Staying Comfortable in Labour
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This leaflet outlines the analgesia options available to support you during your labour and birth.
Preparing for labour
You can prepare for birth by attending antenatal classes, talking to your Midwife, and researching information on labour. You can write down your ideas in your birth plan and will be discussed during your birth preferences appointment at 34 weeks.
The stages of labour
Labour is divided into three different stages. There is a description of each stage below.
The first stage – this includes an early or latent phase, as well as an established phase.
Early labour can vary in duration from person to person. During this phase the cervix begins to shorten and soften (known as effacement) and will start to open (dilate), up to 4cm. Contractions are often irregular, short-lasting and increase in intensity and frequency.
During established labour the cervix opens from 4cm to 10cm (fully dilated), and you experience regular and strong contractions.
The second stage – this is when your cervix has opened fully until the birth of your baby.
The third stage – from the birth of your baby until the placenta is birthed, it may last up to an hour, and you may feel mild contractions during this time.
Evidence shows that labour can be a better experience when you:
- Feel relaxed, knowing what is happening within your body
- Keep active and try to get into comfortable positions
- Use breathing techniques
- Have emotional support and encouragement from a birth partner you trust
- Know what is available to help you through your experience
- Feel safe within your birthing environment
- Personalise the environment: you may want to play your own music, use your own pillow, or use electronic tea lights.
Holistic support methods – these can be used both at home and in the hospital
Massage
Can be invaluable during a contraction and releases endorphins (your natural painrelieving hormones). Your chosen birth partner or midwife can help with this.
Breathing and relaxation techniques
Breathe slowly and rhythmically throughout the contraction and try to relax and stay focused. Your midwife will be able to coach you through different breathing techniques.
Changing positions
Remaining upright and mobile using equipment for support such as beanbags, cub cushions, birthing balls, peanut ball and birthing mat. The hospital bed can be adjusted to support various positions.
Water
Many find that using a birthing pool or shower can help ease pain and aid relaxation, which encourages the release of endorphins. There are two birthing pools on our labour ward with the option of dimmed lights and a relaxed atmosphere.
Transcutaneous Electrical Nerve Stimulation (TENS)
This is a machine which can help to reduce the pain by blocking the nerve signals to the brain and releasing your natural endorphins. It is controlled by you and is most effective when started in the early stage of labour. These machines are not available at the hospital but can be hired.
Hypnobirthing
If you wish to have a hypno-birth and have attended antenatal preparation in hypnobirthing, the midwives will support this through your labour and birth.
All the above can support you at different stages of your labour and have no side effects for you or your baby.
Medicinal forms of pain relief available
There are various forms of medicinal pain relief options available, below are the ones offered at Milton Keynes Hospital.
Paracetamol
This can be effective during early labour. It can be taken every 4-6 hours according to instructions, with a maximum of four doses in 24 hours.
Dihydrocodeine
Another medication that can be effective during early labour. It can be taken every 46 hours according to the prescription.
Entonox (also known as gas and air)
This is breathed in and out through a mouthpiece and is made up of 50% oxygen and 50% nitrous oxide. It takes about 15 seconds to take effect and is used throughout a contraction. It can help to focus your breathing through the contraction, with no side effects for baby. Some people may feel a little sick or lightheaded whilst using the Entonox, however, this feeling passes very quickly after use. Another side effect of Entonox is experiencing a dry mouth, so you will need to have a drink to hand for after the contraction.
Pethidine
This is a pain-relieving drug given by injection that takes approximately 15 minutes to take effect. It can make the contractions more manageable and help you to relax. If required, pethidine can be administered 2-4 hourly, with a maximum of 4 doses. It may make some people feel slightly dizzy and sick so you will be offered an anti-sickness drug at the same time. Pethidine crosses the placenta to the baby and can sometimes make him/her sleepy and slow to breastfeed, especially if given too close to the birth.
You can use Entonox alongside Pethidine if you wish. If you have pethidine, you are advised not to use the birthing pool for two hours after administration, but it may be possible to return to the pool later if you are not feeling dizzy or unwell.
Epidural
This is an infusion of local anaesthetic through a very small tube in your back that takes away the sensation of pain with contractions. A separate leaflet with in-depth information on epidurals is available from your midwife or doctor. Epidurals are not available at a homebirth.
Remifentanil PCA
This is a fast-acting pain relief drug administered via a cannula so that it goes into your bloodstream. You have a button to press to control the amount of pain relief. It does not work as well as an epidural but is stronger than pethidine. However, it can make you drowsy, sick and can affect your breathing. This means extra monitoring during labour is required for both you and your baby.
Each labour and birth are different. As such, a flexible approach is recommended. Your Midwife will be able to offer you advice and support you in making informed decisions.