Posts Tagged ‘pain relief in labour’

How long will it last?
all about labour
How long will my labour last?
This is hard to determine as every woman is different and every labour is different. Also, how long your labour lasts depends on when you start timing it as the start of labour can be a gradual build-up that occurs over a fairly long period of time. Usually, labour is classed as being established when the contractions are regular and getting stronger and do not stop until the baby is born. This, coupled with the cervix opening, are indicators that labour has commenced. During the gradual build-up of contractions, labour is sometimes described as being in the ”latent” phase until it becomes more established. This latent phase may last for a period of around 6-8 hours in first-time mothers.
As a general rule, if this is your first baby -you should expect to labour for around 12-24 hours in total. If you have had a baby before, your labour may be a lot quicker, providing there are no other complications, particularly if you have had a vaginal delivery in the last 2-3 years. In some cases, usually with second or subsequent babies, labours can last for only a few hours, or even minutes, and in these situations the mother may not to make it into hospital. The best advice in all cases is to speak to your midwife or hospital if you think labour has started
I like to know what to expect. What will happen when I first arrive at the hospital?
Hospital routines vary, but generally you will be shown to a room on the labour ward, and one of the midwives on duty will come to see you. As
well as asking you about your labour so far, she will probably ask to check your temperature, pulse, and blood pressure, and listen to the baby’s heartbeat. She will also feel your tummy to assess the baby’s position and how far the head has engaged or
moved down in the pelvis (see p. 148) If -your contractions are regular, an internal examination may sometimes be done to reveal how far your cervix has dilated and therefore what stage your labour is at. This information will give the midwife an insight into the wellbeing of both you and your baby. and will help you both to decide on the next course of action. If your labour is in the very early stages, your midwife may suggest that you return home for a while or spend some time on an antenatal ward If your labour is well established, a delivery room will be found for you
How will the hospital check my progress?
An experienced midwife can tell a lot about your labour just by looking at you and observing your behaviour. For example, a woman who is chatting happily during each contraction is unlikely to be in well-established labour. A woman who is in established labour and starts to be restless and nauseous may be in the ”transition” phase; approaching the second stage of labour (see p.183)
Another way in which your midwife will assess your progress is by feeling your tummy to check the strength of the contractions, and also by feeling the position of the baby’s head in your pelvis
Internal examinations also reveal a lot about how your labour is progressing. By placing two fingers gently into the vagina, the midwife or doctor can feel how far the cervix is thinning out (effacing) and opening (dilating), how the baby’s head is moving downwards, and what position the baby’s head is in.
What is ARM, and is it routine?
ARM stands for”Artificial Rupture of the Membranes”. This means that a doctor or midwife, using a plastic ”crochet hook” with a long handle, control while taking gas and air and therefore you may find that you want to stop taking it while you are pushing if it is distracting you too much and stopping you focusing on the contractions Some women manage their entire labour on gas and air alone, while others find that they need another form of pain relief in the later stages of labour.
How will I use the gas and air and is it likely to make me feel sick?
Gas and air is breathed in through a mouthpiece or mask that is connected to a cylinder or pipes in the wall that lead to larger cylinders elsewhere. You administer it yourself, so are more in control of how much you take and when.
Gas and air can make your lips and mouth feel tingly and dry, and in some cases women report feeling nauseous while taking it. Using a mouthpiece rather than a mask may help to reduce feelings of nausea brought on by the smell of the gas and the sensation of having a mask over your face, and taking sips of water may help As the effect of gas and air is short-lived, you only need to use it during contractions; taking gas and air between contractions will not help with the pain of the next contraction and is likely to increase the sensation of nausea.
I want to have a great birth but you hear such awful stories -how can I stay positive?
For every awful birth story there is an equally positive one — it does tend to be the case that you are less likely to hear about the positive birth stories as these aren’t such good topics of discussion! However your labour and birth proceeds, the birth of your baby will be amazing because you will finally meet the little person who has dominated your life for the past nine months.
It is sensible to remain open minded about labour and birth, because it’s impossible to foresee exactly how things will go on the day However, there is a lot that you and your partner can do to help prepare yourselves for labour and birth so that -you
Gas and air
A form of self-controlled pain relief in labour
A mixture of oxygen and nitrous oxide that is self-administered in labour.
Gas and air, also known as Entonox, is taken through a mask or a mouthpiece during labour. This dulls the pain centres in the brain and produce a sense of euphoria This needs to be timed with your contractions as the effects are short-lasting, with the gas being breathed in just prior to and during a contraction. You will feel normal once you stop using it.
Gas and air tends to be the preferred choice for managing pain in women who want to labour as naturally as possible The reason for this is that gas and air has several advantages, including the fact that you can remain mobile and active while using it; it can he used during a water birth; it doesn’t affect the baby in any way; and it doesn’t make you feel drowsy during labour, which allows you to feel more in control throughout and to remain as focused as possible on your contractions. However, although it is a widely available and a popular choice of pain relief in the UK, it doesn’t tend to be used in the United States
have the best chance of having a positive overall birth experience. For example, you can both learn as much as possible about the process of labour and birth so that you can make informed decisions in labour. You can chat with your midwife, read books, find information on the internet, and attend antenatal classes. Also, knowing how labour progresses helps to demystify the experience and therefore removes some of the fear that accompanies labour and birth. Learning basic relaxation and breathing exercises also helps (see p.173), as being able to relax as much as possible during labour helps you to feel less anxious, which in turn can help the labour to proceed as quickly and smoothly as possible tears a small hole in the amniotic membrane that surrounds the baby and contains the amniotic fluid and the fluid then passes out through the vagina. This procedure is also referred to as ”breaking the waters” and may be uncomfortable. ARM can be used to try to induce, or speed up, labour (see p,191). The idea is that the layer of membrane between the baby’s head and the cervix is removed. This enables the head to press directly on the cervix, which in turn releases the hormones that stimulate contractions and start, or help to speed up, labour.
ARM should not be performed routinely. In a spontaneous labour that is progressing normally, there is no need, and the membranes will usually rupture on their own.
I’m worried about being strapped to a bed and monitored. Is that essential?
If there are no complications or reasons for concern, your baby’s heartbeat will usually be monitored using a hand-held device much like the one used during your antenatal appointments to listen to your
10cm dilated
baby’s heartbeat Once your labour is well under way, your midwife will listen to your baby’s heartbeat for about 30 seconds to one minute every 15 minutes or so, which means that you can move around as much as you like in between.
If you have had complications in pregnancy, or problems develop during your labour, the midwife may recommend that your baby’s heartbeat is monitored continuously using a ‘ CTO”, which stands for ”cardiotocograph” (see p.192). This means that you will have two monitors strapped to your tummy using thick elastic belts. One measures the baby’s heartbeat and the other measures the frequency of the contractions. The monitors are attached to a machine that prints out information in the form of a graph This allows the doctors and midwives to keep a close eye on your baby’s wellbeing and how she is responding to the contractions.
A CTO does make keeping active a little more difficult but by no means impossible. Leads can be moved out of the way and adjusted, and some maternity units have a wireless CTG You can talk to your midwife about how this will be managed.

When can I start pushing?
Ideally you can start pushing as soon as you feel the urge to, assuming that your cervix is fully open. The urge to push is usually stimulated by the baby moving down the birth canal, which happens at some stage once the cervix is fully open. You may experience a sensation of needing to open your bowels and may actually pass some stools or urine, as the baby is pushing on the back passage. This is a very common occurence in labour (see p 188)
If both you and the baby are well, you will be encouraged to follow the natural urge to push. Sometimes, you can feel an urge to push before the cervix is fully open If this is the case, it is important to resist this feeling as much as possible, as pushing at this stage can cause the cervix to swell, which makes it more difficult for it to dilate. Some women find that kneeling on all fours with their head and shoulders lower than their hips is a good position for this stage of labour.
What is “crowning” and should I continue to push during this part of the labour?
This term refers to the part of birth when the widest part of the baby’s head – known as the crown –eases out of the opening of your vagina. Your midwife will encourage you not to push at this stage so that the baby’s head can be born in a slow and controlled way, which can help to prevent serious tears to your vagina and perineum (the muscle and tissue around the outside area of your vagina and anus). Although stopping pushing can be hard, -you could try short panting breaths or slow steady breaths to help you achieve this.
Although many women are worried about the possibility of tearing during the delivery of their baby it can be reassuring to remind yourself that midwives are very experienced and practised at guiding women and helping them to avoid tears whenever possible.
Positions for the second stage of labour
Although by this point in your labour you may be extremely tired and the contractions are lasting longer, it is best to resist any urge to lie down as this will not help the progress of the baby through the birth canal.Your partner can help support you while you hold certain positions and help you to remain upright if possible so that gravity can assist your baby. Many women find squatting or kneeling on all fours the most comfortable, or if you really need to lie down, get your partner to support one leg so that the pelvis can remain as open as possible.

How long will the first stage of labour last?
The first stage of labour lasts until the cervix is fully open, or ”dilated” (see p.181). Women tend to time their labour from the first contractions, but midwives and other healthcare professionals don’t start to time a labour until it is ”established” once contractions are coming regularly, roughly once every three or four minutes, and lasting for about 45 seconds to one minute, and the cervix is around 3cm dilated Due to the difference in how labours are timed, you may hear about labours that lasted 50 hours and others that lasted two! On average, for first-time mothers labour lasts around 12-14 hours. If it continues after this time, the doctor may want to investigate why labour is not progressing
Once labour is established, healthcare professionals usually expect the cervix to open at an average rate of half a centimetre an hour. However, there are huge variations in this average,
and a labour can still be progressing normally with a slower or faster rate of dilation Your midwife will keep you informed about how things are going during your labour, and don’t be afraid to ask how things are progressing.
Is it best to stay upright in early labour?
It is thought that keeping upright and mobile can help labour to progress and make the pain easier
to manage. This is because in an upright position the baby’s head can press down onto the cervix and in turn stimulate it to dilate, and also gravity helps the baby to move down through the pelvis.
I’m having a trial of labour-how long will I be allowed to be in labour for?
A trial of labour is something that is done if, for example, a woman has had problems in pregnancy.
I’m scared in case I poo in labour, how will I feel?
You are not alone — lots of women are very nervous at the idea of pooing while they are in labour. It may not be what you want to hear, but in fact a large number of women do poo, usually during the second, or pushing, stage of labour. This is totally natural and happens as the baby’s head comes down the vagina and pushes against the rectum, where faeces are stored. The faeces are then forced out of the anus and this is totally beyond your control. It is unlikely that you will be aware of pooing at this stage — the overwhelming sensations of birth will be more powerful! Midwives and doctors are very used to women pooing, and will simply wipe it away without a second thought. Also, sterile cloths will be placed around so it will be easily cleared away.
Will I tear when the baby comes out?
Some women do sustain some degree of tearing during the birth of their baby Unfortunately, it is impossible to tell whether you will tear or not until the actual delivery Some tears only involve the skin and may not require any stitches However, others can involve the skin as well as the muscle underneath and the vaginal canal, and this will require stitches Stitching will be performed by an experienced midwife or doctor after you have had a local anaesthetic injection. There is some evidence to suggest that regularly massaging the perineum, which is the area between the vagina and anus, during late pregnancy may help avoid tearing (see p.111) Allowing the baby’s head to be born slowly can also help to prevent tears (see p 186).
What does a “skin-to-skin” birth mean?
”Skin-to-skin” is a phrase that means cuddling your naked baby against your bare skin. Many women wish to have skin-to-skin contact with their baby straight after the birth. This can help with bonding, the baby’s temperature control, and the initiation of breastfeeding. As long as you and your baby are well, there should be no reason why this cannot be done — having your baby cleaned, weighed, and dressed can wait a moment. Most health professionals now recognize the importance of this early skin-toskin contact, and will help you achieve this if that is what you wish. Communicate your thoughts and desires to your midwife as early as you can following admission to the labour ward, so that the midwife can plan your birth to try and meet your wishes.
What is the third stage of labour?
The third stage of labour lasts from after the birth of the baby until the placenta, or afterbirth, and membranes (the amniotic sac your baby has been growing inside) have been delivered. This stage can last for around 10-15 minutes to an hour, depending on whether you have drugs to speed it up (see below).
How does the placenta come out?
After the birth of your baby, the uterus starts to contract again and the placenta shears away from the wall of the uterus and passes out through the vagina. This will not feel the same as giving birth to the baby as the placenta is soft and squashy and much smaller! You may have had an injection to speed up this part of labour, and this is referred to as a “managed” third stage (see below). If this is the case, your midwife will apply gentle traction to the umbilical cord to guide the placenta and membranes out. If you are having a natural third stage, you won’t need an injection, which may mean that this part of labour lasts a little longer, and the midwife will encourage you to deliver the placenta and membranes by pushing, and perhaps squatting over a bedpan Your midwife will advise you as to whether a natural or managed third stage, or a choice between the two, is most suitable for you
What happens when you have an injection for the third stage of labour?
Women are usually offered an injection of syntometrine during the baby’s birth. This is a mixture of two drugs, syntocinon and ergometrine, both of which help the uterus to contract and so speed up the delivery of the placenta and membranes This is also thought to help prevent the risk of heavy bleeding. Having this injection means that the third stage of labour lasts about 10
to 15 minutes. If you have raised blood pressure you will be offered a slightly different injection - just the syntocinon - as ergometrine is known to stimulate a rise in blood pressure.
What happens to the placenta?
checking the afterbirth
The placenta has sustained your baby during her nine months in the womb, and what happens to it after its delivery is a common question.
* The placenta will be checked to ensure it is complete and has been delivered successfully If it looks healthy, it will be disposed of in the hospital
* It may be taken away for analysis in a laboratory if there is anything untoward in its appearance.
* Some cultures perform ceremonies with the placenta; and in some parts of the world there is even a tradition of eating the placenta
However, if your pregnancy, labour, and birth have been straightforward, there is no reason why you should not have a ”physiological”, or natural, third stage of labour.
What will happen once my baby has been delivered?
Once your baby has been born, if all is well, you will be encouraged to hold him and get to know him. The placenta and membranes will be delivered and the midwife will examine your vagina and perineum to see if you need stitches, which will be done under a local anaesthetic When you are ready, your baby will be checked over (see p.217), labelled with your name and her date of birth, weighed, and dressed. If she hasn’t fed already, the midwife will help you with the first feed You and your partner may also be offered tea and toast, which is usually most welcome! Before going onto a postnatal ward, you will be helped to wash and go to the toilet. If you and the baby are fit and well, you may be able to go home within a few hours, sometimes straight from the labour ward, providing you have all the help you both need.
If you have a Caesarean, you will be moved to a ‘recovery” room near to the theatre for up to two hours to observe your breathing rate, pulse, and blood pressure. Your incision and vaginal blood loss will be checked as will your fluid levels, and the midwife will help you to breastfeed your baby. You will then be moved to a postnatal ward.
It all sounds very “busy”. Will we be left alone at all once the baby is born?
Many couples look forward to having some time alone together after the baby’s birth in order to start to get to know, and bond with, their baby in private. There shouldn’t be a problem with this, as long as neither mum nor baby has any medical problems The midwife will make sure you know how to call for assistance if you need it. You would usually be taken to a postnatal ward about two hours after your baby’s birth, if all is well Or an early discharge home may be an option.

The three stages of labour
How your labour -progresses
Your labour is divided into three stages. The first stage begins when you have regular contractions that widen your cervix: the second stage starts when your cervix is fully dilated and ends with the birth of your baby; and the third stage is the delivery of the placenta and membranes
What is the first stage of labour? The first stage of labour describes the process in which your cervix dilates (progressively opens because of the womb contracting) from being tightly closed to being around I Ocm - wide enough to get the baby out, or ”fully dilated”. During this first stage
of labour, contractions generally start off gently and don’t last very long - about 30-45 seconds. It is now recognized that you are in established labour only if you are 4cm dilated. Prior to this stage, the contractions you have been feeling have been
The birth of your baby
ripening (effacing) your cervix During the early stages of labour, it is a good idea to rest and eat carbohydrates such as toast or pasta, so that you will have some energy when the contractions really kick in. This is called the latent stage of labour. Once the contractions do start coming regularly, staying active is beneficial in that it can help labour become established, as gravity will help press your baby against your cervix Going to bed could result in labour ceasing altogether. In a first labour, the time from the start of established labour to full dilation is between 6 and 12 hours, although it is often quicker for subsequent labours.
What is “transition”? Towards the end of the first stage of labour, you may feel a great urge to push with each contraction. This period, when you are between 8-1 Ocm dilated, is called transition. It may
be brief, or could last up to an hour, and is often seen as the most challenging part of labour. You will need to resist the urge to push if you are not fully dilated, and may need to use breathing techniques - such as blowing out in little puffs - to help you.
What is the second stage of labour? Once your cervix is fully opened (fully dilated), this is known as the second s-age of labour At the beginning of the second stage, you may experience a pause in contractions, but they will resume and you will be ready to push your baby out with each contraction. Your contractions will now be very close together and very strong, lasting 60-90 seconds, for which you will probably need pain relief (see p. 174). Most hospitals will limit the length of the pushing stage to less than three hours You will soon see your baby
What is the third stage of labour? The third stage of labour is the delivery of your placenta. This is the afterbirth that has been feeding your baby during pregnancy You will be offered an injection
of syntometrine to speed this process up and reduce the risk of heavy bleeding, or you can to wait until the placenta comes away naturally If you choose a natural, or physiological, delivery of the placenta, this can take from 30 minutes to one hour, and you tend to bleed a bit more than if you have an injection.

A natural breech birth
If you are having a natural vaginal delivery with a breech birth, this will be carefully handled by an obstetrician. A vaginal breech birth can be slower than a head-first, cephalic, delivery as the bottom doesn’t push down as much The obstetrician will
guide the baby out. Usually, the buttocks are delivered first and then the legs will be carefully guided out The baby may then be rotated to deliver the shoulders as smoothly as possible Lastly, the weight of the baby helps to draw the head down for delivery
or has had a previous Caesarean. This allows a woman to be in labour long enough to determine if a vaginal birth may be possible. It is hard to say how long you will be allowed to labour for, as the length of time depends on how your labour is progressing and the opinion of the medical staff caring for you.
Your labour will be closely monitored, with your midwife regularly assessing its progress to check that the cervix is dilating as expected and that the baby is moving down through the pelvis. You may be offered continuous monitoring of the baby’s heartbeat (see p.192) and would be close to medical assistance in the event of a Caesarean being needed.
When will I be fully dilated?
”Fully dilated” means that your cervix is fully open so that your baby can move down the vagina and be born. When your labour begins, your cervix is either closed, or only one or two centimetres open The contractions of the uterus gradually open it further until it is completely open. Once this happens, you are in the second stage of labour, which lasts until the birth. The point at which your cervix is fully
dilated can occur quite quickly after the onset of strong, regular contractions, or can take many hours.
What is meant by “transition” and why do people say it’s the worst bit?
Transition describes the.period of time between the end of the first stage of labour and the onset of the second, or pushing, stage. Contractions are usually at their strongest and most frequent at this point It can last from a few minutes to over an hour, and in some cases may not happen at all. The transition period is often characterized by a woman feeling exhausted, fed up, unable to cope, shaky, or nauseous. In films and books, this is often the time when a woman swears and gets a bit mad with her partner! It is usually around this time that the first feelings that you need to push begin.
If you experience any of the unpleasant symptoms of transition, it helps to focus on the fact that your baby will soon be born. Try to keep your breathing slow and regular, and focus on your partner and midwife for additional support.

Positions for the first stage of labour
In the early stages, many women prefer to walk around, and being active helps labour progress. If you get tired, sitting on a chair leaning forwards can be comfortable, as can kneeling over a birthing ball or pillows Some women find sitting on the toilet comfy! If you want to lie down, lying on your left side is best as the pelvis isn’t restricted and can open as the baby moves down, and the blood flow to the baby is not affected

Dilatation
In the early stages of labour, the cervix begins to soften, known as effacement, and then starts to widen, or dilate, so that the baby can pass through it and out of the vagina The baby’s head cannot pass through
the cervix until it is I Ocm wide and fully dilated The time this takes varies with each labour, Some women are several centimetres dilated at the start of labour while others take several hours to reach this stage.
2CM DILATED:
6CM DILATED:
10CM DILATED:

LABOUR AND BIRTH
It’s all your fault, stop the pain!
choices for pain relief
What is the best form of pain relief in labour?
As each woman and labour is very different, it is difficult to say which is the ”best” form of pain relief. This will also depend on an individual’s coping mechanisms and pain threshold. There are many different types of pain relief (see p 174) including alternative therapies such as aromatherapy acupuncture, homeopathic kits, reflexology and hynobirthing (using self-hypnosis to reach a state of deep relaxation); natural methods, such as water, massage, TENS, and the positions you adopt; and drugs, such as gas and air and pethidine, and epidural. Your midwife will talk to you about the different choices available and the advantages and disadvantages of each one.
Last time I made a real idiot of myself. I don’t want to lose control again - what do you advise?
The best advice is to know your options, have an open mind, and be guided by labour and how you are feeling. Being positive and having appropriate support can not only result in a good experience, but can reduce your preception of the pain, and feeling empowered helps you to stay in control
Are relaxation and childbirth classes helpful?
Relaxation and breathing techniques taught in antenatal chidbirth classes are extremely useful when used together and at the correct times in labour (see p.176). This, combined with working with your partner and the midwife, can help to make the pain more bearable and thus the birth experience more pleasurable. It is worth pointing out that people have different pain thresholds and relaxation and breathing techniques alone may not be enough to help you cope with the pain of labour, especially as
labour advances. Practising breathing and relaxation techniques before labour begins increases the benefit so classes are helpful.
Can moving around during labour help with the pain?
Providing the labour is straightforward, it does
seem to be the case that being as active as possible can help the progress of labour. Not only does this help with the pain, but it can also encourage more effective contractions so that labour is faster As the labour advances, it may be difficult to get into a position that is comfortable, and often women move around to try to find the best one. Favoured positions are standing, kneeling, or squatting, and rocking the pelvis, either on a birthing ball with your legs astride or leaning onto the bed or into the wall
Being prepared
practical and mental preparation for labour
Inevitably, labour will involve a degree of pain. Although this can be a frightening prospect, accepting this and thinking in advance about how you might deal with the pain may help you to cope better when the time comes. * Be as informed as possible about pain-relief options to help you make choices you are happy with in labour, Find out if you need to do anything in advance, such as inform staff if you want a water birth. * Try to think about the final outcome of labour and view the pain as part of the process that brings you closer to your baby.
How can a birthing ball help during labour?
Using a birthing ball during labour has the advantage of opening up the pelvis to allow the baby to move down more easily You can take your own birthing ball into hospital, and this may be advisable as supplies may be limited.
What is a TENS machine and how do they work?
TENS (transcutaneous electrical nerve stimulation) works by stimulating the production of endorphins, the body’s natural painkillers, and also by blocking some of the pain pathways Electrodes placed on
your back or abdomen are attached to a unit that fires electrical impulses when a button is pressed, blocking pain pathways The strength and frequency of the current can be altered according to your needs. This is a natural form of pain relief that requires no drugs and is a good way to involve your partner, who can position electrodes.
The machines will produce a tingly sensation,
but this does not hurt. Some people do not like the sensation, while for others it works very well, so it’s a good idea to hire a machine before labour to see if this form of pain relief suits you.
The advantages of TENS are that you are in control of your pain relief and are free to move around while you are using it. Check in advance whether the unit supplies TENS, or whether you need to hire one before going to hospital
Will I be able to use my TENS machine at the same time as other types of pain relief?
TENS can be used with pethidine or diamorphine and gas and air, but not with water (because it is electrical) or with an epidural (because of the position of the electrodes on your back).
My midwife says that I can have my baby at home, but what pain relief will I be able to have?
There are a variety of, mainly natural forms of pain relief that you can use in your own home. Alternative therapies, such as aromatherapy, homeopathic kits,reflexology. and acupuncture can all be used, as long as an appropriately trained person is providing them. Many women having home births opt for warm water. either in the bath or in a hired pool, as this is an effective form of pain relief. The midwife can also offer gas and air and pethidine as alternatives, if natural forms of pain relief are not working.
However, you may find that just by having your baby at home, you are less likely to need much pain relief. This is because evidence suggests that women who stay at home for as long as possible during tabour, or for the whole of their labour, have a more positive experience, which includes needing less pain relief. By adopting the correct positions, using massage, and breathing and relaxation techniques, you may find that you limit the amount of medical pain relief you need.
How an epidural works
An epidural is an injection into your back that numbs your body so that you are unable to feel the contractions. For about 90 per cent of women it completely blocks the pain. Epidurals work by blocking pain nerves as they enter the spinal cord Setting up an epidural is a medical procedure that can only be done by an anaesthetist. A local anaesthetic is injected to numb the area of the lower back before the procedure is carried out. A special needle is then carefully inserted into the space near to where the nerves enter the spinal cord. A fine tube is pushed carefully through the needle and left in place so that drugs can be run through it The procedure usually takes around 20-30 minutes, and it takes approximately 15-20 minutes for the epidural to start working effectively.
HOW THE EPIDURAL IS INSERTED:
Will I be able to cope through all the stages of labour using breathing techniques alone?
Relaxation and breathing techniques are extremely useful when used together and used at the correct times. It is common for women to breathe short, rapid breaths at the strongest part of the contraction. Studies show that this can cause a panic-type response in your body that can increase tension and heighten the pain. Learning to “sigh out slowly’ (SOS) and keeping your shoulders down can help you in labour, if you have practised during pregnancy, At the end of tabour, when it is necessary to control the head as it delivers, the midwife will ask you to pant or blow. This is two short breaths out followed by a longer breath out. Combining breathing techniques with working with your partner and the
midwife can help to make the pain more bearable and thus the birth experience more pleasurable. It is worth pointing out that people have different pain thresholds, and breathing alone may not be enough, especially as labour advances.
Can a water birth help with pain?
It is well documented that water can help with labour pains (see p 156). The heat of the water reduces muscle spasms, and the buoyancy of the water relieves pressure on the pelvis, which lessens the overall pain experienced The water is kept around body temperature by topping up with warm water and needs to be covering your ”bump” to be effective. Studies have shown that it can reduce the length of labours and the risk of tearing. Babies can be born completely under water so that they do not gasp until they hit the cold air. Most hospitals allow you to use gas and air in a pool as an additional form of pain relief.
I want to remember everything about the birth - how can I achieve this?
Probably the most effective way to remember as much as you can about your labour and the birth of your baby is to try to remain as healthy and rested as possible prior to the start of your labour, which will give you the best chance of staying strong and clearheaded during labour Feeling strong and having plenty of energy may also help you to remain upright and active during the course of your labour, reducing the need for opioids, such as pethidine, which can create a mild state of amnesia, meaning that you may have some difficulty remembering the finer details of the birth It’s also helpful to have a partner or close friend with you throughout your labour so that they too can help fill in any blanks later, and photographs and videos are good prompts If you do find after the birth that there are parts you can’t remember, you could ask your midwife to let you see your birth notes Or you could try to keep a birth journal between contractions!
I want an epidural but I’m afraid about having one -should I be worried?
Epidurals work by blocking pain nerves as they enter the spinal cord (see opposite). The doctor performing the procedure will be very experienced as it is a very small area they need to aim for. You need to sit very still in the position demonstrated to avoid any problems. There is a slight chance that if the needle goes in too far, it can cause a leak of fluid causing a aural tap”, which can result in a severe headache Other fears include future backache, which may be prevented by changing your position frequently in labour There is a very small risk (although this is highly unlikely) that damage is caused to the nerves.
I’m scared to death about going into labour - will I get an epidural?
The availability of epidurals will depend on each hospital It is best to ask your midwife what the procedure is at the hospital you are booked at If you think in advance that you would like an epidural, or decide in labour that you would like one, let the midwife know as soon as possible so that she can contact the anaesthetist and arrange this.
Will having an epidural slow down my labour?
As epidurals numb your feelings, this can make it hard to know when to push As a result, it may slow the labour or increase the risk of a forceps
or ventouse delivery slightly However, if this occurs the midwife or doctor will gently lay a hand on -your abdomen and will be able to feel as soon as a new contraction begins in your uterus. This will be a
sign to them to encourage you to actively push, even though you do not feel the sensation of the actual contraction due to the epidural anaesthesia. Following the advice of the midwife in this way may reduce the need for an assisted delivery, as pushing with a contraction is safer and more effective in terms of easing your baby through the birth canal.
I’m very keen to stay active in labour - can I do this if I have an epidural?
One of the side effects of an epidural is that your legs may feel numb and unable to hold your weight, which can restrict your movements. Some maternity units do offer “mobile” epidurals. These work in the same way as a standard epidural, but you are given a lower dose of the analgesic drug. This means that you are unable to feel the pain of the contractions, but the nerves controlling your legs, abdomen, and bladder are relatively unaffected so you are still able to remain mobile. This leaves you free to move around and be upright during labour and can also mean that you do not need to have a catheter inserted to empty your bladder. A mobile epidural can also increase the likelihood of a vaginal delivery, as being able to move around will assist the progress of labour, and being less numb means that you will be able to push more instinctively during labour contractions You may want to check in advance with your midwife whether your local maternity unit provides this facility
I’ve heard that pethidine can make you feel sick, and the baby drowsy after birth. Is this true?
Pethidine is from the family of drugs called opiates and is the most commonly used drug during labour. It is usually given by injection and its side effects include nausea, vomiting, dizziness, or drowsiness; it can also delay the baby’s breathing.
To combat the nausea and vomiting, an anti-sickness drug is usually given with pethidine If the baby’s breathing is noticeably affected, an antidote injection is sometimes given to reverse the effects of the pethidine, although this is not usually necessary and would only be given if the baby didn’t respond well to other types of stimulus, such as gently rubbing the baby’s back with a warm towel, or gently stimulating and rubbing the feet of a baby, which can be enough to make him inhale. Your baby’s ability to breastfeed can be affected if he is drowsy, and midwives are now encouraged to
provide extra support to mothers choosing to breastfeed if they have had pethidine during labour in an attempt to overcome this side effect.
When is it best to start using gas and air?
Gas and air, or Entonox, is a combination of 50 per cent oxygen and 50 per cent nitrous oxide (laughing gas). It is widely available in maternity units and can be used in home births. This method of pain relief works by reducing the pain messages that the brain receives. It starts to take effect within 20 seconds, so it is advisable to time your intake of gas and air with your contractions, so that you start taking it just before or at the beginning of a contraction to get the maximum benefit, at around 45-50 seconds.
Gas and air can be used from the onset of your labour. However, some women report that they feel slightly drowsy and light-headed and therefore out of
Pethidine and diamorphine
Opiate drugs used for pain relief during labour
These drugs are useful in the early stages of labour, helping you to relax and deal with the pain, and pethidine in particular is widely used. They can only be administered in the form of an injection by a midwife or doctor, usually in the hospital or a maternity unit. As with much pain relief, these drugs have advantages and disadvantages.
* Pethidine has a sedative effect, relaxing the muscles of the uterus, and is especially useful if you are feeling anxious or experiencing a long labour as it helps you to rest.
* Both drugs can make you feel nauseous and they can enter the baby’s system. If given too close to the time of delivery, they can make the baby sleepy and can even cause problems with the baby’s breathing.
control while taking gas and air and therefore you may find that you want to stop taking it while you are pushing if it is distracting you too much and stopping you focusing on the contractions. Some women manage their entire labour on gas and air alone, while others find that they need another form of pain relief in the later stages of labour
How will I use the gas and air and is it likely to make me feel sick?
Gas and air is breathed in through a mouthpiece or mask that is connected to a cylinder or pipes in the wall that lead to larger cylinders elsewhere You administer it yourself, so are more in control of how much you take and when.
Gas and air can make your lips and mouth feel tingly and dry, and in some cases women report feeling nauseous while taking it. Using a mouthpiece rather than a mask may help to reduce feelings of nausea brought on by the smell of the gas and the sensation of having a mask over your face, and taking sips of water may help. As the effect of gas and air is short-lived, you only need to use it during contractions; taking gas and air between contractions will not help with the pain of the next contraction and is likely to increase the sensation of nausea.
I want to have a great birth but you hear such awful stories -how can I stay positive?
For every awful birth story there is an equally positive one — it does tend to be the case that you are less likely to hear about the positive birth stories as these aren’t such good topics of discussion! However your labour and birth proceeds, the birth of your baby will be amazing because you will finally meet the little person who has dominated your life for the past nine months.
It is sensible to remain open minded about labour and birth, because it’s impossible to foresee exactly how things will go on the day. However, there is a lot that you and your partner can do to help prepare yourselves for labour and birth so that you
Gas and air
A form of self-controlled pain relief in labour
A mixture of oxygen and nitrous oxide that is self-administered in labour.
Gas and air, also known as Entonox, is taken through a mask or a mouthpiece during labour. This dulls the pain centres in the brain and produce a sense of euphoria. This needs to be timed with your contractions as the effects are short-lasting, with the gas being breathed in just prior to and during a contraction You will feel normal once you stop using it
Gas and air tends to be the preferred choice for managing pain in women who want to labour as naturally as possible. The reason for this is that gas and air has several advantages, including the fact that you can remain mobile and active while using it; it can be used during a water birth; it doesn’t affect the baby in any way, and it doesn’t make you feel drowsy during labour, which allows you to feel more in control throughout and to remain as focused as possible on your contractions However, although it is a widely available and a popular choice of pain relief in the UK, it doesn’t tend to be used in the United States.
have the best chance of having a positive overall birth experience For example, you can both learn as much as possible about the process of labour and birth so that you can make informed decisions in labour. You can chat with your midwife, read books, find information on the internet, and attend antenatal classes. Also, knowing how labour progresses helps to demystify the experience and therefore removes some of the fear that accompanies labour and birth. Learning basic relaxation and breathing exercises also helps (see p 173), as being able to relax as much as possible during labour helps you to feel less anxious, which in turn can help the labour to proceed as quickly and smoothly as possible

Breathing techniques
Using relaxation and breathing techniques can help you to relax and cope with the contractions throughout your labour. Try practising techniques with your partner before labour. Learning to control your breathing has many benefits, including helping you to increase your energy reserves and let go of tension and anxiety so that you can breathe with the rhythm of the contraction. In the earlier stages of labour, you may want to practise longer, deeper breaths between contractions to help keep you calm and focused You can also try breathing in slowly at the start of a contraction and then exhaling slowly and continuing this pattern until the contraction has passed. Later in labour as contractions become stronger, you may find taking shorter, lighter breaths helps you to ride over the contraction.

How to manage the pain

There are a range of pain relief options available It’s wise to think about which method you would prefer before going into labour.
Relaxation, breathing, keeping mobile,
and massage: You remain in control and avoid intervention. Being upright can help the position of the baby and there are no side effects. This may not be sufficient pain relief for strong contractions
Water: Using a birthing pool in labour and possibly for delivery can hale you to labour quicker and less painfully, with no side effects.
TENS (transcutaneous electrical nerve
stimulation): Sticky pads placed on your back send small electrical impulses to trigger the release of endorphins. You control the current
with a hand-held device. This may not provide sufficient relief for very strong contractions.
Gas and air: 50 per cent oxygen and 50 per cent nitrous oxygen. This is easy to use and drugs don’t accumulate in your body, Some women feel sick or sleepy and find this isn’t strong enough.
Pethidine or diamorphine: These can lessen
the pain, but can cause sickness and affect the baby’s breathing if given too close to delivery.
Epidural anaesthesia: A local injection near the spine, this is the most effective form of pain relief and doesn’t enter the baby’s system. It increases the chance of forceps, ventouse, and Caesarean, as you may not be able to feel when to push. You will be less mobile and will need monitoring