DEFINITION

Labour starts when the uterus begins to contract in a series of rhythmic, progressive movements which cause the cervix to dilate (expand) in preparation for the delivery of a child. These contractions become more frequent and can become painful, in much the same way you may experience pain in other muscles in the body when exercising vigorously.. There are a number of drugs and techniques that help to manage the pain of childbirth.

DESCRIPTION

Childbirth can be a unique and exciting time for a woman, although labour is often described as an intensely painful experience. Factors such as a woman's pain threshold, culture, life experiences and emotional state will all influence the way she experiences and expresses labour pain. Extreme, unrelieved pain is a common reason for dissatisfaction with the childbirth experience. Unrelieved pain, in some cases, can also produce long-term effects such as depression, loss of interest in sex and marital problems. For the well being of both mother and child, medical interventions that use pain relieving medication are common in complicated pregnancies, such as cases of eclampsia, foetal growth restriction, prematurity, multiple pregnancy and breech presentation.

Women should be well informed about the pain-relief options available to them during the birthing process. Effective pain control measures can increase a woman's sense of control during childbirth, making the experience a far more positive one. Many women who opt for non-drug methods of pain relief may change their mind during labour. It is important for a woman to make her own choices about pain relief and to not feel guilty about requesting medication. There is no other medical circumstance where it would be acceptable for a person to suffer severe pain that can be relieved by safe and effective medication. Women who are actively involved in making decisions about their childbirth experience are much more likely to rate the experience as a positive one.

NON-DRUG PAIN RELIEF
Most non-drug methods of pain management for childbirth are considered to be useful in helping women to cope with labour pain. Some of these methods include listening to music, massage, bathing, heat, acupuncture, hypnotherapy, biofeedback, transcutaneous electrical nerve stimulation (TENS), Homeopathy, aromatherapy and flower essences. All of these methods have been found to be advantageous. Both acupuncture and TENS have been found to be reduce pain during early labour and TENS also reduces the amount of pain relieving drugs required during later stages of childbirth.
During early labour, a woman is usually encouraged to stand up and walk around or at least to remain upright. A woman is less likely to feel continuous back pain when upright than when lying down and may experience reduced pain during contractions as a result. Involving a woman's partner or support companions during childbirth is extremely important. Surveys of women have indicated that the presence of caring support throughout labour from loved ones and friendly staff was more important than all other methods of pain relief. Support during labour has proven to be helpful not only in pain management but also in reducing labour time and improving the general outcome of the delivery.

NITROUS OXIDE (ENTONOX)
Nitrous oxide (laughing gas) is a pain relieving gas that is breathed in during the contractions. Nitrous oxide is not as effective at relieving labour pains as other drugs, but it has very few effects on the baby. For the best effect, a woman must start breathing it as soon as she feels a contraction starting. An advantage of nitrous oxide is that a woman can control the amount of gas she inhales, and as nitrous oxide acts and stops acting quickly, a woman can time her doses according to the frequency of her contractions. Nitrous oxide can also be used for pain relief when there is a delay in receiving an epidural.
Nitrous oxide has a very high safety record for both mother and baby. Some side effects that can occur include a fall in the oxygen levels in the blood of the mother, dizziness, dry mouth, excessive sedation and loss of awareness.

OPIOIDS (NARCOTICS)
Muscular injections, usually into the muscles of the buttocks, of narcotic drugs are another method of managing the pain of childbirth. For some women, intramuscular opioid injections provide adequate relief but many others find them to be inadequate at relieving their pain. Intravenous administration of opioids is a method that delivers these drugs directly into the bloodstream of the mother and is associated with a more rapid pain-relieving effect. Some hospitals have devices that allow women to administer the drug herself according to their needs during childbirth. Intravenous opioids can also cause heavy sedation in some women which is not an acceptable method of managing pain. Fentanyl is the recommended opioid drug for intravenous use. It acts quickly and is less sedating and nauseating than pethidine.
Despite the overall safety of opioids, there are some risks associated with these drugs. Intramuscular injections of opioids, particularly pethidine, can cause side effects in the mother such as sedation and vomiting. These injections, particularly if given near the time of the birth, can cause breathing and heart rate problems in the baby<. For this reason, pethidine is not usually given to a woman if her unborn baby is sick and/or if she is experiencing premature labour. Intravenous fentanyl can cause dizziness and tiredness in the mother and there is a small chance that it can affect the breathing and heart rate of the baby.

EPIDURAL ANAESTHESIA
Epidural pain relief is a popular method of pain management for women in labour. An epidural allows the woman to be alert and enjoy the childbirth experience with little discomfort. Epidural anaesthesia involves the injection of local anaesthetic drugs (and sometimes small amounts of opioid drugs) into the epidural space, which is located at the base of the spine. The nerves from the uterus and birth canal travel through this part of the lower back up to the brain, so pain-relieving medications injected into this area can dull sensation in these nerves. Opioid drugs administered in this manner are sometimes called neuraxial opioids or intrathecal opioids. Epidural procedures block sensation in the pelvic, abdominal and genital areas. A distinct advantage of this type of anaesthesia is that a catheter (small tube) can be inserted into the epidural space so that small amounts of pain-controlling drugs can be administered when required to effectively control pain. This is sometimes called a 'mobile epidural'. Any stitching that is required after the child is born can be done while the catheter is still in place, so there is minimal discomfort. Between 80 and 90% of women surveyed in the UK who received an epidural described the pain relief as effective during the birthing process.
Epidural anaesthesia may increase the duration of labour and the chances of requiring an assisted delivery, but is generally not associated with any adverse effects to the health of the baby. Mothers who receive epidural anaesthesia are generally happier with their birthing experience than those that were given inhaled pain control gas or no analgesia at all. The drugs used in epidural procedures can cause temporary maternal hypotension (low blood pressure in the mother) and difficulty urinating. There are medical techniques to reduce the severity of these side effects. Contrary to popular belief, there is no increased risk of a woman developing chronic lower back pain if she has an epidural than if she had another form of pain relief. Very occasionally, the epidural can cause a small leak of spinal fluid after the procedure, which can cause headaches and mean the woman must lie flat in bed for a couple of days until the leak seals itself. There are slight risks of other side effects and complications, but overall, epidural complications are rare and any concerns a woman has should be discussed with her health care professional.

TREATMENT OPTIONS

In no way is this information intended to replace the advice of a medical practitioner. Always consult your Doctor for diagnosis and advice.
It is important to consider and discuss with your Doctor the different types of pain management available before your baby is due. This will help to prevent stress at the time of delivery. Your Doctor can give you the latest advice about pain management options and refer you to a specialist if required.

PHARMACIST'S ADVICE

Ask your Pharmacist for advice.
1) Discuss with your Doctor the different types of pain management available before your baby is due.
2) Massage and heat are two non-drug methods of pain relief used by women during labour. Ask your Pharmacist for advice about heat packs and massage oil or lotion for use during childbirth.
3) Certain essential oils have calming and relaxing properties which may be beneficial in the management of labour pain. A few drops of lavender, rose, neroli, clary sage and geranium essential oils can be applied to a diffuser, added to a massage oil and/or applied to a handkerchief kept close to the face during labour. See the lavender oil, rose oil, neroli oil, clary sage oil and geranium oil topics on the Healthpoint.

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