Diary Of A Pregnancy

For many women using some of the self-help suggestions above may be sufficient to help them through the first stage of labor, but others sometimes need stronger pain relief to help them to cope. Remember – this is your experience, nobody else’s – and only you can say how you feel at the time. If you get to the stage in your labor where self-help suggestions are not enough for you, or if your labor is prolonged or complicated, you may need something else to help you cope.

Do not feel let down or guilty about this – it is important that you make this decision for yourself in order to stay in control of what is happening. In no way does it mean that you have somehow ‘failed’ if you use drugs or have an epidural to help you – regard this as a positive move for your baby. If you reject additional pain relief when you need it, you will become tired and distressed, labor will become prolonged because the oxytocin and endorphin levels will be affected and you will feel less able to enjoy welcoming your baby when he is born.

There are several options that may be offered to you, although it may depend on where you choose to have your baby as to whether all forms of pain relief are available. For example, it is not possible to have an epidural if you are at home and this will need to be taken into account when deciding on your preferred place of birth.

TENS
TENS is available in many maternity units; you can also hire the equipment privately. TENS is the use of pulsed electrical stimulation via small rubber pads over areas where the nerves to your uterus pass, about an inch either side of your spine, at the level of your waist. The pads are attached to wires connected to a small box, which enables you to adjust the amount of pulsation you require to relieve pain. TENS works on a principle similar to acupuncture, in which touch impulses reach the brain quicker than pain impulses; it also triggers the release from your brain of pain relieving and ‘feel good’ chemicals. It is best to start using TENS early in your labor as it can take some time to build up and become effective. The big advantage of TENS is that it appears to have no adverse effects on your labor or your baby and enables you to remain in control, although conversely, it does not always provide sufficient pain relief.

Caution: if you obtain access to a TENS machine before about 37 weeks of pregnancy, you should not use it until you are actually in labor as some research has suggested that it can trigger premature labor, leading to possible complications. Also, if you are considering a water birth, you will not be able to use TENS once you are immersed in the birthing pool.

Epidural
Epidural or spinal anaesthetic is a local anaesthetic injection given into your lower back by the doctor (anaesthetist). After giving you a small injection to numb the area, a large needle is inserted through the skin of your back into the space between two of your spinal bones until it reaches the part of your spinal canal where the nerve endings for the uterus are situated. A fine tube is passed down the needle and left in your back and the needle is removed. The specific painkilling drug is injected to work directly on the nerves to reduce pain. This is ‘topped up’ by your midwife as you need it or may be given through a continuous pump. Epidurals are especially good if you have a long, tiring labor -being pain-free allows you to sleep – or if you need a Caesarean section. You may also be advised to consider an epidural if you are in premature labor or if there are other complications, as complete pain relief can enable your body to do its work without the stress of progressive discomfort. You would, however, be advised against having an epidural if you have any blood clotting disorders, an infection such as severe genital herpes, very low blood pressure or, occasionally, major back problems. The epidural drug can cause a drop in blood pressure so you will automatically be given an intravenous drip to replace fluid if necessary, and your contractions and your baby’s heartbeat will be monitored with a cardiotocograph machine. Some units offer ‘mobile epidurals’ so that you can be up and about in labor, although the dose of the drug used tends to be smaller so it may not be quite as effective as the normal type.

Epidurals can sometimes cause difficulties with passing urine so you may require a catheter to be inserted, with an increased risk of urinary infection. There is a slightly higher risk of forceps delivery as the loss of sensation caused by the epidural can mean that you are unable to feel where to push your baby out for the birth. A few mothers suffer headaches, neck or backache in the first few days after delivery but this usually passes off fairly quickly. Very occasionally, the procedure of inserting the needle into your back can cause it to move too far inwards, causing what is called a ‘dural tap’, leading to severe headaches and requiring you to lie flat for 24 hours to recover. More severe complications are, fortunately, very rare.