Each woman’s labour is unique. The amount of pain a woman feels during labour may differ from that felt by another woman. Some women attend classes to learn breathing and relaxation techniques to help cope with pain during childbirth. Others may find it helpful to use these techniques along with pain medications.

This pamphlet explains:

• Types of pain medication for labor and delivery
• How they are given and how they work
• Anesthesia for Cesarean delivery
• Easy ways to manage discomfort
• Side effects and risk

Types of pain-relieving drugs:

• Analgesia is the relief of pain without loss of feeling or muscle movement. Analgesics do not always stop the pain completely, but they do lessen it.
• Anesthesia is to block all sensations, including pain. Some forms of anesthesia, such as regional anesthesia blocks all sensations while you stay conscious.
• In such cases, analgesia is offered to women in labour or after surgery or delivery, whereas anesthesia is used during a surgical procedure such as Cesarean delivery.

Pain Relief In Labour “Pain Relief”

Coping strategies and pain relief for labour should be discussed between the woman and her nurse/midwife. Nalbuphine (nubain) 10mg IM 4 hourly prn can be given (with metoclopramide 10mg IM 8 hourly prn). Entonox and regional blockade are also available. If an epidural is anticipated, the anesthetist should be involved in discussions early.

How they are given:

Not all hospitals are able to offer all types of pain relief medications. However, an anesthesiologist will work with your health care team to select a suitable analgesia for you.

• Systemic Analgesics
  Some analgesics are given straight in the veins or muscles. They lessen pain but will not lead to loss of consciousness. Other medications may be added to prevent nausea and vomiting which may happen during the procedure.
• Local Anesthesia
  Local anesthesia provides numbness or loss of sensation in the specific area supplied by the nerve blocked. It does not, however, lessen the pain of contractions.
  A procedure called Episiotomy may be done by your doctor during delivery. Local anesthesia is helpful for this procedure or when a vaginal tear happens and should be repaired. Local anesthesia rarely affects the baby. There are rare side effects from local anesthetics.
• Regional Analgesia
  Regional analgesia tends to be the most effective method of pain relief during labor and causes few side effects. Epidural analgesia, spinal block and combined spinal-epidural block are all types of regional analgesia that are used to decrease labour pain.
• Epidural analgesia, or block
  This sometimes causes loss of feeling in the lower half of the body, yet you remain awake and alert. An epidural block may be given soon after the beginning of the contractions or as labor progresses. When required, a stronger medication can be given for Caesarean section or instrumental vaginal delivery.

• • Epidural analgesia is to be given in the lower back into the epidural space outside the spinal cord. There are possible side effects such as headache. Usually, pain relief is immediately experienced.
  • You may be allowed to go to the bathroom after your blood pressure is well maintained. In a “walking epidural” type you may also be allowed to walk.
  • Although epidural block will make you more comfortable you still may be aware of your contractions.
  • Some women get headaches following the labour and delivery. This headache will subside within a few days. However, accidental injury of the covering of the spinal cord may increase the incidence of headache, but the incidence is quite rare and easily treatable if it happens.
• Combined Spinal Epidural block
  This procedure has the benefit of taking away pain immediately at the beginning of labour by direct administration of anesthetic into the spinal fluid and epidural provide pain relief throughout the labour. Some women may be able to walk around after the block is in place; the name “walking epidural” is given for this method.

Anesthesia for Cesarean delivery
Whether you have general, spinal or epidural anesthesia depends on your health, that of the baby, and the presence of certain medical conditions. If you have an epidural catheter in place and a caesarean section is required, a stronger epidural anesthetic can be administered and the epidural medication will be continued so that you can have a pain-free, post-operative period. An epidural analgesia can provide you with the best way of pain relief with minimal side effects.

Easy ways to manage Discomfort
The following are some ways to ease the discomfort you may feel during labor:

• Do relaxation and breathing techniques that you learned in childbirth classes.
• Have your partner massage or firmly press on your lower back.
• Change your position often.
• Take a shower or bath, if permitted.
• Place an ice pack on your back.
• Use a tennis ball for massage.
• Rest between contractions, taking slow, deep breaths as they become stronger & closer together.
• Soothe yourself with cool, moist cloths if you become warm or perspire.

Side effects and risk
Most women have epidural without side effects. The usual side effects are easily managed and treated well. Some drawbacks which are encountered are.

• Epidural analgesia can lower your blood pressure.
• After delivery, your back may hurt you at the injection site, just like any other injection at any part of the body.
• If the covering of the spinal cord is accidentally injured you may get a headache. If not treated this headache may last for a few days. This is a rare occurrence.
• When the epidural is inserted late during labor it may be hard to bear down and push your baby through the birth canal.