Aromatherapy
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Pregnancy and Childbirth Aromatherapy may be used occasionally during the second and third trimester of pregnancy to alleviate fear and anxiety, to aid relaxation and encourage a positive attutide. It may help to relieve aches and pains in the back, pelvis, legs and hands, and may be useful for other common discomforts of pregnancy. It may aid pain relief and relaxation during labour. During the post natal period, it may be useful for healing, relief from anxiety, encouraging a positive attitude and confidence, promoting relaxation and relief from tiredness.
Pain Relief in Labour
We hope that if you know what to expect you will not find labour alarming, and that, with good pain relief, the birth of your baby can be comfortable and enjoyable.
What will labour feel like?
Towards the end of your pregnancy you may notice your uterus tightening from time to time. When labour starts these tightenings become regular and much stronger. This causes pain which at first feels like strong period pain but usually gets stronger as labour progresses. The amount of pain varies. Your first labour is usually the longest and hardest. Sometimes it is necessary to start labour artificially or to stimulate it if progress is slow, and this may make it more painful. Over 90% of women find they need some sort of pain relief.
Preparing for labour
It is helpful to attend antenatal classes run by midwives who know about Liverpool Women’s Hospital. They teach you about pregnancy and labour and caring for your baby. They will tell you what to expect when you go into hospital, what procedures may be needed and the reasons for them. Understanding what may happen during labour will make you feel less anxious, help you to relax and cope better. During pregnancy, physiotherapists can teach you breathing exercises, relaxation and good posture to help your back. At the antenatal classes you can also learn about the types of pain relief that are in use. Ask to see an anaesthetist if you want further advice about certain types of pain relief and whether they may be suitable for you. Anaesthetists are doctors who provide epidurals, and who can also advise you about other types of pain relief
What methods of pain relief are available?
There are several ways of helping you cope with pain. It is difficult for you to know beforehand what sort of pain relief will be best for you. The midwife who is with you in labour is the best person to advise you. Here are some of the facts about the main methods of pain relief you may be offered.
Simple Methods
- Mild pain in early labour can often be managed by simple methods
- A supportive companion is invaluable
- Relaxation is important and moving around sometimes helps
- A warm bath and gentle back rubbing by a supportive partner can help you relax and take some of the pain away
- Aromatherapy can be helpful in labour and is available at this hospital. Certain aromatherapy oils are contraindicated in pregnancy. Please consult a qualified aromatherapist before using them
Transcutaneous Electrical Nerve Stimulation (TENS)
- A gentle electrical current is passed through four flat pads stuck to your back
- This creates a tingling feeling
- You can control the strength of the current yourself
- It can be helpful at the beginning of labour, particularly for backache
- If you hire one you can start it at home
- The hospital may have a few sets that can be lent out. It has no harmful effects on the baby
- It is unusual for this to be the only method of pain relief you would need but it can help you through early labour
Entonox (50% nitrous oxide and oxygen, sometimes known as gas)/newimg_038.jpg)
- You breathe this through a mask or mouthpiece
- It is simple and quick to act
- It sometimes makes you feel light-headed or a little sick
- It does not harm your baby
- It does not take the pain away completely but it helps
You control the amount of gas you use, but timing is important. You should start breathing the gas as soon as you feel a contraction coming on so that get the full effect when the contraction is at its strongest. You should not use it between contractions or for long periods as this can make you feel dizzy. Also breathing very hard is not very good for your baby.
Diamorphine
- A pain relieving injection usually given by midwives
- It makes you drowsy, relaxed and more comfortable
- It can make you feel sick, but this effect can be reduced by another injection
- It can sometimes make your baby drowsy when delivered. An antidote can be given to the baby for this if necessary, and the baby looked after on the neonatal unit for a few hours
- It delays stomach emptying which might be a hazard if a general anaesthetic is needed. You should also not eat or use the birthing pool if you have had diamorphine
- It does not take the pain away completely
- Some mothers find it helps them relax, while others find it less effective
- Up to two doses can be given by midwives
Pethidine
- This is an alternative to diamorphine also given by injection
- It acts in a similar way
- It may be less effective than diamorphine
- It has the same advantages and disadvantages
Epidurals
- Given into a very small tube in your back
- Most complicated method, performed by an anaesthetist
- Little effect on you baby
- Small risk of headache
- Most effective method of pain relief
Who should have an epidural ?
Most people can have an epidural, but certain complications of pregnancy and bleeding disorders may make it unsuitable. If you have a complicated or long labour the obstetrician may recommend one and you may find you need one. In such circumstances it will benefit you and your baby.
What does it involve?/maternity_10.jpg)
You will first need a drip, that is fluid running into a vein. This is often necessary in labour for other reasons. You will be asked to curl up on your side or sit bending forwards. Your back will be sprayed with a cold antiseptic lotion and a little injection of local anaesthetic given into the skin, so putting in the epidural should not hurt. A small plastic tube is put into your back near the nerves carrying pain from your uterus. Care is needed to avoid puncturing the bag of fluid that surrounds the spinal cord, as this may give you a headache afterwards. It is therefore important to keep still while the anaesthetist is putting in the epidural, but after the tube is in place you will be free to move.
Once the tube is in place, pain relieving drugs can be given as often as necessary, or continuously by a pump. While the epidural is taking effect, the midwife will check your blood pressure regularly. The anaesthetist and the midwife will also check that the epidural is working properly. It can take up to twenty minutes before it is fully effective. Occasionally it does not work very well at first, and some adjustment is needed.
What are the effects?
Nowadays it is usually possible to provide pain relief without numbness or heavy legs, in other words a ‘mobile epidural’. This is the sort of epidural that is most likely to be offered to you at Liverpool Women’s Hospital although we do not actually recommend walking about when the epidural is in progress.
- An epidural should not make you feel drowsy or sick
- Occasionally it drops your blood pressure, which is why you have the drip
- It sometimes makes you shivery, but this usually stops quite soon
- It may prolong the second stage of labour and reduce the urge to bear down but with time the uterus should push the baby out. You are more likely to have a normal delivery than any other type of delivery
- It removes much of the stress of labour, and this is good for the baby
- In this country as a whole, there is about a one in hundred chance of your getting a bad headache after an epidural. If you develop a headache afterwards, it can be treated
- Backache is common during pregnancy and often continues afterwards when you are looking after your baby. There is now good evidence that epidurals do not cause long-term backache, though you may feel local tenderness for a day or two afterwards
- About one in 10,000 mothers gets a feeling of tingling or pins and needles down one leg after having a baby. Such problems are more likely to result from childbirth itself than from an epidural
- Other more serious problems happen even more rarely
What if you need an operation ?
If you need any operation such as caesarean section or forceps delivery, you should not need a general anaesthetic, as the epidural can usually be used instead. This is safer for you and the baby.
What about spinals ?
Epidurals are rather slow to act, particularly in late labour. If the pain killing drugs are put directly into the bag of fluid surrounding the nerves in your back they work much faster. This is called a spinal. In some hospitals spinals, or a combination of spinals and epidurals are used for pain relief in labour and spinal anaesthesia is often used for caesarean section.
