Birth & Pain Relief

After 9 months of pregnancy you'll probably more than ready for the big day. Although your midwife and antenatal classes will prepare you for what to expect during labour, the experience will be unique to the individual and no two labours will ever be the same.

Going into labour

Labour is divided into three different stages.

The first stage of labour is the time from when your contractions start until the cervix is completely open (dilated), although you won't be considered to be in labour properly until your cervix is 3cm dilated. This stage of labour is usually the longest. It can last many hours, even a couple of days.

Up to a week before labour starts you may get some signs that your due date is close. Early signs include: increased vaginal discharge, a 'bloody show' - which is a plug of mucus often streaked with blood, increased energy ('nesting' such as an urge to clean the house), and Braxton Hicks which are painless 'practice' contractions.

When your contractions become more frequent, rhythmic and longer you have entered the early stage of labour. This means your cervix is starting to soften and dilate (open up).

When you first go into labour, it's a good idea to stay at home, and only go into hospital when your contractions are coming every ten minutes. If in doubt call the hospital and they will tell you whether you need to come in. While at home it's a good idea to keep relaxed by taking a warm bath, walking gently or practising your breathing techniques.

Your contractions will eventually get stronger and more frequent. At this stage you'll want to get to the hospital (or clinic) where your midwife may carry out an internal examination to see how dilated you are. Your midwife (or obstetrician) will check you baby's heartbeat from time to time, usually with a hand-held device.

During this time you may want your birth partner to massage your back and you may want to move into an upright, forward-leaning or kneeling position to help the baby get into a good position and to ease your pain. The National Child Birth Trust says remaining upright can result in the need for less pain relief during the first stage.

The second stage is when the baby is pushed out. This rarely takes more than a couple of hours, and most health professionals prefer not to let a woman push for more than an hour.

The third stage is the delivery of the placenta.

Most births go smoothly, but a small percentage will require some intervention including: a caesarean section, the use of forceps, a ventouse cap or an episiotomy (a cut to make it easier for the baby to be born without causing tearing).

Pain Relief

Giving birth can be a painful experience, and every woman experiences pain differently. There are a wide range of pain relief options available.

Entonox (gas and air)

Gas and air is composed of half oxygen and half nitrous oxide. You breathe it through a mask or mouthpiece. It provides some pain relief but won't remove all pain. It works best if you breathe it in just as a contraction begins.

TENS

Transcutaneous electrical nerve stimulation is thought to be most effective during the early stages of labour when many women experience lower back pain. Electrodes are taped onto your back which you control with a small battery-powered stimulator. TENS is thought to work by stimulating the body to produce endorphins (natural painkillers) and by reducing the number of pain signals sent to the brain. TENS can be bought or hired and may help during the first stage of labour before you go into hospital.

Pethidine

Pethidine is a narcotic that changes the way you feel about pain. It is injected into the thigh and starts working within 10 to 20 minutes, and wears off after an hour or two. Pethidine can cross the placenta after about two hours, and affect the baby, so its use is limited. Pethidine is useful if you have had a long labour and need to rest as it may allow you to sleep between contractions. It does not however take away all the pain and can make you feel sick, sleepy and disoriented.

Epidural

For full pain relief, an epidural is the best option as it numbs the nerves that carry pain impulses from the birth canal to the brain. An epidural is a type of local anaesthetic which gets injected into the gap around your spinal cord in the lower back. It can only be given by an anaesthetist, which means it will not be available in a midwife-only unit or for a home birth. About one in 100 women gets a headache after an epidural. Epidurals can also prolong the second stage of labour as you may no longer feel the contractions and have to rely on the midwife for when to push.

Water

A relaxing warm bath can be effective to relieve labour pain. Most labour wards now have en-suite bathrooms. You may also opt for a water birth where you spend some or all of your labour in a birthing pool. Not all hospitals have these so you should check this in advance. You can also hire birthing pools for use in the home. The National Childbirth Trust says women who labour in water require fewer interventions and are less likely to need other drugs. Both the Royal College of Obstetricians and Gynaecologists and the Royal College of Midwives support labouring in water for healthy women with uncomplicated pregnancies.*

Alternative methods of pain relief

Some women prefer to use hypnosis, massage, reflexology, acupuncture or homeopathy for pain relief. Hospitals will rarely offer these services so you'll need to source a practitioner prior to the birth. You should check the Institute for Complementary and Natural Medicine to ensure that they are properly trained.

Whatever you decide, it is a good idea to write down your preferences in your birth plan, so that all the personnel involved in your labour know what you would like.