Pain relief by benbenzhou

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									Pain relief
Labour pain is like no other. It is pain with a purpose. It lets us know we are in labour so
we can find a safe place to give birth. It tells us that the body is stretching and opening to
give birth. As the intensity of contractions increases we know labour is progressing. If
baby is in an awkward position discomfort helps us move the baby. The pressure
sensations and stretching sensations of the second stage allow us to give birth gently.
We need to concentrate on how to cope with intense sensations rather than try to
eradicate them. Use all the self help methods possible as no pain-killer given in labour
guarantees complete pain relief. If the anaesthetist is busy epidural will not be an option.

SELF HELP STRATEGIES
Fear leads to tension which increases labour pain (1) Comfortable surroundings, feeling
safe and well cared for will reduce fear. Visualisation and relaxation can also help
     Breathing – focus on slow breathing and don’t hold your breath. Sing or chant.
     Mobility – if you remain upright and mobile in labour” it is less painful” and
        “could be slightly shorter” (2).
     Birth Partner – if you are supported in labour it is less likely you will need pain
        relief (3).
     Water – in the form of a shower or bath “may reduce pain and the need for other
        forms of pain relief”. (4).
     Massage – is comforting and reassuring “causing the body to release natural pain-
        killing substances called endorphins” (5).
    Alternative therapies such as Homeopathy, Hypnotherapy, aromatherapy and
    acupuncture may help. Consult a trained professional.

BIRTH POOLS
Like a huge bath which should be kept at a comfortable body temperature. Can be used at
any point in labour. Entonox can be used in the pool but not pethidine or T.E.N.S
Advantages include greater ease of movement, relaxation, privacy. It may shorten labour,
be less likely you’ll have a PPH or a tear and baby is less likely to have a low apgar
score. (6)
Disadvantages include contractions can slow or stop. Just get out and they should resume

TRANSCUTANEOUS ELECTRICAL NERVE STIMULATION (T.E.N.S)
A hand held controller which transmits a low volt current to electrodes stuck on the back.
Thought to work by stimulating the body’s own endorphins. Takes several minutes to
build up an effect. Useful in early labour.
Advantages include being self-administered and a good distraction technique. No known
adverse effects on mother or baby.
Disadvantages are that it may effect electronic fetal monitoring and you may be asked to
remove it.
ENTONOX
A gaseous mixture of 50% oxygen and 50% nitrous oxide. It is self administered via a
mouthpiece or facemask. It is available at home births. Useful in all stages of labour but
may be discouraged in the second stage so you can push more effectively. It takes 15-30
seconds to take effect and lasts 15-30 seconds after you stop breathing it. It is therefore
most effective when breathed at the start of a contraction. It doesn’t remove pain but
alters your perception of it.
Advantages are that it is short acting and wears off completely between contractions.
Disadvantages include feeling drunk and nauseas. You may need support whilst using it.
A recent survey suggests a possible link to amphetamine abuse in adulthood (7).

PETHIDINE
A powerful synthetic narcotic derived from morphine. It is a sedative and muscle relaxant
given by injection into the thigh or buttock muscle. A dose of 50 to 150mg is usually
given with another drug to combat nausea. It takes effect within 20mins and can last for a
few hours. It does not remove pain but makes you less aware of it.
Advantages include the ability to relax muscles which may help labour progress. You
may be less aware of what is happening.
Disadvantages.” Side effects commonly include nausea, vomiting, and dizziness” (8).You
will need to stay in bed and may waken at the height of contractions. It can slow labour
down and can affect your ability to push in the second stage. It crosses the placenta and
“may cause breathing difficulties” in the baby (8). It can lead to feeding difficulties
which may persist for several days. These effects are more likely after large or repeated
doses and more likely if given 1-4 hours before birth.

EPIDURAL
Requires an anaesthetist to site a fine plastic tube (catheter) into the lower back via a
needle. The needle is removed and the catheter remains in place. An anaesthetic is
injected via the catheter and can be continuous or repeated doses. It takes 20 minutes to
set up (if an anaesthetist is available) and is then effective almost immediately. It comes
as a package with an intravenous drip, frequent blood pressure recording and continuous
fetal monitoring. It may also require a syntocinon drip if contractions slow.
Advantages. Total numbness below the waist if effective. You may be able to get some
sleep.
Disadvantages. Immobility means confinement to bed. Blood pressure can fall (the drip
can counteract this). If the effects last into the second stage it is “three times more likely
that you will need a forceps or suction cup (ventouse ) delivery, and more likely that you
will have a caesarean for a slow labour”(9). It may affect the ability to pass urine so a
catheter may be necessary. Sometimes the effects are unevenly spread and there may be
windows of pain. Some mothers suffer short term backache and “about 8 in 1000 women
get a bad headache as a result of the epidural”, called a dural tap(9). The anaesthetic
crosses the placenta and may affect the baby making it irritable or difficult to feed.
References
    1. “New Generations 40 years of Birth in Britain” J.Moorhead (1996).
    2. “Positions in Labour and Delivery” Midirs Leaflet (1996)
    3. “Support in Labour” Midirs leaflet (1996)
    4. “Labour and Birth in Water”, NCT leaflet (1995).
    5. “Being Pregnant, Giving Birth”, M. Nolan (1996).
    6. “On the Crest of a Wave”. D. Garland. Midirs Digest 16:1 (2006).
    7. “Nitrous Oxide – No Laughing Matter”. A. Robertson Midirs Digest 16:1 (2006)
    8. “A Guide to Effective Care in Pregnancy and Childbirth”. Enkin, Keirse, Renfrew
       and Neilson (1995) “Epidural Pain Relief During Labour”. Midirs Leaflet (1997)
9. “Epidural Pain Relief During Labour”. Midirs Leaflet (1997)

								
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