and begin breastfeeding^1,4,7. You may not be given this injection close to the birth of your baby for this reason. Your midwife will be aware of the drugs you have been given and take any action needed.

Pudental block

This is an injection of local pain relief given to numb the nerves in your vagina and the muscles around your vagina.

It is used if your baby needs to be delivered by forceps or ventouse (suction cup) and you do not have an epidural in place. It works very quickly and is usually very effective.

Epidural analgesia

The word epidural comes from the area around your spinal cord called the epidural space. The nerves that send pain impulses (messages) from your womb and birth canal to your brain pass through this epidural space. An epidural is an injection of local anaesthetic (painkilling) drugs into the epidural space. This will prevent the pain message getting to your brain and stop you feeling pain^1,4.

Can anyone have an epidural?

Most women can have an epidural. An epidural may not be advised if you have some medical conditions, for example back problems, some drug treatments or complications during your pregnancy.

If you would like an epidural, you should discuss this with your midwife, who can arrange for you to see an anaesthetist (a doctor who specialises in anaesthetics for pain relief), if needed.

The anaesthetist will discuss the options available to you.

Contact numbers

If your call is urgent you should contact the hospital where you are due to have your baby.

University Hospital of North Tees

Non-urgent messages can be left on the answering machine and will be picked up throughout the day.

Community Midwives

Monday to Friday, 8.30am – 9.30am
Stockton North: 07795390901
Stockton South: 07912483403

Ragworth Children’s Centre

St John’s Way
Stockton
Admin Phone: 07881211090

University Hospital of Hartlepool

Antenatal Day Unit

Telephone:  01429 522879
Monday – Friday, 9.00am – 5.00pm

When the Day Unit is closed calls are transferred to the Birthing Centre.

Birthing Centre

Telephone: 01429 522876
24 hours a day, 7 days a week

Community Midwives

Telephone: 01429 522279
7 days a week, 9.00am – 10.00am

Non-urgent messages can be left on the answering machine.

Further information is available from:

NHS Choices website

at www.nhs.uk/conditions/pregnancy-and-baby

Active Birth Centre

25 Bickerton Road
London
N19 5JT
Telephone:  020 7281 6760
Or via the website at www.activebirthcentre.com

The National Childbirth Trust

Alexandra House
Oldham Terrace
Acton
London
W3 6NH
Telephone NCT helpline: 0300 330 0700
Or via the website at www.nct.org.uk

Association for Improvement in the Maternity Services (AIMS)

c/o Chair B Lawrence Beech
5 Ann’s Court
Grove Road
Surbiton
Surrey
KT6 4BE

Telephone helpline: 0300 365 0663 or via the website at www.aims.org.uk

References

1. Bradford N, Chamberlain G. (1995) Pain Relief in Childbirth, London, HarperCollins Publishers.
   
2. Hodnett ED Continuous support for women during Childbirth (Cochrane review).  In The Cochrane Library, October 2012.  www.onlinelibrary.wiley.com/doi/10.1002/14651858.CD003766.pub4/abstract
   
3. Brayshaw E, Wright P (1994) Teaching Physical Skills for the Childbearing Year, Hale, Books for Midwives Press.
   
4. Obstetrics Anaesthetists’ Association, (2001) Pain Relief in Labour, London, Obstetric Anaesthetists’ Association.
   
5. Smith CA, Collins CT, Cyna Am, Crowther CA.  Complementary and alternative therapies for pain management in labour (Cochrane Review).  In:  The Cochrane Library Issue 9, 2010.   www.onlinelibrary.wiley.com/doi/10.1002/14651858.CD003521.pub2/pdf
   
6. British Medical Association and the Royal Pharmaceutical Society of Great Britain (2003) British National Formulary, Beccles, William Clowes
   
7. Howell CJ.  Epidural versus non-epidural analgesia for pain relief in labour (Cochrane Review).  In : The Cochrane Library, Issue 12,2011.  www.onlinelibrary.wiley.com/doi/10.1002/14651858.CD000331.pubs.pdf

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