What Is Labour Pain All About?
1st stage of labour - During this stage, uterine contractions occur
at regular intervals. These are accompanied by dilatation of your
cervix to allow your baby's head to pass into the birth canal. Pain
is felt in your lower abdomen and sometimes in your back.
2nd stage of labour - During this stage, contractions continue. In
addition, a bearing-down sensation or pressure helps you to push
your baby's head down the birth canal, stretching the muscles and
tissues of the vagina.
The 3rd stage of labour involves expulsion of the placenta.
All these sensations are conveyed through the nerves to your
spine, when messages are transmitted to the brain which releases
the pain signal to your body.
How long labour is painful is difficult, if not impossible, to
predict. The range is from a few hours to 12 hours or more, but it
is important to realise that prolonged pain and stressful labour is
undesirable for both yourself and your baby. Resorting to pain
relief methods during labour is not an indication of failure, but
is a means of having a pleasant birth to which every mother-to-be
is entitled.
What Can I Do To Relieve My Labour Pain?
Different methods are available to relieve labour pain.
Effectiveness varies among individuals, but it is helpful to
familiarise yourself with the more common methods before you go
into labour, so you will be able to come to a quick decision when
necessary.
Breathing and Relaxation:
These refer to the breathing exercises and relaxation techniques
which you will probably practise during your antenatal class. When
labour starts and you begin to feel pain, concentrating on your
breathing rate and breathing out loud will help you to relax.
With the help of your partner, your discomfort may also be
relieved by gentle massage on your back. You may find this adequate
in early labour, but many mothers may have to seek other methods of
pain relief when contraction pain becomes more severe.
Other Techniques:
These refer to those methods of pain relief that involve
application of drugs.
Nitrous Oxide
Gas This gas, commonly known as "laughing gas", is mixed with
oxygen. To use this method, a mask or mouth piece draws gas from a
machine beside the bed. You need to take deep and steady breaths
before each contraction becomes painful as it takes about 20 to 30
seconds for the gas to be effective. Since the gas will neither
build up in your nor your baby's bodies, it is safe. However, the
gas may make you feel light-headed, drowsy or nauseated, and not
all mothers find this method of pain relief effective.
Injection of Drugs
Pain relieving drugs such as Pethidine (which is the most commonly
used) can be injected into the muscles to reduce your labour pain,
but their efficacy varies among individuals. They tend to make some
nauseated or drowsy and reduce the mother's cooperation in pushing.
In addition, these drugs cross the placenta to the baby and make it
drowsy and depress its breathing after it is born. If this happens,
an "antidote" can be given to your baby to reverse these side
effects.
Epidural Analgesia
Analgesia means pain relief. The anaesthesiologist will place a
very fine plastic tube into your epidural space by passing it
through a needle which is inserted in your back at about waist
level. After the needle is removed and the tube in place, local
anaesthetics is then injected to provide pain relief. This normally
takes about 10 minutes to perform and another 10 to 15 minutes for
the drugs to work. Each dose may last for about 2 hours before it
is necessary to inject more drugs down the plastic tube.
Alternatively, a continuous slow infusion of local anaesthetics is
sometimes used.
Epidural analgesia is the only method that is capable of providing
pain relief in labour, and let you stay awake at all times. The
local anaesthetics has the tendency to numb your legs but has
minimal effect on your baby. With the help of your midwife or
obstetrician, you should still be able to push during the 2nd stage
of labour. The tube also allows administration of surgical
anaesthesia should an urgent Caesarean section or assisted delivery
be required. It may also be used to provide post operative pain
management. Epidural analgesia is particularly valuable when labour
is long and difficult.
Combined Spinal Epidural Analgesia (CSE)
Combined spinal epidural analgesia resembles the epidural analgesia
procedure described earlier. However, after putting the needle in
your back and before placing the plastic tube, your
anaesthesiologist will insert another finer needle through the
first needle to puncture the dura (the tough membrane around your
spinal cord) for injection of a small amount of anaesthetics. After
that, this needle will be removed and the plastic tube will be put
in the epidural space as described earlier.
One of the major advantages of combined spinal epidural analgesia
is that it is one of the better and quicker ways to relieve your
pain and you can still maintain your mobility.
When In Doubt, Don't Hesitate To Ask
Can I have another injection of Pethidine after it wears off?
- This can be done but it tends to accentuate the side-effects on
the mother and the baby.
If I inhale too much gas, will I become unconscious?
- Theoretically this may just be possible, but the equipment is
designed to prevent this from happening.
Will an epidural (or combined spinal epidural) hurt my spinal cord?
- The procedure is performed by well trained anaesthesiologists
at your lower lumbar region, below the end of your spinal cord.
Therefore, the chance of causing damage to it is very
unlikely.
Will an epidural (or combined spinal epidural) cause any backache?
- Backache is common after giving birth whether you have epidural
analgesia or not. But apart from some tenderness for a day or two
from the needle, this has been shown to be no more likely after an
epidural.
Will I get a headache after epidural or CSE?
- Headache rarely results from an epidural. If this happens, it
usually only lasts for a few days and can be cured by special
treatment if required.
People have told me that epidural will prolong labour, is that
true?
- There is no definite answer to this question. With lower
concentration of drugs, modern obstetrical epidural anaesthesia may
shorten the 1st stage of labour, but may sometimes prolong the 2nd
stage of labour.
When will I regain sensation in my legs after an epidural block?
- This depends on the type and concentration of local
anaesthetics you have received. Usually after delivery, the plastic
tube will be removed from your back, and sensation should return to
normal within a few hours.
When should epidural analgesia start?
- It can be started at any time during the 1st stage of labour.
However, your obstetrician or anaesthesiologist will be able to
help you to determine when is the best time for
administration.
