From Entonox to Epidural...
Relaxation and breathing exercises can help you manage your birthing pains. Sometimes this may be all that some women need. Gentle exercise, breathing, posture and relaxation techniques can be very helpful in the early stages of labour. A warm bath may also help. But if they are not enough, here are some other suggestions for getting you through labour.
TENS consists of attaching pads to your back. A low voltage electric current is passed across these pads and this stimulates your body to produce its own natural pain-relieving substances. It takes about 30 minutes before an effect is felt. There are no known side effects from TENS. For some women it is of considerable value. Some mothers find that the TENS is sufficient as a coping strategy for their birthing.
Entonox is a mixture of oxygen and nitrous oxide. The gas works quickly, taking about 30 to 45 seconds to have an effect. In order to utilise the benefit you need to start breathing the entonox as soon as you feel a contraction starting. Entonox can be used throughout both early labour and the birth of your baby. Entonox crosses the placenta but is not known to have any effect on your baby.
Some mothers feel light-headed during use. Occasionally nausea can be experienced. Some mothers complain of a dry mouth, so you may wish to have a glass of water to sip, or small ice cubes to suck. You may experience a tingling in your fingers. This is due to overbreathing. Entonox only works when you breathe it in, so its effects wear off very quickly once you stop breathing it, normally within a minute.
Diamorphine, or Pethidine are injections that may be used to help you to cope with your birthing. They are administered with an injection into the muscle of your thigh or buttocks
These drugs are available to all expectant mothers on request, but individual circumstances are taken into account. The dose given broadly depends upon body weight. You may have more than one dose during labour. They can slow your breathing down if you have too much. If given close to the birth of your baby, they can slow down the baby's breathing and make him or her sleepy.
Powerful painkilling drugs can give good relief. The effect of each injection can be around two to three hours. If given often, in big doses, or too close to the delivery of the baby, they can make you and your baby sleepy and may delay successful breastfeeding.
The nerves from the uterus and birth canal go to the brain through part of your lower back. It is possible to bathe these nerves with local anaesthetic using an injection.
A fine tube is placed in the region of the nerves so that painkiller can be injected. This can be repeated or 'topped up' when needed during your labour. Positioning of this tube is done by an anaesthetist. Once the tube is in position you will be almost unaware of its presence.
A standard epidural
This technique uses a strong local anaesthetic solution. You may find your legs feel quite heavy with this technique.
A mobile epidural
A fine needle is placed in the region of the nerves and a single injection of painkiller is made. The fine tube is then placed in the same region so that 'top ups' can be injected. The 'top ups' are a combination of two types of painkiller. The local anaesthetic is weaker than a standard epidural and it is less likely that your legs will feel heavy. Good pain relief is achieved by the use of a second pain killer in the mixture used for 'top-ups'.
This type of analgesia can be started at any time during labour.
Advantages and disadvantages of epidurals
• An epidural gives much more complete relief from discomfort in labour than any current alternative.
• Normally epidural analgesia is straightforward and very effective, with little risk of harmful effects.
• Epidurals may cause low blood pressure and a drip is routinely set up before they are commenced.
• These methods may not always work in a satisfactory way. In this case it may be possible to switch from the mobile epidural dose to a standard epidural, but it may be necessary to reposition the epidural.
Very rarely a slow leak of spinal fluid can occur afterwards and may cause a headache, meaning you have to lie flat for a day or so until the leak seals itself. Very occasionally a second injection has to be used to seal the leak.
Despite the few disadvantages, most women find that an epidural makes their labour much more enjoyable.