Exploring Pain Relief Choices in Childbirth: Understanding Benefits and Risks
Are you considering your pain relief options in labour?
Childbirth is a unique and transformative experience, and managing pain during labour is a crucial consideration for expectant parents. There are several pain relief options available, each with its own benefits and risks. In this blog post, I will explore a comprehensive range of pain relief choices in childbirth and provide insights into their advantages and potential considerations.
1. Natural Techniques, Hypnobirthing and Relaxation:
Natural pain relief techniques focus on utilising relaxation, breathing exercises, and positions to manage pain during labour.
These techniques can be beneficial for promoting a sense of control, reducing anxiety, and allowing the body to work harmoniously during the birthing process. They include:
- Breathing exercises
- Using a comb on acupressure points
- Rebozo (as pictured)
- Arm stroking
- Arm drops
- Gentle massage
- Tens machine
- Counter pressure
- Using water (either a pool, bath or shower)
- Relaxation techniques, such as visualisation and hypnobirthing
- Movement and changing positions
Benefits: Research published in The Cochrane Reviews suggests that natural techniques and relaxation during labour can lead to reduced use of medical interventions, shorter labours, and increased maternal satisfaction. (Source: Smith et al., 2018)
Considerations: There is limited research on the effectiveness on these methods.
2. Entonox (Gas and Air):
Entonox, commonly known as gas and air, is a mixture of nitrous oxide and oxygen that is inhaled through a mouthpiece or mask during contractions.
It provides quick pain relief and is self-administered by the labouring individual.
Benefits: A study published in the Cochrane Review reported that Entonox is a safe and effective method for relieving labour discomfort. It allows individuals to maintain control over its administration, and its short-acting nature ensures that it does not interfere with the progress of labour. (Source: Jones et al., 2012). It is also safe to use in the pool if you are having a water birth.
Considerations: Some individuals may experience dizziness, nausea, or a sense of detachment while using Entonox. It may not provide complete pain relief for everyone, and additional methods might be required for managing intense pain.
3. Pethidine and Diamorphine:
Pethidine and diamorphine are opioids commonly used for pain relief during labour. They are usually administered through injection into a thick muscle such as the bum or thigh.
Benefits: Studies have shown that pethidine and diamorphine can provide effective pain relief during labour. They act as sedatives, reducing pain and promoting relaxation. (Source: Eberl et al., 2018)
Considerations: Both pethidine and diamorphine can cause side effects such as drowsiness, nausea, and reduced respiratory function in both the parent and the baby. They can also cross the placenta, potentially affecting the baby’s alertness after birth and subsequent feeding journey. Parents may also find it limits their ability to be mobile and active during labour, and it is not safe to use when in the pool. There is also some interesting research that says intravenous paracetamol may be more effective than Pethidine.
Remifentanil is an opioid painkiller that can be administered through a controlled intravenous infusion during labour. It provides pain relief while allowing individuals to remain awake and mobile.
Benefits: A systematic review published in the British Journal of Anaesthesia concluded that remifentanil can provide effective pain relief during labour. It offers rapid onset and offset of action, allowing for flexible dosing and adjustment based on individual needs. (Source: McDonnell et al., 2016)
Considerations: Remifentanil can cause side effects such as nausea, drowsiness, and reduced respiratory function in both the parent and the baby. Close monitoring is necessary, and it may not be suitable for everyone. Remifentanil crosses the placenta and therefore may have an impact on baby’s respiration and alertness when born.
An epidural involves the administration of a local anaesthetic into the epidural space, which numbs the lower body and provides pain relief during labour. It is typically administered by an anaesthetist.
Benefits: Epidurals are considered highly effective in providing pain relief during childbirth. A study published in the Cochrane Reviews showed that epidural analgesia significantly reduces severe pain and increases satisfaction with pain relief. (Source: Anim-Somuah et al., 2018)
Considerations: Epidurals may slightly increase the duration of the second stage of labour, and there is a small risk of side effects, such as low blood pressure and the need for instrumental delivery. This is likely down to the limited movement and common practice for healthcare providers to encourage epidural receivers to lie on their back. It’s important to be aware of your birthing position and try and birth on your side or supported in a leaning forward position.
Making decisions that are right for you
When it comes to pain relief choices during childbirth, there are a range of options available, each with its own benefits and considerations.
It’s important for you to have open discussions with a wide variety of sources to help you make informed decisions based on their preferences and the available evidence.
Remember that pain relief choices can vary based on hospital policies, individual needs, and contraindications. Remember also that many guidelines that exist are not always based on good quality evidence and in some cases are not always evidence based.
Attending good quality antenatal classes can provide additional guidance and support in making the best decisions for a positive and empowered birth experience.