About 8 weeks before your baby is due, your doctor will sit you down and ask you to start thinking about your birth plan. Your birth plan includes all of those things you would like in an ideal world to happen when you are in labour. Such as who you want to be in the room with you (your husband, your mother), what sort of birth you would prefer (natural, Caesarean, water birth), and what type of medication you would like to help you deal with the pain.
Some women have very precise birth plans, others prefer to go with the flow. The first thing you should know is this: your birth plan is your choice. Having a birth plan is about making you as comfortable as possible during a very physically uncomfortable process. Your comfort is the most important consideration.
The second is this: all of the decisions you make regarding your birth plan will either be made from the comfort of your own home or from the doctor’s consulting room. You will make them without knowing what giving birth feels like; you will make them when you are not in pain. So. It’s OK to change the plan. I was adamant that I didn’t want an Epidural, but when my baby got stuck and I remained at seven centimetres dilated for over five hours, I changed my mind pretty quickly.
Whether you decide to opt for a more or less complicated birth plan, the one thing you should definitely research before you give birth is what pain relief options are available to you and when during labour they stop being options (as some of them do).
So, with this in mind, here you go.
#1 – Transcutaneous Electrical Nerve Stimulation (TENS)
What is TENS?
TENS is a technique in which nerves in the lower back are stimulated using a TENS machine. A TENS machine is a small, portable, battery-operated device that features (i) a number of small electrodes that are attached to your back using sticky pads, and (ii) a hand-held controller. The TENS machine sends gentle electrical pulses through the body, like small electric shocks.
“Transcutaneous” means through the skin. “Electrical” refers to the small electrical pulses to the body. “Nerve” is the way in which pain signals reach the brain. And “Stimulation” refers to the basic technique of blocking pain signals. If pain signals can be blocked by the tiny electrical shocks from the TENS machine then the brain will receive fewer signals from the source of the pain.
Most TENS machines have a “high intensity” and a “low intensity” mode. Between contractions, you can use the “low intensity” mode, and then, during a contraction, you can use the “high intensity” mode. The “low intensity” mode is believed to stimulate the body to produce its own pain-relieving chemicals called endorphins, while the “high intensity” mode interferes with and blocks pain signals sent to the brain.
Are there any side effects of TENS?
TENS has no known side effects for either mother or baby.
When can I use TENS?
Because you can control the strength of the electrical pulses using the “high intensity” and “low intensity” modes, many women find this method helpful either on its own or in combination with other methods of pain relief during labour.
TENS has not been shown to be effective during the active (or later) phase of labour, when contractions get longer, stronger and more frequent. It's most effective during the early stages, when many women experience lower back pain.
When can’t I use TENS?
You cannot use a TENS machine:
During pregnancy before you go into labour
If you are in a bath or birthing pool
If you suffer from epilepsy
If you have a pacemaker
If you suffer from certain types of heart disease
Once you have had an epidural.
Where can I buy a TENS machine?
Some hospitals have TENS machines that you cannot borrow. If not, you can hire or buy your own TENS machine. We recommend TensCare MamaTENS Digital Maternity Machine for Pain Relief During Labour (which is also an “Amazon Choice”).
#2 – Co-codamol
What is Co-codamol?
Co-codamol is a combination of two different painkillers – paracetamol and codeine – and must be prescribed by a doctor. Co-codamol comes in tablet or capsule form and is swallowed whole with water.
Are there any side effects of Co-codamol?
Common side effects (occur in more than 1 in 100 people) include constipation, feeling sick or vomiting, and feeling sleepy or headachy. Rare side effects (occur in fewer than 1 in 100 people) include dizziness, changes in peeing, a skin rash and changes to eyesight. Inform your doctor immediately if you experience any of these rare side effects.
When can I use Co-codamol?
Co-codamol is recommended for the early stages of labour, when you are no more than a few centimetres dilated. If you are over 18 years of age, you can take 2 tablets up to 4 times in 24 hours. You must leave 4 hours between doses.
When can’t I use Co-codamol?
Co-codamol is not found to be effective during the later stage of labour once contractions get longer, stronger and more frequent. If you are in pain, you may vomit, which will prevent the co-codamol from being absorbed into your bloodstream and will not act as effective pain relief.
#3 – Entonox (“Laughing Gas” or “Gas and air”)
What is Entonox?
Entonox is a colourless, odourless gas made up of half oxygen and half nitrous oxide. It is sometimes referred to simply as “Nitrous Oxide” and is also known as laughing gas. It takes the edge off labour pain, rather than blocking it out completely.
You inhale Entonox through an antibacterial filter using a mouthpiece or mask, which you hold yourself. For this reason, many women prefer not to use Entonox during the active (later) stages of labour as they find it difficult to concentrate on pushing and holding the mask at the same time. The mask is made of a light, transparent plastic.
Mouthpieces and filters are usually designed for one person to use, so you should be provided with a fresh set. A few hospitals use reusable masks and tubing, which should be changed regularly and cleaned between each use. If the mouthpiece you have been given doesn't look clean, ask for a new one.
Are there any side effects of Entonox?
Side effects of Entonox can include drowsiness, nausea and vomiting. If you experience any of these side effects, you may find Entonox to be an ineffective form of pain relief. Or you may find that it makes you feel light-headed and giggly as well as relieving the pain.
Entonox can give you a dry mouth if you use it for a lengthy period of time.
When can I use Entonox?
Most hospitals will pump Entonox into labour wards from a central supply, so once you have told your doctor that you would like to use it, it should be available whenever you want it. You can use Entonox at any stage during labour.
If you are somewhere without a central supply, such as a birthing centre or at home, you can arrange for your healthcare provider to bring Entonox to you in portable cylinders.
Entonox is the most popular method of pain relief used for labour in the UK. According to NHS England, about 80% of women use it to help them cope with pain during labour.
When can’t I use Entonox?
Experts recommend that you avoid using Entonox for protracted periods of time. For this reason, your doctor may advise against using Entonox during the early stages of labour, as early labour can last several hours or even days.
#4 – Pethidine
What is Pethidine?
Pethidine is a strong and effective form of pain relief that comes from the same family as heroin and morphine ( known as “opioids”). It is usually injected directly into a muscle in the buttock. It may also be administered intravenously (directly into a vein) in the thigh.
Another opioid that is commonly used during labour is Diamorphine. However, it is thought that Diamorphine may block the production of oxytocin, a natural hormone that helps to relieve pain during labour, so women can end up experiencing more pain overall. For this reason, Pethidine is recommended over Diamorphine.
Some people are more sensitive to opioids than others. If you know from experience that you are very responsive to opioids, or if you are cautious about trying Pethidine for the first time, ask for a small initial dose.
Are there any side effects of Pethidine?
Side effects of Pethidine can include nausea, dizziness, altered perception, disorientation, and respiratory depression. It is important to remember that many women experience no side effects at all. Because Pethidine can make you feel sick, anti-nausea medications are usually administered at the same time as the Pethidine injection.
Depending on how soon your baby is born after the Pethidine injection, the baby can also experience some side effects such as slower breathing, drowsiness and depressed reflexes. This is because the baby is exposed to the drug via the umbilical cord.
When can I use Pethidine?
Pethidine can be administered in 50mg or 100mg doses. Your doctor may repeat the dose between one and three hours later if the initial injection does not appear to be having an effect. Your doctor will ensure that you do not get more than 400mg of Pethidine in a 24 hour period.
Pethidine is recommended during the early stage of labour, when you are going from one or two centimeters dilated to fully dilated (ten centimeters). It is not recommended during the later stage of labour, once you start pushing, or if it looks as though your labour is progressing quickly.
When can’t I use Pethidine?
Most doctors will refuse to administer Pethidine once you are seven centimetres dilated. This is because the baby is exposed to the drug via the umbilical cord and can experience similar side effects to you, including drowsiness and slower breathing. It is considered less safe for the baby to be delivered in this state, and the drowsiness can persist for several hours after birth.
#5 – Epidural Anaesthesia (“Epidural”)
What is an Epidural?
An Epidural is a mixture of painkilling drugs and is the most effective form of pain relief available during labour. Epidurals are used during natural (vaginal) births and also during Caesarean sections (“C-sections”) as they allow you to stay awake and alert during your baby’s birth.
Epidurals are administered as injections into the lining of the spinal cord in your back and make you feel numb from the waist down. If you require a C-section, you may be given a top-up Epidural, which makes you numb to just below your bra line.
Some hospitals use low-dose Epidurals that contain a local anaesthetic, either bupivacaine or levobupivacaine, plus an opioid, fentanyl. These have fewer side effects (see below). Some hospitals also provide you with a unit by the side of your bed that allows you to top up your Epidural yourself every one to two hours. This is known as “patient-controlled epidural analgesia” but is not available in all hospitals.
Are there any side effects of an Epidural?
It is normal to experience some side effects following an Epidural. These can include nausea, light-headedness or headaches and are treated by the administering of intravenous fluid.
Because of the sudden drop in blood pressure, Epidurals can make your baby stressed. For this reason, your baby’s heart rate will be monitored continuously once you have had an Epidural.
The numbness in your lower body means that you will not be able to tell when you need to urinate. A urinary catheter should be inserted, which will collect your urine in a bag so you no longer experience the urge to pee.
A low-dose Epidural should allow you to retain some sensation in your legs and feet, which means you can move around in bed and change position when you want. Changing your position a little bit at regular intervals prevents you from developing pressure sores on the numbed area of your body. You'll only be able to get out of bed to stand or walk if there are enough staff to support and monitor you, and if your baby’s heart rate can be monitored remotely. This is known as a mobile epidural.
If the Epidural administered is not low-dose, the numbness may mean that you cannot feel your legs at all, in which case your doctor will probably advise you to remain in bed.
Sometimes an Epidural can slow down your contractions and lengthen the active stage of labour, so you may be given a drug called Syntocinon to keep your contractions coming, allowing your labour to progress. If you are unable to push effectively due to altered sensation and reduced muscle strength in your lower half, you may require an assisted delivery. An assisted delivery involves your doctor helping you to deliver the baby by pulling it out using forceps or a suction cap known as a Ventouse.
An Epidural does NOT increase the length of the early stage of labour, increase the likelihood of a C-section or cause long-term backache.
When can I have an Epidural?
You can have an Epidural at any stage during labour, once your contractions become regular – usually three to five minutes apart. As Epidural is a strong painkiller, you may prefer to wait until your contractions become stronger, perhaps when you are five or six centimeters dilated.
When can’t I have an Epidural?
Epidurals are only available in hospitals. You cannot have an Epidural if you decide to give birth in a birthing centre or at home. Some doctors may advise against having an Epidural if it looks as though your labour is progressing quickly (as it takes about 30 minutes to administer the Epidural and for it to take effect) or if you are already ten centimeters dilated, because of the effect the numbness can have on your ability to push.
Remember: it’s your body, your baby, and ultimately your decision. But it’s worth having a Plan B just in case your original birth plan and pain relief choices don’t come to fruition.