Pain control

Most women experience pain during labour. Every woman experiences contractions differently. The reason for this often has to do with where the pain is situated. Most women experience abdominal pain during the contractions. But there are also women who feel most pain in their back and/or legs. Sometimes the pain moves from place to place. Try to remain relaxed when labour begins. Tension can increase the feelings of pain, and contractions may not progress in the correct way. There are various things you can do yourself to manage pain, and feel relaxed and comfortable. Good preparation can also help you to cope with contractions.  There are various pregnancy courses available that you can follow. Search the Internet for reliable information, or read a book about labour. Make sure you know what will happen, and what you can do yourself. This way you will be in control, and have a more confident idea about facing the experience of labour. This will also contribute to feelings of relaxation and serenity.

The following items might help you to feel more comfortable during your labour:

  • look for something to distract you
  • rest between contractions
  • count your contractions, each one you count, means one less to face!
  • concentrate on your breathing
  • make sure you are nice and warm
  • have a bath or a shower
  • have a massage (or not)
  • try different positions
  • have someone with you to support you that you care about: your mother, partner, friend
  • Use TENS. This is a machine which gives small doses of low voltage electricity.

If you need something more to dull the pain, you can take painkillers. Apart from nitrous oxide, medicated labour must take place within a hospital. This is because some painkillers can cause complications.


Sophia Birth Centre

Nitrous oxide
 All healthy mothers-to-be (except women with a vitamin B12 deficiency) who are under the supervision of our group of midwives may use gas and air during labour at the Sophia Birth Centre. All Rotterdam West midwives are qualified to use nitrous oxide. This gas can, in principle, be administered by your midwife throughout the dilating phase.

If you want to use laughing gas, you will have to wear a special mask. This mask sucks out the exhaled air, and in doing so it lowers nitrous oxide concentrations in the delivery room. The laughing gas that you inhale yourself is sent through a cap within the mask which you can manipulate when you feel you need a dose. Our experience shows that most women are not put off by the mask. You can use laughing gas until you start to push. From this moment we need you to fully concentrate on pushing. After stopping the nitrous oxide you will be given oxygen for a few minutes.

Laughing gas pros
• it works within one minute
• it helps you to relax, and in this way you will find your pain is easier to cope with
• it is safe for both mother and baby
• you are conscious throughout the birth
• once the flow of laughing gas has been stopped it is quickly expelled from your body and it will not have any long term effects

Laughing gas cons
• a small percentage of women feel a little nauseous. You might also feel sleepy. These side effects quickly disappear when you let go of the mask cap/stop inhaling the gas.
• you may not walk around
• you may not use it when it is time to push. We need you to be able to fully concentrate on your pushing technique 

Erasmus MC

Epidurals (epidural analgesia)

The pros and cons of an epidural:

 

– The most effective form of pain control during labour. In principle, medications administered via the epidural may run continuously, both during dilation and during the pushing phase. Dosage will sometimes be reduced or stopped during the pushing phase to encourage you to actively fulfil your part of the process. This means you might feel pain during this phase.
– Both you and your baby will need continuous and comprehensive monitoring. You will need an intravenous drip, a blood pressure cuff, and by way of the epidural a very fine catheter is inserted into your spine. A medication pump will be attached to this catheter. Your baby will be set up with CTG monitoring via an electrode placed onto its head, and you will have a pressure probe inserted into the uterus to register your contractions. You will also need a urinary catheter.
– The chance of serious complications is very small. Some women undergo unpleasant side effects that are in themselves not dangerous: a drop in blood pressure, headaches, loss of strength in the legs, itching, and loss of bladder function. These symptoms are easily treated and temporary.
– During labour you must stay in bed.
– Approximately 5% of women still experience pain
– Your labour will be supervised by a gynaecologist. Your chosen midwife will therefore not accompany you to the delivery room.
– Approximately 10% of women who have an epidural experience fever during labour. This is either a side effect of the epidural, or the mother may have an infection. For safety reasons, the baby will be treated with antibiotics after it is born until it is certain that no infection is present.


Pethidine
Pethidine is administered via an injection in the bottom or upper thigh. After about 15 minutes you will begin to feel the effect: the worst pain becomes duller and you are often able to relax between contractions. Some women will feel woozy or even fall asleep. The effects last for 2 to 4 hours. Pethidine can only be given to cope with pain during the dilation phase. It is sometimes combined with a sedative such as Phenergan or Normison.

The pros and cons of pethidine:

  • Easy way to deal with pain, which can be given in the hospital at any time during labour (not birth), and which on the whole makes pain bearable.
  • Relaxes and calms you.
  • The effects do not last for long; you will soon be feeling normal again.
  • You may not walk around, but must remain in bed.
  • There are sometimes side effects, and combination with other medications is not always recommended.
  • The baby’s heart tone becomes flatter and the CTG more difficult to assess.
  • Sometimes the baby is a little woozy after birth, and will not take deep breaths. Another medication can resolve this.
  • Labour must be supervised by a gynaecologist. Your own midwife will therefore accompany you to the delivery room.

 

Sint Franciscus Gasthuis

Remifentall pump (PCA-pump)

Remifentanil is, like pethidine, is an opiate drug which is administered via an intravenous catheter by way of a pump system. PCA stands for patient controlled analgesia, which means you can administer a dose of remifentanil yourself by pressing on a button when you feel you need some pain relief. The dosage of the pump is locked, making it impossible to give yourself an overdose.

The advantages and disadvantages of remifentanil at a glance:

  • Administered via an intravenous catheter.
  • Rapid working painkiller which dulls pain with a greater effect than that of pethidine.
  • You are in control, thanks to the button which allows you to administer pain relief when you feel it is necessary.
  • Possible side effects such as itching, drowsiness and nausea are temporary as remifentanil is quickly broken down in the body. An overdose or incorrect dosage can cause slow and shallow breathing.
  • You do not need an anaesthesiologist, waiting times are shorter, and you do not need a needle to be placed in your back.
  • Both mother and baby must be monitored.
  • You may not walk around during labour, but must stay in bed.
  • Labour must be supervised by a gynaecologist. Your own midwife will therefore accompany you to the delivery room.
Pethidine

Pethidine is administered via an injection in the bottom or upper thigh. After about 15 minutes you will begin to feel the effect: the worst pain becomes duller and you are often able to relax between contractions. Some women will feel woozy or even fall asleep. The effects last for 2 to 4 hours. Pethidine can only be given to cope with pain during the dilation phase. It is sometimes combined with a sedative such as Phenergan or Normison.

The advantages and disadvantages of pethidine at a glance:

  • Easy way to deal with pain, which can be given in the hospital at any time during labour (not birth), and which on the whole makes pain bearable.
  • Relaxes and calms you.
  • The effects do not last for long; you will soon be feeling normal again.
  • You may not walk around, but must remain in bed.
  • There are sometimes side effects, and combination with other medications is not always recommended.
  • The baby’s heart tone becomes flatter, and the CTG more difficult to assess.
  • Sometimes the baby is a little woozy after birth, and will not take deep breaths. Another medication can resolve this.
  • Labour must be supervised by a gynaecologist. Your own midwife will therefore accompany you to the delivery room.

For more information about the various forms of pain relief drugs, please have a look at the following website:
http://www.demidwife.nl/labour/subtekstpagina/77/painbehandeling-met-medicijnen/

Spoed / Emergency

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