Management of pain in labour

Every labour and birth is experienced differently. Labour pains may start with irregular small cramping feelings which build up to strong regular cramping pains felt not only in the abdomen but depending on factors such as the position of the baby, they can be felt in the back as well. These pains are caused by contractions of the muscles of the uterus and by pressure on the cervix – which opens gradually in response to these contractions.

The options for managing pain relief in labour can be discussed with the midwife (lead maternity carer) during pregnancy. As part of the labouring process women’s bodies release natural pain relief called endorphins – these are neurotransmitters that help reduce pain, reduce stress, and they are often referred to as “feel-good” hormones.

There are medication-based options, as well as non-medical options for pain relief. Preferences for pain management in labour can be included as part of a birth plan. It’s important to remember that women’s birth plan preferences can change when needed, and this includes choices previously made about pain relief during pregnancy. Midwives support women with their decisions and/or changes of plans. One to one, continuity of midwifery care supports women to manage their labours and increases maternal satisfaction with the birthing experience.

Non-medical options for pain relief

These include breathing techniques, back massage, acupuncture, acupressure, immersion in water, either in a bath or birthing pool, and a warm shower if immersion in water is not available. The position of the labouring woman is also important and can make a difference to both the woman’s experience and the progress of labour. Staying mobile during the first stage of labour, standing during contractions, being supported to stay upright, or using a birthing ball can support labour progress.

Key factors to support non-medical pain management during labour

Support during labour and birth
A known midwife providing continuity of care throughout pregnancy, labour, and birth
Using water – a birthing pool
Comfort measures – for example, massage, warm packs
Staying mobile as much as possible /adjusting position during contractions

Overview of pain relief options

Te Whatu Ora – Labour and birth pain relief options

Non-medical options for pain relief

Transcutaneous electrical nerve stimulators (TENS)

TENS are available for hire in some centres and can be ordered on-line. These are small devices which can block or change pain perception by using low voltage electrical currents. Pads are attached to the lower back and connected to the TENS unit. The TENS Unit has adjustable intensity options to be used at the beginning of contractions. Studies indicate that using TENS is safe and can reduce the experience of pain, although the precise mechanism is unknown. It is thought that the current stimulates the secretion of chemicals in the body that reduce pain. TENS can be used at any time during labour. https://nationalwomenshealth.adhb.govt.nz/assets/Womens-health/Documents/Mat-patient-information/TENS.mp4

Relaxation techniques

The use of some relaxation therapies such as yoga, or music, has been found to be helpful with reducing the intensity of labour contractions and increasing women’s satisfaction with their labours.

Hypnobirthing

Hypnobirthing is becoming popular with pregnant women, and it works by using the power of the mind to ease contraction pains and aims to reduce fear and anxiety. The key techniques for hypnobirthing are controlled breathing, visualisation, and relaxation. Hypnobirthing classes are available in most centres. Here is a detailed explanation about hypnobirthing https://homebirth.org.nz/hypnobirthing/

Medical options for pain relief

Entonox

Entonox is a mixture of oxygen and nitrous oxide, and it is inhaled via a face mask during a contraction. It works quickly and also wears off quickly so breathing the Entonox via the mask during each contraction is usually necessary. There are no known side effects on the baby, but it can make some women feel nauseous or faint.

Medication

Medication in a hospital setting morphine can be used to reduce labour pains and is given via injection. This is an opioid injection which does have other effects as well as pain relief. For example, depending on the time injectable pain relief is given it can impact on infant feeding as babies may be drowsy and disinterested in breastfeeding after birth. It can also affect the baby’s breathing after birth if given too close to the time of birth.

Epidurals

Epidurals are used only in a main maternity hospital as they require insertion by an anaesthetist. A small plastic tube is inserted into the lower back under local anaesthetic. Pain relief medication is injected into this tube during labour. Once the epidural is working there is usually complete pain relief for the majority of women within 30 minutes, as the epidural works by numbing the nerves. Because an epidural numbs the body from the insertion in the back, women are immobilised and unable to walk. It also numbs the bladder and so a urinary catheter may need to be inserted if the urge to pass urine is not felt. Women are also required to have an intravenous drip and continuous monitoring of the baby’s heartbeat.