Childbirth – what are my options to manage labour sensations?

Did you notice how we didn’t refer to ‘pain relief’ in labour?

Believe it or not, not all mums will describe their labour as painful, so here at MummyNatal, when we talk about what a Mum may experience in labour, we like to use the phrase ‘intense sensations’, as a Mum may or may not feel her labour sensations as ‘pain’.

During our weekly MummyNatal classes for expectant mums, we do something that we call ‘intense sensation practice’. This is our way of empowering expectant mums with various tools that they may like to choose from, in order to cope with the sensations they experience in labour. We talk about mindful breathing, movement, doing a body scan, mantras, visualisations, and sounding meditations amongst other things.

Of course, when we talk about the birth environment and birth choices, we may get some questions around the more ‘traditional’ or medical options for pain relief. And we’ll always answer any questions or signpost our mums to different places where they can find out more, to be able to make informed decisions. Seeing that we may not cover these points in such a detailed way in a MummyNatal class, here is some additional information that you may want to read on the topic.

Non medicalised tools to use in labour

1. Choose an environment that’s right for you

We touched on this in previous blog posts when we talked about the risks of hospital births and the benefits of home births. The environment where Mum chooses to give birth is fundamental for how labour and birth will develop. And this isn’t to say that you should prefer one place over the other (for example, hospital over home, or vice versa), or one way over another (for example, birthing in water or on ‘dry land’). Something that’s very important to consider is how Mum feels. Mum should give birth where she feels comfortable and safe. And the people who are supporting her in the process should ideally be people she feels comfortable and safe with.

With dads being the most obvious, and often the only, birth partner choice for many families, it’s important that dads know exactly how to support their partners and advocate for them during labour and birth. Creating an environment where Mum feels comfortable, confident, at ease, and protected, can be a fantastic way to help her have a more relaxed, more straightforward and less intense labour and birth.

If you want to know more about how to do this, you can pick up a copy of The Expectant Dad’s Handbook by Dean Beaumont, or of The His and Hers Guide to Pregnancy and Birth by Steph and Dean Beaumont, founders of The Natal Family programmes. Or you can always book on a 4-hour MummyNatal Birth Workshop!

2. Use water

Using warm water during labour can help you relax while you’re experiencing contractions. If you’re still in early stages of labour and are still at home, you can run a nice, warm bath and stay in it until you find it comfortable.

Or, if you’ve chosen to give birth in hospital and one is available, you can use a birth pool. And if you’re planning a home birth, did you know that you can hire or purchase your own birth pool? Remember that you don’t have to necessarily give birth in water if that doesn’t feel right for you – in fact, in some hospitals you may need to check if they are ok for you to give birth in a birth pool. But if you do choose to use water during early labour, it’s worth mentioning that women who do so report experiencing less pain and tend to be less likely to use medical pain relief options, or have an epidural, for example.

3. MummyNatal mindfulness-inspired tools

As briefly touched on, during our MummyNatal classes we like to provide expectant mums with a range of ways, or ‘tools’, if you like, that they can use during labour. That’s why we encourage mums to try mindful breathing, movement, body scans, mantras, visualisations, and sounding meditations, as ways to manage the intense sensations experienced during labour. Everyone is different, and whilst some tools may work for you, they may not work for everyone. But it’s hard to know if you haven’t had the chance to try, which is why we like to provide all our expectant mums with the opportunity to safely explore during our weekly classes, if they wish to.

Medicalised forms of pain relief.

1. Using a TENS machine

You may have come across this term, but what does TENS actually mean? It stands for Transcutaneous Electric Nerve Stimulation, and effectively it’s a hand-held device attached to sticky pads that Mum places on her back. It works by sending electrical impulses that stimulate the body to release endorphins, which are hormones that act as a natural painkiller in our bodies.

Some of the key points to remember if you’re considering using a TENS machine are:

• You can use the machine at home or in hospital, without medical supervision, as long as you have access to someone who can help you position the pads on your back.
• A TENS machine is perfectly safe, and can be used as long as you feel comfortable to – you can continue to move around and control the machine yourself. Just be aware that you may be required to remove it if for any reason the baby’s heartbeat is monitored electronically.
• Although you can buy a TENS machine, a very popular choice is to hire one for as long as you think you may need it.
• A TENS machine CANNOT be used in a birth pool (neither at home nor in hospital).
• Always make sure you read the instructions before using the machine!

2. Entonox or ‘gas and air’

Entonox, which is more often referred to as ‘gas and air’, is a colourless, odourless gas, which is composed of half oxygen and half nitrous oxide. Breathing on this gas happens through a pipe, and the act of inhaling the gas can, in itself, have a profound calming effect, helping you pace your breathing, or simply to breathe more deeply. Entonox is however mainly used to relieve pain.

Some key points to remember are:

• Entonox is easy to use and can be used in hospital as well as at home, provided that your midwives have brought a canister with them!
• When using gas and air, you’re in control. You can breathe at your own pace, and you can stop whenever you feel like it, if you find that it doesn’t agree with you, for whatever reason.
• Entonox has no negative impact on Mum or Baby – it’s perfectly safe, and because you’re breathing in extra oxygen, you may actually find this extremely beneficial.
• Entonox can be used in a birth pool.
• Some mums report feeling drowsy, light-headed, or even nauseous when breathing onto Entonox – if this happens to you, you may decide to stop breathing on it.

3. Pethidine or diamorphine

Pethidine is a painkiller that belongs to the opiate drug family and has properties to aid relaxation. It can be given as an injection by a midwife, it takes about 20-30 minutes to start working, and its effects can last between 2 to 4 hours. It can help you relax and rest during labour. Sometimes, less commonly, a drug called diamorphine (also an opiate) is used instead of pethidine.

A few points to bear in mind about pethidine injections:

• Because a midwife can administer it, it can also be available at a home birth.
• Some mums report that the side-effect of opiates make labour more uncomfortable and find that pethidine only provides limited relief – some of the side-effects can include making Mum feeling sick or even vomit, even when combined with an anti-sickness drug (which can be given to you when you take pethidine, if you choose to have it).
• Some women report that pethidine (or diamorphine) makes them feel dizzy, elated, or, on the contrary, depressed.
• Opiates can cross the placenta and might impact the baby’s breathing, causing them to potentially be drowsy for several days after the birth. It may also interfere with the baby’s rooting and sucking reflex, and could therefore negatively impact breastfeeding, at least in the first few days.

4. Epidural

An epidural is a type of local anaesthetic, and it has to be administered by an anaesthetist under medical control, so an epidural can only be given in hospital. While Mum stays very still, a fine tube is inserted into Mum’s spine, and painkilling drugs are passed into her back via the tube to numb her nerves, thus blocking any sensation around her abdomen. This should mean that if you’re having an epidural, you shouldn’t feel any pain during labour, and even birth.

Things to remember:

• If you have high blood pressure, an epidural may help to lower it.
• An epidural can be topped up with stronger local anaesthetics, should an emergency c-section be required.
• For about 1 in 8 women, an epidural doesn’t work well enough and only numbs parts of the stomach, rather than the whole abdomen, and sometimes the legs.
• It takes about 20 minutes to set an epidural up, and another 20 minutes for it to start working.

Some of the side effects include:

• Mum may feel shivery and even develop a fever.
• Mum will need to stay in bed, as her legs are likely to feel very heavy and weak.
• It can affect Mum’s ability to wee, so she may need a catheter until the effects of the epidural have worn off after the birth.
• Mum will need more monitoring to make sure both her and the baby are ok.
• An epidural can increase the chances of the baby being born with the aid of forceps or a ventouse – this may be because whilst Mum cannot move, it may be difficult for the baby to descend into the pelvis and position themselves in the best way to be born through the birth canal.
• There is a 1% risk that Mum could develop a severe headache.
• There is a very small risk of nerve damage, leaving Mum with a numb patch on her leg or foot, or a weak leg. The risk is rare – about 1 in 10,000 for temporary nerve damage and 1 in 13,000 in permanent nerve damage.

As with all options, you always have to consider what is right for you in your circumstances, as whilst there are options you’d never consider, these may be absolutely perfect for someone else.

And please remember that in everything we do here at The Natal Family, through the MummyNatal and BabyNatal programmes, we always try and enable and empower families to make informed choices. This is why we believe that being able to ask the right questions can make all the difference in the options you decide to consider, and ultimately go for.

Now over to you. What was your experience in labour? What choices did you make? Were you aware of your options and their potential side effects? Do you wish you had known more or done anything differently? Or, if you haven’t given birth yet, did you find this useful? Is there anything else you’d like to know more about?