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Birth pain relief options

Facts verified by Dr Raewyn Teirney.

There are various types of pain relief available to women during labour, although there are several factors that will influence what types can be administered including:
- Where the birth is taking place (eg: hospital, birthing centre, private home)
- Who is helping to deliver the baby (eg: obstetrician, midwife)
- How far along the mother is in labour (eg: first or second stage) and how close the baby is to being born.

TENS machines, showering or labouring in warm water and massage are all pain relief options for women who wish to have a natural birth, and are most useful in the very early stages of labour when the pain is mainly concentrated in the back and abdomen. They can of course be used during every stage of labour, although they gradually become less efficient as labour becomes established. Once labour is established, this is when pharmacological forms of pain relief can provide the most respite for women.

Gas/Air/Etenox
This form of pain relief is known by all three names because etenox is the combination of oxygen and nitrous oxide. It is the most popular analgesia for labour in Australia and works by dulling the pain of the contractions being experienced when it is inhaled through a mouthpiece or mask. Once inhaled, it enters the bloodstream, blocking the pain receptors in the brain for up to a minute, thereby helping many women to get through contractions.
ADVANTAGES
- It can be used at any time during labour and at any type of birth, including home births and water births.
- It leaves the body quickly and does not impact on the baby’s health.
DISADVANTAGES/SIDE EFECTS
- It can make women feel light-headed, dizzy, nauseous and develop a dry mouth, although it has no effect on the baby.
- For many women it is not strong enough to help them cope with the pain throughout the entire time they are in labour.

Sterile Water Injection
This is an intra-dermal injection whereby water or saline is flushed into the spine to relieve the strong back pain experienced during labour. It works by altering pain perception where the stinging effect of the needle into the back alleviates the pain of the contractions on the lower back muscles within several minutes and lasts for up to an hour and a half, and can be given at any time throughout labour, and constantly, if the mother wishes.
ADVANTAGES
- It has no physical effect on the baby whatsoever.
- It can be used by almost all women, even those with underlying medical conditions in hospitals, birthing centres and at home births.
- It has an extremely low percentage of infection and complications associated with its use.
DISADVANTAGES/SIDE EFFECTS
- The stinging feeling before the injection takes effect can be quite painful for some women, who may not find it to be worthwhile when they don’t experience adequate pain relief (although this is uncommon).

Pethidine/Metpid
These are both opioids that give pain relief throughout the entire body by blocking the pain receptors to the brain for up to several hours once injected into the muscle (usually the buttocks or thighs) and take about 15 minutes to start working. Pethidine and/or metpid are used by 25% of labouring women in Australia.

ADVANTAGES
- It can be given by a midwife, and does not need to be monitored by an anaesthesiologist.
- It won’t draw out the length of labour in the same way as an epidural.
DISADVANTAGES/SIDE EFEFCTS
- Women will feel drowsy, breathe less deeply and often have to be given anti-nausea medication at the same time they are given the pethidine or metpid, to stop them from feeling sick.
- It’s a drug that can cross the placenta and slow your baby’s breathing which is why it shouldn’t be used within 3 hours of delivery. Some babies are affected by the drug for days after the birth which may delay the beginning of breastfeeding.
- It can prevent women from being able to have a water birth and home birth.
- It cannot be used for women who are taking antidepressants.

Epidural
There are a few different types of epidurals available but normally, an epidural is a form of regional anaesthetic where a needle is fixed to a thin catheter tube that is inserted amongst layers of tissue in the lower back enabling anaesthesia to be dispensed directly into the spine and the nerves that connect to joints, muscles and organs in the lower part of the body including the bladder.
An epidural can be requested anytime between the first stage of labour until the cervix is fully dilated to ten centimetres. It can also be set up to be continuously fed.
Spinal block epidurals are given to women when the anaesthesia needs to take effect very quickly such as for emergency procedures like Caesarean sections and when labour has been sped up and contractions are extremely intense and painful.
All women who are given epidurals need to have their baby’s heartbeat monitored by medical staff. This is because occasionally there can be a plummeting of the mother's blood pressure  leading to a reduction of blood flow to the placenta causing a severe drop in the baby's heart rate (called foetal bradycardia).
ADVANTAGES
- It takes effect within half an hour of insertion and lasts for several hours.
- It won’t cause drowsiness or nausea although some women can feel itchy, shaky and cold, especially as the drugs starts to wear off.
DISADVANTAGES/SIDE EFFECTS
- It can only be given in a hospital, where an anaesthesiologist is available (although after the epidural has been placed, a midwife can extend the dosage as needed), and not in a midwife-led maternity unit, birthing centre or at a home birth. It is also not compatible with water birth.
- It makes women lose all feeling in their body from the waist down so that they must be in a sitting or lying position, and will have limited mobility and control over their bladder. Mobile epidurals are available in some hospitals but they aren’t commonly offered.
- It can slow down the second stage of labour and has been linked to a greater chance of having an assisted delivery with ventouse and/or forceps.
- Not everyone can receive an epidural – such as people who have bleeding and neurological disorders.
- There is also a small risk of developing short-term or permanent nerve damage with epidurals but it is very minimal.


Dr Raewyn Teirney is gynaecologist, obstetrician and fertility specialist and a visiting medical officer at the Royal Hospital for Women in Sydney and also consults from her private rooms at Maroubra and Kogarah.