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 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, we have the following options:
- 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. We give 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.
Information video about TENS (in Dutch)
Pain is part of giving birth, but you do not have to endure it if you do not want to. If you ask for pain relief with medication, we arrange it with the gynaecologist. That is only possible 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.
An epidural has these advantages:
- 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
An epidural has these drawbacks:
- 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 are closely monitored. You are given a drip, the nurse checks your blood pressure regularly, you often have a bladder catheter and your baby's heartbeat is monitored continuously by CTG.
If the birth does end in a caesarean section, the anaesthetist usually uses the epidural that is already in place for the anaesthetic, so that you consciously experience the birth. General anaesthesia is only needed in a real emergency.
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.
Remifentanil has these advantages:
- 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
Remifentanil has these drawbacks:
- 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 advantages and drawbacks on De Verloskundige (in Dutch), the public website of the Royal Dutch Organisation of Midwives (KNOV).