| Pain relief without drugs
You have already had a lot of experience of coping with pain. Nobody gets to adulthood without becoming fairly expert in dealing with painful situations! Think of all the things you instinctively do to alleviate pain, such as:
All of these comfort measures can be useful in labour. If you’re having your baby at home, you will be free to cope with contractions in any way that seems appropriate to you. In hospital, you may need to ask for comfort items such as ice or a bean bag or to turn down the lights. Do ask! Talk to your midwife and your birth partner while you are pregnant and when you are in labour and let them know what they can do to help you. One method on its own may not be enough - you may need a combination for more complete relief. Relaxation Many women are frightened of the pain of labour. During labour this fear can make you feel more tense and therefore feel the pain more acutely. Learning to relax will help reduce any tension and will be good for both you and your baby. Relaxation is good for you because:
Relaxation is good for your baby because:
You can go to antenatal classes* to learn more about relaxation. Even if you don’t go to classes, you can try some of the simple things mentioned below to help you relax during labour. SupportChoose your birth partner carefully: you need someone who will not be overwhelmed by the situation and will be able to encourage you, reassure you, hold you and stay with you physically and mentally until you have given birth. This person could be your:
You may wish to consider having more than one birth partner, although do take into consideration the size of the delivery room when making this decision. Discuss with your supporter what you want him or her to do for you during labour. Make sure that they have some idea of what is going to happen, what the hospital is like and under what circumstances you might want to change your mind about things you have agreed beforehand. Positions
When labour starts, keep active. You don’t have to go to bed. You’ll almost certainly be more comfortable moving around and getting into different positions. Try:
When one position no longer seems to be helping you cope with contractions, try another. If you are too tired to move, ask your midwife or your birth partner to help you. Breathing
Massage
You might find that some massage is helpful for easing the pain. Most women feel their contractions in the lower part of their back. Ask your supporter to:
When you are having contractions, you might find it helpful to visualise the neck of the womb (cervix) opening up, and to think of your baby moving down through the pelvis. Or you might like to distract yourself by imagining that you are in a special place where you feel safe and can relax - perhaps by the sea, or in a garden or your bedroom.
If you have decided to have your baby at home, your midwife will bring a supply of gas and air in a cylinder when she comes to you in labour. If you are having your baby at a hospital, gas and air will probably be piped to your delivery room from a central source. TimingGas and air is useful whenever you need some extra help during your labour, but is most often used towards the end of the first stage when contractions often come thick and fast. In the second stage of labour (when you are actually pushing your baby out) your midwife may suggest that you have a little gas and air at the beginning of each contraction and then concentrate on pushing. How it is usedYou use a mouthpiece or mask with a two-way valve so that you can breathe in and out through it. As soon as you feel a contraction starting, you hold the mask to your mouth and breathe deeply and evenly through the mouthpiece. The gas builds up in your blood stream over a period of seconds so that by the time the contraction is at its peak, you’ve had enough gas to give you some pain relief. When the gas starts to make you feel a little light-headed, your muscles relax and your hand automatically drops away from your face so you stop breathing the gas. By the end of the contraction, you are no longer affected by it. Side effectsThe oxygen content of Entonox is probably good for your baby. If you use gas and air over a long period of time, your mouth and throat will become very dry. It’s vital, therefore, to have sips of water in between contractions, or try sucking some slivers of ice. Women’s viewsSome women find that gas and air isn’t enough to tide them over the most difficult parts of labour and that they need to choose stronger pain-relieving drugs to help them. Some women don’t like the light-headed feeling that gas and air produces. But by and large, it is well tolerated by most people and you will often hear women say that they couldn’t get enough of it in labour!
Physiotherapists are very knowledgeable about TENS and you may find that your hospital has special physiotherapist-led sessions to tell pregnant women about TENS and to show them how to apply it. TimingThere isn’t a great deal of research into TENS in labour, but what there is suggests that it is most effective when you start using it at the very beginning of your labour and increase the intensity of the electrical impulses gradually as labour progresses. To do this, you will either have to hire a TENS machine, (which will cost you about £30) so that you can use it at home in early labour, or go to hospital as soon as you think your labour has begun so that you can use one of the hospital machines. Most hospitals have TENS available, but do check, as some haven’t got enough machines to ensure that every woman in labour can use one. The machines may need to be pre-booked and a member of staff may have to teach you their correct use beforehand. How to use TENSThe TENS machine is about the size of a cassette tape box and you can easily hold it in your hand or clip it to a belt. Four pads are attached to it by wires and these pads are placed on either side of your spine, two just below bra-strap level and two at the level of the dimples in your bottom. The machine emits small pulses of electricity and has two or three dials which change the frequency and the intensity of the pulses. There is also a boost button you can press to maximise the output of the machine to help you cope with contractions. Side effectsIt is not thought that using TENS in labour has any adverse effects on either you or your baby, although there isn’t a great deal of research evidence available. You are free to move around while using it and you can use it in conjunction with gas and air. However, you can’t use TENS if you want to try a birthing pool for pain relief. Also, you can’t use it if you have a cardiac pacemaker. Women’s viewsWomen having their second or subsequent babies often say that TENS is excellent, particularly when combined with gas and air. Feedback from women having their first babies tends to be more mixed, with many saying that it is very helpful during the first half of labour, but less so when contractions get very strong. Women like TENS as a form of pain relief they can control themselves, but sometimes find the added stimulus of the electrical impulses is not welcome on top of strong contractions.
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