Pain Management Options for Labour Support

Pain during childbirth is unique to each mother and each labour. Pain is a positive sign meaning that the labour is progressing. There are many different ways to manage the pain experienced during childbirth. Some prefer to cope with the pain using comfort measures. Others prefer medical interventions, like epidurals.

• Comfort Measures - Pain management can occur using a variety of comfort measures. These include breathing techniques, changing positions, relaxation, massage, or warm bath.
• Pain Relief with Medications - There are many different types of pain medication during labour. Depending on your need for pain control, different types and times for pain medication can be used.

Comfort Measures
(Taken from Penny Simkin, Comfort measures for your partner to use)

Massage - Using firm and smooth stroking, massage the low lower back and buttocks using lotion or oil. Listen to your partner and let her guide your moves.

Counter-pressure - Using your fist or heal of your hand, apply pressure to the lower back and buttocks of your partner. Try moving around to different places. She will soon tell you that you have 'found the spot'.

The Double Hip Squeeze - From behind, place your hands of both sides of her buttocks and squeeze them towards the center (so her hips press together). Do this when she is going through a contraction.

The Knee Press - This is to release tension and discomfort in her lower back. Have her sit on a chair that does not slide. While kneeling on the floor place each of your hands cupped around each of her knees. Push towards her hips.

Cold or Hot Compresses - Make sure there is always one or more layers of cloth between her skin and the cold/hot compress. Place an ice pack, hot water bottle, cold or hot towel or a frozen wet washcloth on the low back between contractions to relieve back pain.

Shower or Bath - Since both showers and baths are relaxing, they may help with relieving back pain. Point the showerhead against her low back.

Rolling Pressure Over Low Back - Use a rolling pin, a hollow rolling pin filled with ice, a can of frozen juice or a pop can that has been sitting in a bowl of ice. Roll it over the lower back during or between contractions.

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Pain Relief with Medications

Narcotic Analgesics
These drugs (Demerol, Morphine and Fentanyl) are given by injection to help you relax between your contractions. They are said to 'take the edge off', but do not necessarily take the pain away. They are usually offered during well-established labour.

Possible Side Effects on Mom - Temporary nausea, slowed dizziness, a 'high' feeling, hallucinations, lower blood pressure and heart rate, confusion, respiratory depression, and slowing of active labour.

Side Effects to Newborn - (depends on the amount of drug that has crossed the placenta and entered the fetus' system). Depressed respiratory effort with possible need for resuscitation, poor suckling ability, depression of other reflexes. These drugs also change the heart rate of the fetus.

Epidural Analgesia
An epidural is a narcotic and local anesthetic combination injected into the epidural space in the lower back. Epidurals start working in 5 to 30 minutes. The nurse will give you an IV line for fluids, a catheter to empty your bladder and an electronic fetal monitoring device. It will take a few hours to for the drugs to wear off once the catheter has been removed from your back. You will not be able to walk until then.

Possible Side Effects to Mom - Decreased blood pressure (may also cause nausea and vomiting and dizziness), slowing of labour, decrease of the urge to push and therefore increase the chance of using vacuum extraction or forceps during delivery, shivering, occasionally a small membrane is punctured during the epidural and a headache will result for 12 to 48 hours.

Possible Side Effects to Newborn - (depends on the amount of drug that has crossed the placenta and entered the fetus' system). Decreased alertness and muscle tone, increased fussiness. There may be temporary heart rate changes to the fetus caused by the lower maternal blood pressure.

ALERT: Always talk to you doctor or midwife about the use of epidurals before going into labour. Rare side effects of the medication include: ringing in the ears, blurring of vision, tingling around the mouth and seizures. Extremely rare side effects include meningitis, paralysis and death.

Nitrous Oxide
This is a self-administered gas of 50% nitrous and 50% oxygen inhalation analgesia used to cut the edge of the pain. During labour you would breathe the gas throughout the entire contraction. The gas clears in about a minute. Between contractions your will feel drowsy.
There are no known side effects to mom and baby (or fetus).

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Medical Interventions During Labour

Electronic Fetal Monitor - Electronic fetal monitoring may be used to monitor the Fetal Heart Rate due the stress of labour on your baby. This way, any potential problems can be identified before they become a threat for your baby.

Internal Monitoring - Internal monitoring may be used to record your baby's heart rate once your labour has been established and your membranes have ruptured. A small wire is attached to your baby's head or buttocks through your vagina.

IV Fluids - Usually, intravenous fluids are used only if there is a reason, for example, with an epidural, fetal distress, or a cesarean birth.

Episiotomy - This is an incision made to enlarge the vaginal opening after local anesthetic is given (freezing). Episiotomies are not common practice anymore. Studies done on deliveries without episiotomies show that tears are generally smaller and heal more quickly than the average episiotomy. Both episiotomies and tears are sewn following delivery with self-dissolving sutures.

Artificial Rupture of Membranes - If your membranes do not rupture on their own, your doctor or midwife may choose to artificially rupture the membrane using an amnihook (looks like a crochet hook). This is a painless procedure. This may also induce labour.

Induction or Augmentation of Labour - Several reasons to induce labour include: if you are greater than 41 weeks of gestation, have gestational diabetes, or have pregnancy-induced hypertension.
Prostaglandin (Cervidil - the most commonly used form) - Cervidil is placed outside a closed cervix used to help 'ripen' the cervix for 12 to 16 hours, so that induction is easier and takes less time. Cervidil contains the hormone prostaglandin E2.

Oxytocin Drip - Intravenous oxytocin is used to help your labour progress faster. Contractions are likely to become stronger and closer together very quickly and your baby will be closely monitored.

Vacuum Extraction - A vacuum cup is applied to your baby's head to guide the baby through the birth canal as you push at the end of your labour. Your baby may have the appearance of a slight 'cone head'. This will disappear in 24 to 48 hours. There may be bruising where the vacuum has been applied, but this will fade following delivery.

Forceps - These are only used if vacuum extraction is not effective. Baby may have red marks on the sides of his/her face or buttocks. But don't worry, they will fade within a few days.

Apgar Scores - This score is completed at one minute after birth and five minutes after birth to rate the overall condition of your baby. The score is out of ten. Most infants get an 8 or 9 but very few will score a 10.

Spinal Anesthetic - Almost the same as an epidural, but medication is injected into the spinal space. The risks are the same. Generally spinals are used for cesarean births. Relief comes within five minutes. The anesthetist decides whether to use an epidural or spinal.

General Anesthetic - In an emergency situation, general anesthetic will be given if you do not already have an epidural or spinal. This means you will be put to sleep. Your partner will stay in the waiting room until your baby is born. When you wake up, you will join your baby.

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Cesarean Birth

Sometimes a vaginal delivery is unsafe for you or your baby. In these circumstances, a cesarean birth may be needed. This is where the doctor delivers your baby through a surgical incision in the abdomen. In Canada, 18% of all births are cesarean births. If you had your first child by cesarean delivery, there is still a chance that you will be able to deliver vaginally for subsequent pregnancies.

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