Pain Relief during Labour

Your stamina matters for your labour process. Labour is a physical performance and you can handle labour better, if you are in good physical shape. A thirty-minute workout every day would make a difference for your labour process.

Controlled breathing during labour is important. Good controlled breathing makes sure that your blood gets oxygenated properly. For many, controlled breathing helps to stay focused and relaxed. The midwife will help you control your breathing during labour, but it is also good to train your breathing and relaxation during your pregnancy. We have made a sound clip for you so that you can train your breathing: Breathing Exercises.

Be prepared mentally and physically. It will make you feel more secure if you know what is going on and have had an opportunity to discuss your wishes and expectations. Talk to your midwife and use the various offers within the pregnancy and family preparation.

Firstly - the most part of the labour consist of the breaks between the contractions, and here, most women do not experience pain.

It is important that you are rested and have had something to eat, so that your body can work effectively during labour. It is a good idea to get some rest and something to eat in the beginning of the labour.

Let the body do its work and say "yes". Be confident, relax, and breathe deeply and slowly. Imagine that your body is opening itself for the baby every time you are having a contraction.

Movement helps labour and reduces pain so move about. You can move about and stand in various positions, even though your child's pulse has to be supervised with a CTG machine.

Praise, touching, and caring from the labour-helpers means a lot when experiencing how your body handles labour and this is possible in our delivery rooms.

During labour the body activates its own sort of morphine (endorphin), which functions as a pain relief. The non-medical forms help to activate these substances. For some this is enough pain relief but others need medical pain relief.

Massage helps for example on your loin. Your companion can be a good support and it is a good idea to practice before hand. There is no method that is the best method to give a massage. Some feel that the best method is a light touch, and others feel that a harder massage or a constant pressure, for example above the loin or the sacrum, is the best method.

Warm water can be used as a pain relief at home and at the delivery room. At the beginning of labour it can be nice to take a warm shower. The showerhead can be directed to that spot on your body where the contractions feel most intense.
It can be a great help to take a bath when the contractions become stronger. It relieves pain, relaxes you, and gives you freedom to move. When the midwife has assessed that everything is normal, then you can stay in the warm water for as long as you wish. You can also give birth in the warm water.
Unfortunately you cannot have a warm bath if you or your child need extra supervision, for example if the amniotic fluid is green or your blood pressure is too high.

Warm Gel Bags are applied where the contracitons feel most intense. They can be applied everywhere on your body and can be used by everybody. The warmth relieves your muscles of pain and relaxes them.
At home you can use a hot-water bottle or an electric heating pad. You can also use a wet towel that has been warmed in the microwave for 2-3 minutes (or use hot water). The towel must be placed in a thin plastic bag to keep the water inside. Finally you must wrap the towel in some sort of fabric for example a pillowcase and then you can apply it to the aching part of your body.

Acupuncture can be used throughout labour. Acupuncture is done with the help of thin, small needles that are placed in different acupuncture spots on your body, depending on where you can feel the contractions coming from. It usually does not hurt to have the needles applied. You will feel a small prick and a whirling sensation in your skin.
The effect og acupuncture starts after a couple of minutes. The effect is relaxation and can relieve pain, but it can also make you drowsy which can help you sleep in between contractions.
Preferably the needles need to stay on your body during labour, but can be removed if they feel uncomfortable.
Acupuncture can be combined with other forms of pain relief for example a warm bath.
There are no side effects from acupuncture for you or your baby.

At the beginning of labour TENS can be a good pain relief, especially for the loin area.
Small electrodes are placed on your skin, where the contractions feel the most intense. The machine will then send a small current to your body and you can deicide how strong the current is. This will give you a tingling, vibrating, and a light pricking sensation.
There are no side effects from TENS for you and your baby.

Sterile water papules can be used throughout labour. It can relieve pain from your loin and also from the lower part of your stomach.
A small amount of sterile water is injected beneath your skin. Typically you are inhected in four areas. With each injection there will be a small amount of swelling. The injection feels like a strong burning or stinging sensation, which can be compared to a bee sting. The pain from the injection can be relieved, by placing a small ice cube on the skin before injection. The pain lasts for about 30 seconds but the papules work quickly thereafter and you can count on being relieved from pain for a couple of hours.
There are no side effects from sterile water papules for you or your baby.

"Cocktail" is a combination of painkillers, which we can provide for you. It consists of 1 g Paracetamol, a sleeping tablet (10 mg Stilnoct), and an injection with a medication, which makes your uterus relax (Bricanyl).
The combination can be given to pregnant women who are at the beginning of labour and are having trouble with sleeping or getting rest.
It can help during the rest of the labour as you can get some rest ans gather strength to the work that lies ahead.
If you and the midwife agree upon the solution of having a "cocktail", then you can recieve the injection at the hospital and take the pills at home, or you and your company can stay and sleep at the maternity ward.
All medicine in the mother's bloodstream will also affect the child and the "cocktail" will also make the child drowsy. The effect, though, will stop after a couple of hours.

Morphine is given as an injection. It can be given during the early part of labour - like a "cocktail" - if the beginning of labour has been a long process and you need some rest.
To prevent any side effects to the baby, morphine is not given, if the midwife estimates that there is less than 4 hours to the actual birth.
Morphine can relieve some of the pain, makes you relaxe and sleepy, so that you can get some rest.

Side effects

Morphine can cause itchiness, nausea and vomitting.
Your child will also recieve some of the morphine that is injected and if you give birth within a short period of time after it is administrated (3-4 hours) then it could make your child sluggish at birth and affect the child's breathing. The child would then been given an antidote so that it can counteract the morphine.
The child can also experience sluggishness a couple of days after the birth and have a reduced sucking ability. Therefore it can also make it harder to start breast-feeding. The maternity ward however is attentive towards this and offers special support in these situations.

Epidural and spinal anesthesia is used as analgesia during labour. In some cases the anesthesia is also used in the treatment of high blood pressure during labour.
The epidural analgesia can be commenced when needed during labour and is effective until the birth of the baby is near.
The spinal analgesia is working almost immediately but only last a couple of hours making the effect of the spinal analgesia best towards the end of labour.
If a caesarean section is necessary in labour a well-functioning epidural can often be used as anesthesia whereas a spinal analgesia will need repeating for the operation.
An anesthetist will administer the analgesia. There may be some waiting time before the anesthetist is able to attend the labour ward if he/she is called for an emergency elsewhere in the hospital.

How is the analgesia administered?

The Epidural analgesia:
The epidural catheter is a thin plastic tube (approximately 1 mm) that is placed between two vertebrae in the lower back after an injection with local analgesia. The catheter lies in the epidural space, which surrounds the spinal cord. It remains in situ throughout the labour.
Generally, the administration of the catheter is no more painful than having an IV cannula. It will be administered while you are either sitting up or lying on your side, and the anesthetist will advise you on the position. Prior to the administration you will have an IV cannula in your hand.

The Spinal anesthesia:
The spinal analgesia is a local anesthetic administered once through a very thin cannula into the spinal cord spreading downwards via the spinal fluid. You are requested to sit up during the administration and preferably remain sitting for 5 minutes hereafter giving the analgesia time to work as intended.

Effect

The Epidural analgesia:
Once the catheter is in place it will take up to 10-15 minutes for the analgesia to work. You will not be completely pain free but most of the pain will disappear.
A pump is connected, continually providing the medication and occasionally extra medicine may be needed.
The medicine is a mixture of a local anesthetic (Naropin) and a morphine-like drug (Sufentanil). Prior to this a test dose (Lidocaine) is administered. As Naropin and Sufentanil enhances each other the mixture is highly diluted and has no side effects on the fetus.
The epidural analgesia is most effective on contraction pains. The pain related to the pelvic floor at the birth itself is often somewhat less.
The epidural catheter is removed a few hours after the birth.

The Spinal analgesia:
The analgesia works on the pelvic floor and in an area slightly lower on the abdomen than the epidural analgesia. It typically takes 5 minutes to work. The medicine is a mixture of a local anesthetic (Marcain) and a morphine-like drug (Sufentanil) and as the medicine enhances each other the mixture is highly diluted and has no side effects on the fetus.

Side effects

• Approximately 1 % get pronounced headache after epidural or spinal analgesia. With pronounced or prolonged symptoms it may be necessary to inject some of your own blood into the spinal canal. This treatment is very effective and almost all patients are cured immediately
• Your legs can feel heavy but with the technique we use most women will be able to walk around
• You may find it difficult to urinate as the muscles of the bladder are also anesthetized. Therefore it may be necessary to empty your bladder with a catheter during labour. It will be the midwife who performs this procedure
• Itching may occur as a side effect of Sufentanil
• Your blood pressure may drop and this may make you feel nauseated. It is treated with extra fluid and medicine
• Your body temperature may rise by up to one degree without any indication of an infection. However, it is not always possible to determine if the rise in temperature is due to an infection and this often leads to antibiotic treatment
• The birth often takes about 30 minutes longer and an oxytocin drip is also often needed
• Vacuum extraction happens a little more frequent
• Back pain may occur in general after a birth but there is no increased risk after an epidural or a spinal analgesia
• Transient sensory disturbances as a tingling sensation in one leg or in the hip may occur after an epidural analgesia, but this will disappear on its own during the first weeks post partum. Persistent sensory disorders occur very rarely (in fewer than 1:13,000 births with an epidural analgesia)
• Infection or the formation of a blood clot around the epidural catheter is extremely rare (in fewer than 1:100,000 births with an epidural analgesia). Worst case scenario - an infection and a bleeding may cause meningitis or paralysis, making early treatment of symptoms as pain and sensory disorders important

This information on epidural and spinal analgesia is published in cooperation with the Department of Anesthetics, HEV.

The pudendal block is applied during the pushing period and numbs the perineum when the child's head is born at the very end. The distending feeling in the perineum and the vagina reduces.
The pudendal block also numbs the area if it is necessary to perform an episiotomy or to suture a rupture after the labour. If the anaesthesia has not benn applied before labour then it is also possible to apply it after labour.
The pudendal block is applied through injections with a local anaesthetic remedy about 5 cm (about 2 inches) inside the vagina, close to the pudendal nerve. The needle is led to that spot through a safety tube. It takes about a minute to apply a pudendal block and the effect start after 5 minutes.

Side effects

The anaesthesia can initially reduce the urge to push, so therefore we would prefer to apply the block when the pushing period has started properly, so that you have a feeling of what it is like to push during labour. For these reasons there might be an increased risk for using a contraction-stimulating drip or a vacuum delivery.

Some women might experience sensory disturbance, typically in one leg for about 24 hours after labour. This is due to the anaesthesia spreading to your leg, but it will disappear after a short period of time.

If a pudendal block has not been used then a local anaesthetic can be applied in the perineum before labour to relieve some of the distending feeling in the perineum.
If you have to be sutured after labour, local anaesthetics can be used with an injection.
When you have a small tear it can be done with local anaesthetic spray or gel. The spray will sting a bit when applied.
The anaesthetic will make sure you cannot feel the pain of being sutured, but you will be able to feel that you are being touched.
There are no side effects with ordinary dosages of local anaesthetic.