Desert Storks

PAIN RELIEF DURING LABOUR AND CHILDBIRTH

Each woman’s labour is unique. The amount of pain that women experience is dependent on many different factors, which include:
• the size of the baby
• the position of the baby
• the dimensions of the pelvis
• the strength of the contractions
• fatigue, fear and anxiety
• previous labouring/birth experience and expectations
• many issues not yet understood
 Therefore, it is hard to predict how much pain a woman will have until she goes through labour. Some women have tolerable, controllable levels of pain, while others may benefit from some form of pain relief. Many non-medical techniques exist that can help the pain during labour, including breathing and relaxation techniques, warm showers, massage, supportive nursing care, position changes (standing, sitting, walking, rocking), and using a labour ball to name a few. However, for some women, these measures may not be enough. These women may seek a medicated form of pain relief.

 NON MEDICAL METHODS OF PAIN RELIEF DURING LABOUR.
 In an effort to provide views based on good research we have summarised information on the following methods of non-medical pain relief.
 AROMATHERAPY has garnered attention recently as a way to promote stress relief during labour.
 More and more women are turning to Aromatherapy during their labour to help them cope with the emotional issues facing them. There is no direct or indirect pain relief involved but the labouring mother may find Aromatherapy helps reduce stress thereby allowing pain to be better tolerated.
 Technique- essential oils of rose, lavender, neroli, clary sage and others are placed in baths, on face cloths, in massage oil, or directly on the labouring mothers skin. Many labouring women are particularly sensitive to certain smells that may enhance nausea and vomiting associated with labour. While there are no good studies demonstrating benefit to the labouring mother, the minimal risks and costs associated with Aromatherapy make this a good adjunct for many labouring women. It may be wise for the mother to pick out pleasing oil blends prior to the onset of labour. This can help prevent using scents that enhance nausea and vomiting. Many women recommend picking a few different oils to use for different stages of labour. Some women may have allergic reactions to particular oil preparations. More information can be obtained from the www.aworldofaromatherapy.com
 *RELAXATION exercises often with the help of tapes or music. Learning how to relax in this way should ideally start early in pregnancy and be practised throughout pregnancy.
 *Breathing techniques. These are taught during antenatal classes. An understanding of controlled breathing is important if a facemask or mouthpiece (to deliver pain-relieving gas) is used during labour.
 *YOGA, HYPNOSIS, SELF-HYPNOSIS OR MEDITATION, all of which requires training and practise, well before labour starts.
 *ACUPUNCTURE by a medical practitioner trained in its use.
 *BATHING, HOT SHOWER OR HOT PACKS.
 TENS is the application of a very small electrical current to the skin to decrease the perception of pain*.  TENS has been used for surgical and chronic pain patients. The current acts like a gate preventing pain signals from reaching the brain, which may stimulate the body’s production of higher levels of endorphin’s (natural painkillers). The TENS machine is controlled by the woman. TENS treatments have not been found to harm either mother or baby.
 *MASSAGE. Many mothers appreciate touch and massage while in labour. Most often the provider of this is a loved one or supporter. While there are not very many good studies of the benefit of touch and massage it is clear that mothers receive significant emotional and physical relief.
 Therapeutic touch and massage can include a wide variety of hands on interventions for the mother ranging from therapeutic massage to light caressing and hair stroking. This may include the use of hands, fingertips, or devices to stroke and apply pressure relieving pain and facilitating relaxation. Mothers may be better able to tolerate the pain of labour with better relaxation and a lower baseline level of anxiety.
 Many women feel lower back pain associated with the posterior position of the baby’s head. Massage or  pressure on this area can provide relief from this pain. Pain relief may occur through stress reduction, distraction, or through the stimulation of other receptors.
 During labour labouring women find some positions and movements more comfortable than others.
 When the mother alters position, she may change the relationship between the position of the baby’s head, her pelvis and uterine contractions taking advantage of gravity. Movements and positioning in labour may be recommended to rotate a baby whose position may not be optimal or to correct slow labour progress. Many studies suggest walking, sitting more upright, or adopting a hands and knees position speed the rate of labour.
 Sample Positions:
• Upright
• Squatting
• Side
• Hands and knees
 *Birthing balls have been used to provide comfort during labour.
 No studies have reported any position that has been found to be harmful to the baby or mother. Women should be encouraged to seek any position that provides comfort MEDICAL PAIN RELIEF DURING LABOUR
 NITROUS OXIDE mixed with oxygen.
 This gas mixture is inhaled through a mouthpiece. Pain relief usually starts in one minute. Inhalation should start at the first sign of a contraction and not when the contraction is at its peak. The gas does not usually cause drowsiness. Nitrous oxide is not known to have any harmful effects on the baby. Nitrous oxide is not a strong pain reliever but has helped many women cope with short periods of intense pain. Nitrous oxide is usually used in second stage of labour. In some women, nitrous oxide may cause nausea, tiredness and a dry mouth, which is often helped by sipping cold water or sucking on ice chips. Some women may also have feelings of light-headedness or tingling in the hands, feet and lips. This occurs when a woman’s breathing rate increases with pain. Therefore good breathing techniques learned from antenatal classes are beneficial.
 OPIOIDS- PETHIDINE OR MORPHINE most common
 These are medications that are given either into a drip or via injection in to the leg or bottom to decrease the amount of labour pain. Opioids are the most effective medications for the relief of pain. The have a long history of use in obstetrics for the relief of the labour and birth pain.
 These medications enter the blood stream and allow women to better tolerate the pain of labour and birth. They do not normally provide complete analgesia. The amount of pain relief from these medications does vary, but they can take the “edge” off the pain and make labour more tolerable. The advantage of an opioid is that it does not slow labour down. The disadvantage is that it may cause side effects to the mother (Nausea, vomiting and drowsiness)
 Effect on the baby:
 Side effect of narcotics is due to the fact that they all cross the placenta and enter the baby’s circulation. As a result of this, the baby may also show some effects. The baby has the ability to metabolise the medications, but it does so more slowly than the mother. After the baby is born, the baby may be slightly sleepy. It is unlikely that the baby will be affected adversely, but it is important to realise that the medication is getting to the baby.
 EPIDURAL is an anaesthetic delivered by injection near the lower spine. It numbs the body below the injection, allowing women to remain alert but more comfortable during contractions of childbirth.  Epidural anaesthesia and spinal anaesthesia are called regional anaesthetics because they anaesthetise one specific region of the body. The medications used here include local anaesthetics and narcotics.
 These medications block the nerves that carry sensations of pain from the uterus and cervix back to the spinal cord in the backbone and brain. This method allows women to be awake and alert, yet relatively free of pain.  A disadvantage of epidurals is that they can slow labour down. Although rare, side effects and complications do exist.
 Common side-effects:
• Walking around may not be possible due to heaviness or numbness in the legs.
• Legs often feel heavy and may be difficult to move.  Passing urine may also be more difficult. If necessary midwives will help with movement, and the passing of a small tube (catheter) into the bladder is sometimes necessary.
• A woman’s blood pressure may drop. This will be checked and treated with intravenous (I.V.) fluids and medication, if necessary.
 Possible problems:
• Some studies have suggested that epidurals in early labour may increase the risk of forceps delivery or caesarean section.
• Some women have an area of numbness, which lasts for several days.
• Local tenderness and bruising may occur around the insertion site.
• Shivering, nausea and vomiting may occur. (These symptoms may also occur during normal labour).
• Intense itching with some types of epidural may occur but can usually be treated by medications.
 Serious problems:
 These are rare.
• About 1-2% of epidurals enters the fluid, which surrounds the spinal cord. This frequently causes a severe headache, which may need further treatment.
• The epidural catheter can be put in the wrong place. About 5% of the time it goes into a blood vessel in the back, and has to be pulled back or reinserted.
• Other complications include the introduction of infection into the area around the spinal cord.
• Very rarely  a dose of local anaesthetic is injected into the blood vessel and the woman notices a metallic taste in her mouth, becomes dizzy, and may go on to have a fit or even a heart attack. With prompt treatment, complete recovery from this complication is possible.
• Exceedingly rarely, epidural analgesia can cause an allergic reaction to an anaesthetic agent, death or permanent paralysis. Anaesthetists are specially trained to know these risks, and avoid or treat complications.
Effect on baby:
Epidural analgesia has little or no effect on the newborn.  (Although indirectly the complications to mother may effect the baby)
Effectiveness:
Epidural analgesia works well, providing about 9 women out of 10 with complete or nearly complete pain relief. Sometimes it is necessary to add more medication, adjust the tubing, or even reinsert the epidural in order to achieve good pain relief. Epidural analgesia often avoids the need for a general anaesthetic, which is much more risky than epidural analgesia. (IN CAESAREAN BIRTHS)     

The information provided has been obtained from:
The Royal Australian and New Zealand College of Obstetrician and Gynaecologist -www.ranzcog.edu.au
 A world for Aromatherapy.- www.aworldofaromatherapy.com

Nonpharmacological means of pain relief for labor and delivery. Eappen S, Robbins D. Review 2002 (Chochrane Library)