Introduction
This leaflet is designed to make you aware of the pain relief available to you once you are in labour. It will explain the choices available and any benefits or risks that may be associated with each method. Midwives can help enable you to choose what is suitable for you by discussing the options and answering your questions.
What causes pain and what does it feel like?
Pain in labour comes from the nerves around the bottom of your womb – the nerves pass through muscles to reach the brain. Women describe labour pain in many ways, and they also feel the pain in different places – such as the lower back, lower tummy, legs, or labia. At the point of giving birth, women often describe a very strong burning sensation. Many things will affect the pain you experience, such as the position of your baby in the womb, how tired you may be, if you are anxious, and whether you have someone with you for support. Other things going on in your life can affect how you cope with pain speak to your midwife who will support you throughout your labour.
Drug Free Methods
Remain mobile
Remain mobile for as long as you are able. Mobilising often helps labour to progress. If you go into spontaneous labour (start on your own), are more than 37 weeks pregnant with a low risk pregnancy, stay at home for as long as you are comfortable.
Let your midwifery team / midwife know that you are in labour and ring for advice about when to go into the unit. If you are planning a home birth the Delivery Suite or the wards at Grimsby will let the team midwife know and she will assess when she needs to see you.
Think positively, remember that pain is normal.
You may find ways of distracting yourself in early labour:
- Enjoy a game of cards with your partner in early labour
- Watching television
- A favourite piece of music can help you to relax and CD players are available in the Maternity units
- Walking or use of a birthing ball
Transcutaneous Electrical Nerve Stimulation Machine
(TENS) is most effective if used from early labour. You may wish to hire one and if you plan to use it at home your midwife will be able to give you details of how to do this.
Benefits
A small battery operated pulsar sends weak electric signals through electrodes taped to your back. These block the pain signals sent through your spinal cord to your brain reducing the pain sensation. The TENS also causes your body to produce natural painkillers, called endorphins which further enhance the sensation.
The electrical stimulation can then be increased by you as the contractions become stronger.
Risks
It is not possible to use the TENS in water.
Water
You may find it soothing to rest in a warm bath during early labour, even your own bath tub at home will help. All of the units within the Trust have water birth facilities.
Benefits
Water allows you to remain upright (sitting) and mobile and the warmth of the water reduces the pain associated with labour. This has been proven to assist the progress of labour in the majority of women who choose this as a method of pain relief. You may wish to use the pool only for pain relief during labour and leave the pool to deliver your baby. Alternatively, you may prefer to remain in the pool and deliver your baby into the water.
Risks
Unfortunately, not all women will be suitable for water birth. Your midwife will be able to advise you whether or not this is a suitable / advisable option for you. There is a leaflet available should you require further information. Should you wish to have a water birth at home, you will need to make the arrangements to hire or buy a pool yourself. Whilst your midwife will be able to offer advice, you must be aware that the setting up of the pool, as well as the filling and emptying of it, is your responsibility.
With all of the drug free methods of pain relief you will be able to eat and drink as you wish. We would suggest that you eat food that is easily digestible and avoid fizzy drinks. Your Midwife will be happy to advice you in this regard.
Drug based Methods
Paracetamol and codeine (Oral Pain Relief)
Benefits
May be taken orally; these are particularly useful in early labour. They can be taken at home and may help with mild pain, allowing you to have some rest.
Risks
You must not exceed the recommended dosage during a 24 hour period. Although rare some women may experience side effects as listed on the packaging and may be ineffective as your labour progresses.
If you intend to breastfeed; it is advisable not to take codeine; as this may make your baby sleepy and affect feeding.
Entonox (Gas and Air)
Benefits
Is a gas, which is a mixture of oxygen and nitrous oxide. The gas may be piped from a wall attachment or come from a cylinder. It is inhaled through a mouthpiece. And only used for one patient. You control how much you have and the effects of Entonox wear off very quickly once you stop using it (usually within 10-15 minutes). Entonox can be used with other pain relief, including water.
You can eat and drink when using Entonox and your midwife will advise you of which food to avoid. Entonox is effective towards the end of the first stage of labour and also available for use in a home birth setting.
Risks
Whilst it can be used earlier in labour, it is felt that it can be quite tiring and research has shown that whilst women find it useful it may not be very effective in lessening the pain for long periods.
Injections
There are several opioid drugs in use within the Trust. All have the same effect and are normally given as a single injection into your buttocks or leg. At Grimsby, the drug offered is Pethidine. At Scunthorpe the drugs offered are Diamorphine, Meptid or Pethidine. At Goole the drug offered is Meptid.
Benefits
The effects of the drugs are very similar. You will probably feel very sleepy and relaxed and may even go to sleep. The drugs do not remove the pain completely but they reduce the sensation and make you more relaxed and therefore more able to cope.
Risks
There is a limit to how much of the drug you can safely have in labour. The drugs also cross the placenta and your baby may be affected. This will depend on how much you have had and how long before delivery you had your last dose. The baby may be very sleepy at birth and sometimes may be slow to feed. Observations for your baby will be required for 12 hours following this option, which may delay your discharge home. You will not be able to eat after having the injection but will be allowed water to drink. This is because your stomach does not empty well following the injections and you may have an increased tendency to vomit.
The use of injections for pain relief in home birth is not recommended due to the risks of your baby being sleepy at delivery.
Epidural
An epidural is a local anaesthetic, which is given through a very fine catheter (tube) that is inserted into your back. An anaesthetist will site the epidural for you. Although there is a 24- hour epidural service at both Grimsby and Scunthorpe, out of hours the Anaesthetist also covers Intensive Care and in some cases the needs of the patients there must come first. In these instances, other pain relief would be offered and the Anaesthetist would see you as soon as they were able.
Benefits
The epidural will usually take your pain away completely. You will have reduced sensation to your lower limbs, the sensation returns approximately 6 hours after the epidural is stopped but this varies. We would suggest that you do not try to walk until you are advised you are fit to do so.
Your epidural will be continuous via a pump (like a small drip through a catheter). This should maintain your pain relief at a fairly constant level.
Risks
It will be necessary for you to have a drip in your arm as the epidural can make your blood pressure fall, this can make you feel quite nauseated and lightheaded. Extra fluids, given through the drip can reverse this quickly. Due to the risks of your blood pressure falling and the effects this can have on your baby, it will be necessary to attach you to the monitor for the rest of your labour to record the contractions and the baby’s heart rate. You will not be able to eat or get out of bed when you have an epidural but you may be able to take fluids.
There is no epidural service at Goole and epidurals are not available for home confinements.
If you have any further queries about the pain relief that is available, please discuss this with your midwife. It is often best not to plan too much, but to see how you feel, when you are in labour.
Reference Section
Contact Details for Further Information
You will be provided with the contact number for your community midwifery team at your booking appointment.
Any Comments, Compliments, Concerns or Complaints
If you have any other concerns please talk to your nurse, therapist or doctor. Our Patient Advice and Liaison Service (PALS) are available on 03033 306518 (Grimsby, Scunthorpe and Goole). You can also contact nlg-tr.PALS@nhs.net
As a Trust we value equality of access to our information and services, therefore alternative formats available on request at nlg-tr.interpreters@nhs.net
Review Information
Date of Issue: June, 2022
Review Period: June, 2025
