(Q4 on the birthplan: During labour, I would like the following pain relief:)
I’m just a few weeks off the birth of my second child right now, and with the birth of my first I was so prepared. I’d spent eight months reading, learning, studying. This time I’ve been less focused on the birth, and more on surviving a relatively rough pregnancy while still being mother to a two year old. It’s been fun.
But, I’m trying to ‘focus in’ on myself at the moment. I’m trying to set aside all the extras that fill up life, and prepare for the arrival of this baby.
A good place to start, in my opinion, is with a basic birth plan. While many people think a birth plan sets you up for failure and disappointment, I personally view it as a wonderful way of thinking about things you didn’t even know where options in a birth, especially if it’s the first time round for you.
Now, it’s time to start thinking about the pain. It’s the one thing mothers-to-be fear more than anything else, an no wonder, when you see the portrayal of childbirth in the media. Your waters break and two seconds later you’re lying on your back with people all around yelling at you to push, push, push, while you’re screaming. Well, from personal experience (of myself and millions of others), I can assure you that birth doesn’t have to look like that.
And I’m not even talking about drugs.
Understand something: it’s not about getting a medal for natural childbirth. (I get a bit angry when people say ‘you don’t get a medal for going natural’. Actually, you do. It’s just not round and shiny. Choosing not to go drug-free or not is entirely a personal choice, but belittling someone else’s decision to do so is simply rude. And visa versa.)
Something very important to remember about fear and pain is how they work together. Fear increases your adrenaline pumping through the body. Adrenaline overrides Dopamine, which is the feel good hormone and Endorphins, which are your natural pain killers, leading to a heightened sensation of pain. The more you fear, the more you feel.
I had a fantastic independent midwife, Sofie Jacobs, who gave us our private antenatal classes before Ameli’s birth, and below is a transcript of my notes from her discussion on Pain Management During Labour:
- Maternal movement and position changes – otherwise known as active labour, can help managing contractions especially early on. Aids such as a Swiss ball (birth ball) pillows or leaning over a chair can be useful. I’ve been reading a lot about yoga or belly dancing to help during labour too. It’s very interesting and worth trying.
- Touch, massage and counter pressure – some women find having their lower back pressed or their hips pushed together during contractions can relieve some pressure. Massage can help relax between contractions too. Application of hot cloth or ice pack can also help here. I didn’t enjoy being touched during contractions and just wanted my body submerged in water.
- Breathing and relaxation – hypnobirthing, golden thread breathing and a host of other breathing techniques can be used. They should be practiced during pregnancy so that they are natural and familiar during labour. There’s a large variety of ‘birth relaxation’ CD’s on the market. My favourite is Birth Beyond Fear – Beautiful Birth Relaxation by Lorraine Hale. Definitely become ‘accustomed’ to it during your pregnancy as there’s little more distracting than a grating or irritating voice droning on during labour and not every CD will appeal to every listener.
- Hydrotherapy – whether this is in the bath, shower or a birth pool, water is known to provide pain relief in many conditions, and labour is the same. That said, some women have planned waterbirths, then found they hated being in the water – there’s no way of knowing, but most of us have access to running water. I planned to give birth on my knees, but during labour found I couldn’t bare to be on my back on land, and once in the pool didn’t want to move off my back – being submerged in water was the most incredible relief!
- Attention focusing and distraction – being able to focus on something else may help deal with contractions. Alternatively having a mantra or song or affirmations to repeat or have repeated to you. This was invaluable to me during labour. I had music I was listening to and was so focused on singing along during transition that I remember the midwife saying she’d never heard anyone singing while giving birth before. It took my mind totally off the ‘pain’ and made me entirely focused on the baby moving down the birth canal. I also had a list of affirmations stuck up on the fridge (we had a birthpool in the kitchen) and my husband repeated those and others he’d heard me repeat during the pregnancy over and over. One of my overriding memories of our daughter’s birth is my husband kneeling behind me repeating those affirmations quietly in my ear during each contraction. I’ll never forget the sound of his voice during contractions. It was so calming and reassuring to me. Ali from Sunrise Rants baked a cake for their new baby during early labour as a means of distraction.
- Self-hypnosis – there are a number of different techniques and options available. I found them all to be too expensive for me to do the proper classes, but CD’s and books are available. I found deep relaxation to be as effective as I have heard hypnosis can be.
- TENS (Transcutaneal Electrical Nerve Stimulation) – You have to start using the TENS machine when contractions start, and gradually build up with it. You can not stop and start, and once you’ve stopped you cannot restart. The electrical impulses stimulate the production of endorphins. Apparently the baby is not affected by the nerve stimulation. There are different TYPES of TENS machines. Not all are suitable for labour. Be careful if you buy to buy one intended for use in labour. I found this a great relief until I went into the birthpool. They can be hired or bought.
- Reflexology, acupressure, acupuncture and aromatherapy – all can be used during labour and are especially effective when treatment is started during the last trimester of pregnancy. All should be done with a qualified therapist as they can help with the induction of labour and some essential oils are not recommended in pregnancy.
- Paracetamol – can be taken at home every 4 – 6 hours during labour. While useful in early labour it won’t have much effect later on and dosages MUST be adhered to.
- Entonox (Gas and Air) – the mother is in control of how much she has, and it has immediate effect. There’s no need for monitoring when on G&A and there’s no effect on the contractions. On the negative side, it can cause light headedness and vomiting. I vomited badly on entonox, and didn’t like it at all. It made me feel light headed and unfocussed. I used it for a while as I was exhausted after 2 days of labour, but I didn’t feel that it did much for the sensation – it just made everything blurry and forced me to focus on my breathing. That part was helpful.
- Pethidine (Demerol in the US) – while some midwives can administer Pethidine at a home birth, it is unlikely. It (apparently) works quickly and can be repeated later in labour. Pethidine is generally administered by injection, and it can cause nausea and dizziness – whereas with gas and air that will dissipate in minutes, Pethidine will have to be left to work it’s way out of the body. Pethidine can also cause the baby to have a ‘sleepy heart rate’ which may be misconstrued as the baby’s heart rate dropping, leading to interventions.
- Epidural– this can come in two ways: half and full. Epidurals cannot be administered in a home birth. A half epidural means you can still move around somewhat, and will be able to feel your body’s urges to push. With a full epidural you will not be able to move and will be constantly monitored. You will also need to be coached to push when the monitor shows you’re having a contraction. Epidurals carry more risks than the previously mentioned methods of pain relief. These include:
- 5% risk of hypotension
- localised lower back ache
- prolonged labour
- reduced bladder sensation
- 1 in 200 risk of dural puncture resulting in headache
- 1 in 1000 risk of temporal nerve damage
- 1 in 10000 risk of permanent nerve damage
- may increase risk of operative delivery (c-section)
I hope you find this as helpful as I did when Sofie gave it to us. It really laid it all out clearly to me, and helped me decide what I would and would not like to use during labour.
Disclaimer: I am not a medical professional – this is a summary of my own research into the birth of my own children. I recommend you do the same and make informed decisions about your own situation.
For additional reading:
- Effect of Labor Epidural Anesthesia on Breast-Feeding of Healthy Full-Term Newborns Delivered Vaginally – Medscape
- Epidurals and Breastfeeding – La Leche League
- Effects of Pethadine on the Newborn – BMJ
- Does medication administered to a woman in labour affect the unborn child? – an AIMS leaflet
- Belly Dancing as the Dance of Childbirth – Barbara Brandt and Gigi Groth Devitt
- Belly Dance for Birth – a Youtube video
- Breathing techniques for labour and birth – look specifically at Golden Thread Breathing, this focused me so much in transition, it was a beautiful experience.
- Side Effects of Epidural Anesthesia: Research Data
Medicated vs unmedicated births: personal stories
- Sweet Birth Doula Services
- Babycenter – an interesting thread with personal experiences from a range and variety of mothers