Labour is an intense process, and choices for working with or relieving pain are a personal choice. Some options for working with or relieving pain are:
Water
Warm or hot showers or baths are a popular type of pain relief that can help you work with the pain of labour. If you birth in a facility, showers are available in almost all rooms with unending hot water, and baths are available in some rooms. If you birth at home, hiring a birth pool can be a good option as many homes do not have endless hot water! If you need continuous monitoring for your baby in labour, some facilities have waterproof monitoring equipment, and if you choose intermittent auscultation, most Dopplers have waterproof probes, so you do not need to leave the water to check in on baby. Manawatu Home Birth Association have birth pools for hire if you need one.
Heat pack
Heat packs on your back or belly can be soothing and are especially good to help with back pain in early labour. Most hospitals have options for heat packs available, but if you birth in a primary unit or at home you may need to think ahead and have wheat packs or hot water bottles prepared.
Counter pressure
Pressure on your lower back or sacral area during contractions can be helpful, especially if you feel pain in your back during contractions. This is something that your support people can do to help you through labour. Strong, steady pressure or massage from the heels of a support person’s hands to the lower back can help you cope with contraction pain.
Birth comb
These are a popular tool to help with labour. They are a sturdy wooden comb that you grip in your hand during contractions and they work on the gate control theory of pain, sending signal to your brain to distract it from contraction pain. Facilities tend not to have these so if you are interested in one, you will need to buy it before your birth. A similar option that has come out is the birth weapon, which is a spiky ball that floats in water so it’s easier to pick up if dropped in a pool. Both of these options are readily available in Aotearoa through online stores.
TENS machine
A TENS machine is a small machine that has electrodes that you place on your back, and it can help with labour pains. They cannot be used in water but if you are not in the shower or bath, they are a good option to try. They are available for hire online, and Manawatu Home Birth Association have them for hire locally.
If you need continuous monitoring in labour, TENS machines are compatible with traditional CTG units, but they interfere with ‘pod and patch’ units.
Entonox
Also known as ‘gas and air’, Entonox is a mixture of nitrous oxide and oxygen. It is available in hospitals and most primary units, but not commonly carried by home birth midwives. It is delivered through a mouthpiece or face mask, and you breathe it in and out via the mouthpiece. Some people find it very effective for labour pain, but some find that it makes them nauseous or uncomfortably dizzy.
If you are using Entonox right up to the pushing phase, you may need to discontinue it during pushing to help you push more effectively.
Opioids
Opioids drugs such as codeine, morphine, and fentanyl can be helpful at different stages of labour. If you are being induced, you may be offered codeine to help you sleep at night during longer inductions. In early labour, you may be offered morphine, especially for long early labours where you need to get some rest. Fentanyl is more often used in established labour, as it leaves your body quicker than morphine.
Morphine can be given through an injection into your thigh or an IV line, and fentanyl is always given via IV. Codeine is given as a tablet.
Opioids in labour are a useful tool, but if your baby is born quickly after having them, they may need some assistance to breathe (resuscitation) as opioids can suppress breathing. Opioids are only offered in hospital, or occasionally during ambulance transport. If you choose to have morphine or fentanyl in labour, you will likely be asked to have continuous electronic foetal monitoring.
Epidural
An epidural is a regional anaesthetic injected into your spine. A thin flexible tube is left in your back to deliver more anaesthetic to top it up as needed. The drugs used are usually fentanyl and a local anaesthetic like bupivicaine or ropivicaine. These drugs are mostly confined to the epidural space in your back, but small amounts may enter your body and cross the placenta to baby.
Before an epidural is placed, the anaesthetist will numb your back using local anaesthetic. This can sting, but once it takes effect you should feel pressure rather than pain as the epidural is placed.
An epidural is placed by an anaesthetist, so it is only available in hospital. It can take up to an hour from starting the process of insertion to working well. You will need an IV line and fluids running to prevent your blood pressure from dropping, and continuous electronic foetal monitoring. When the IV line is placed, some blood tests need to be taken to ensure that it is safe for you to have an epidural, and to send to blood bank in case you need a blood transfusion.
If you need an unplanned caesarean birth, and you have an epidural in place, it may be an option to have your baby with a top up of your epidural.
Spinal
If you are having a caesarean birth, it is usually carried out under spinal anaesthesia. This is an injection of morphine and local anaesthetic into your back, using stronger concentrations than an epidural. It is carried out by an anaesthetist in theatre. It means that you have good pain relief, but you are able to be awake for your baby’s birth and your partner is able to stay with you.
General anaesthesia
If you have an emergency caesarean and it is considered that a spinal will take too long, or for some planned caesarean births, you will be offered general anaesthetic. This means that you will be put to sleep for your birth, and your partner cannot be in the room for the birth. They may have the baby taken to them after the birth if baby is well, or they may be invited to accompany baby to the neonatal unit if baby is unwell, before you wake.
You will not feel any pain under general anaesthetic, and after the birth you may be offered a patient controlled analgesia pump to help with post operative pain.