Labour pain is a pain of its own. You only have it when you are giving birth. It is a signal that it is time to seek help and to go somewhere you feel safe and calm. The pain is not there for nothing: your baby is being born. Holding on to that thought can make the pain easier to bear.
Your body makes its own painkillers, called endorphins, and they make you feel less pain. But being very tense or frightened can get in the way of producing them.
Labour pain is caused by contractions. A contraction is a tightening of the muscle of the womb. Contractions come and go, and in between them you have time to recover. The pain is not equally bad all the time. After a while the pauses between contractions get shorter, and the contractions themselves become stronger and more painful.
Some women find the pain quite bearable. Others find it unbearable. Most women feel the pain of contractions mainly in the abdomen, but some feel it mainly in their back and/or legs, and sometimes it moves about. Breathing and relaxation exercises can help you ride out the contractions. Even so, some women do find the pain unbearable, particularly when the birth takes longer than average. Exhaustion, fear or tension can play a part. Some women ask for something for the pain during labour.
To take the edge off the pain, a community midwife has the following at her disposal:
- warmth (a hot water bottle or a shower)
- sterile water injections
- a TENS machine
Sterile water injections give relief from pain in the lower back. The midwife gives you four injections of a small amount of sterile water in your back, just above the top of the buttocks. That reduces the pain in your lower back. Water injections work for one to two hours, have no side effects and can be repeated as often as you like.
TENS stands for transcutaneous electrical nerve stimulation. It is a small device with which you give yourself little pulses of current. You have to hire it in advance yourself. You operate it yourself, which can give a sense of control. The pulses enter your body through electrodes stuck to your back. They give a prickling or tingling feeling that draws your attention away from the pain of the contractions. TENS has no adverse side effects or consequences for you or your baby.
Video about TENS
In the Netherlands it is not usual to give painkillers as a matter of course. Pain is simply part of giving birth and is a normal thing. If you do want pain relief in the form of medication, a gynaecologist is always called in. The birth will then take place in hospital under the care of the gynaecologist or a hospital midwife.
There are several forms of pain relief by medication:
- epidural
- remifentanil
- pethidine/morphine
Epidural
An epidural is an injection in the lower back with a combination of anaesthetic drugs. Under local anaesthetic, the anaesthetist places a needle low in your back. A thin, flexible tube is passed through the needle into your back. The needle is then removed and the tube stays in place. Pain-relieving drugs are given through this tube during the birth. You feel the anaesthetic working after about 15 minutes.
The advantages of an epidural are that:
- most women feel little pain during contractions
- it gives better relief than an injection of pethidine or a remifentanil pump
- it does not make you sleepy or drowsy, so you experience the birth fully aware
The drawbacks of an epidural are that:
- now and then it does not work, or not well enough, so that it sometimes has to be given again
- your blood pressure can drop
- you can develop a fever
- some women get itching during an epidural because of the make-up of the drugs
- you cannot get out of bed, because you have less feeling in your legs
- some women have a headache afterwards
With an epidural, you and your baby need close monitoring. You will in any case be given a drip, a blood pressure cuff, a pressure catheter in the womb to record contractions and sometimes a bladder catheter. Your baby is watched more closely by means of CTG monitoring, which records the heartbeat.
With an epidural it is worth bearing in mind that you will be put under general anaesthetic if the birth ends in a caesarean section. In that case you will not consciously experience your baby's birth.
At ZGT in Almelo an epidural is available 24 hours a day. It is usually placed by the anaesthetist within an hour of the gynaecologist requesting it.
Remifentanil
Remifentanil is a morphine-like substance given through a drip in the arm. You control the amount yourself with a pump. The pump is set so that you can never have too much.
The advantages of remifentanil are that:
- it works quickly, often within a few minutes
- it dulls the pain about as well as pethidine
- it disappears from the blood fairly quickly after the birth
The drawbacks of remifentanil are that:
- it can affect the mother's breathing and the amount of oxygen in her blood
- it dulls the pain less well than an epidural
- you can no longer walk about, and the drowsiness means you could fall
- its effect on breastfeeding has not yet been properly researched
Pethidine/morphine
Pethidine is given by injection into the buttock or thigh. It is similar to morphine. You feel it working within half an hour and it lasts two to four hours. Pethidine has its advantages and drawbacks too. As this medication is barely used in this region any more, please see the website of the Royal Dutch Organisation of Midwives (KNOV): www.knov.nl.
