Friday, 20 January 2012

Pain Relief Options

Last night, Ross and I attended our second birth preparation class and it was SOOO much better than the first.  Hooray!  Our midwife, Mandy, was there to help out (which was a factor in the improvement, but not the only reason).  The midwife who led last week was still in charge, but seemed more relaxed and confident.  There was also a LOT more content covered and we learned several useful pieces of information.

The topics we covered were pain relief options, final stages of labor, and after care.  I figured I'd break it up into a couple of posts because there is so much to tell you.  Here are the pain relief options available to women giving birth in the UK.  (I'm going to talk a big game about my ideals and desires for a natural birth, which may come back to bite me later... so enjoy!)

Pain Relief Options:
1.  Entonox (Gas & Air)- a mix of 50% nitrous oxide and 50% oxygen

    This method of pain relief is available in all settings (home birth- they'll deliver canisters to your home!, Birth Centre, or Hospital).  Of the 4 midwives I've spoken to about it 3 were BIG fans.  The valve on the mouthpiece (pictured above) is 2-way, so you can breath in and out normally while it's in your mouth.  The midwives who were fans said that it was great to regulate breathing and calm down mothers who were freaking out.  It's completely controlled by the mother and so many women like it.
     For maximum benefit, the gas should be inhaled at the start of the contraction so that it's reached full effectiveness by the time the contraction peaks.  Apparently, some women feel nauseous or disoriented when they use this, but the good news is that it doesn't stay in your system long, so if you do feel ill you can just stop using it.
     They like to say that this method of relief doesn't affect the baby, but from what I've read it does cross the placenta- it just doesn't stay around long, so I guess they don't worry about it...  (One person in the class even tried to list "Gas & Air" under the "Natural Methods" heading of pain relief options.)  Ross found online that it can also deplete your B12, but the midwives poo-pooed that and said it would take prolonged exposure for that to be an issue.  It can also dry out your lips, mouth and throat.
   Personally, I'd rather not use this.  I'm not ruling it out completely, but it seems the biggest benefit is to calm the laboring woman down, rather than actually relieve pain.  It's my feeling that I shouldn't need meds to manage my fear/anxiety.  I should be able to stay calm through other methods.  (But I make no promises or guarantees and reserve the right to change my mind once I'm actually in pain!)

2.  Pethidine/Diamorphine-  an injection, delivered into the hip/butt of one of these two opioid drugs

    This method of pain relief is available in both the Birth Centre and Hospital settings, as it can be administered by a midwife.  The midwives seemed to be doing that thing where they had to tell you about all the options, but weren't really fans of this one.  They didn't say anything specific, but Ross and I both got that feeling.  Women can get this shot multiple times, but the first 2 don't need a prescription so it's harder to get 3 or more.  The midwives did say that most women only need one shot, so that isn't too much of an issue.
    Pethidine isn't used as frequently any more because it seemed to affect the babies more and could make women feel ill.  (In fact, it's automatically mixed with an anti-emetic for injection because of this.)  Diamorphine does still cross the placenta, but they said it doesn't seem to make the baby as sluggish.  
    This options makes me nervous because it is an opioid- which seems fairly hard core.  The fact that it would be in our baby's system is an even bigger deterrent for me.  Ross has had some fairly extreme reactions to medications in his past, so the idea that baby might genetically be pre-disposed to react makes me VERY uncomfortable.  For some reason, I feel like this is the method I'm least likely to use.

3.  Epidural- drugs delivered via a catheter into the spine

    This method is only available in the Hospital setting and must be delivered by an anaesthetist.  The midwives said that at North Manchester General (where I would be) only has registrar level anaesthetists give these.  I still don't really understand the British levels-of-doctors system, but a Registrar is a senior doctor.  The midwives said that a good epidural should stop the pain, but leave you able to feel the contractions and have some lower half mobility.  There is a port where they can "top up" the epidural as time goes on.
    The epidural does cross the placenta to the baby, but there are mixed reports on what effect this has on the baby.  The midwives said that they'd have a hard time discouraging a woman from an epidural if she was having a really long, arduous labor or had to be induced with pitocin.  
     I'm really hoping to avoid an epidural, but- never say never!

This has gotten really long, so I'll leave it there.  Next time, I'll cover all those "Natural Methods"- especially the ones that I'm hoping to use to avoid all the stuff I talked about above.

Were any of those news to you?  (They were to me!)
What kind of pain relief did you go for?


  1. I hated, hated, HATED gas and air. Like, with a passion. In fact, after I threw up from trying it the midwife kept telling me to 'fight through it' and get past the sick. I just couldn't. I refused pethidine because of the crossing over to the baby. I spent time in the tub, which I loved, and then caved at about 7 cm and got an epidural, which didn't work. So all natural.

    Then, with my daughter here in the US, I chose to go natural, and had a water birth. At different points I was begging for an epidural but didn't cave, and am so glad I didn't, for me. I loved the water, it was so helpful with pain, and she was born in the water which I loved. Is a water birth an option for you?

    Oh - I had a TENS machine for my son. It did help a little but I didn't use it for long.

  2. Gas and air also made me sick. And I felt sick for at least an hour after I stopped using it which is so much fun when you are in that much pain. I also had the Diamorphine twice which only worked minimally with the first dose for about twenty minutes. I'd say epidural every time (if you can get one - which you might remember, I couldn't due to the doctors being "too busy").

  3. Just saw your comment on Happy Homemaker. I'm due any day now, and as the first was a C-section in the US, I'm actually happy giving the second a go in France. Wanted to wish you a healthy and enjoyable rest of pregnancy, and good luck with your UK birth; I'm glad to see a mom doing her research.

  4. I'm with Andrea, I absolutely hated the gas and air. My midwife kept trying to get me to use it and I got so frustrated with her I almost threw the inhaler tube in her face. I got to 6 cm on my own before begging for an epidural, but had to wait the most painful hour of my life before they finally got around to giving it to me. I felt absolutely no contractions once my epidural kicked in and I felt like I was almost cheating at giving child birth because of how pain free it was!! ha ha! Of course I paid for it later when they had to use forceps to bring my little gal into the world. Ugh sorry, this is not the kind of story you want to hear while you are anticipating what your own delivery will be like!
    It's great that you are researching and staying open to all of the options available to you, as you never know how you will react when you are in labor yourself. It's best to know what's available and then use whatever form of pain relief feels right for you at the time.

  5. Thanks for the insight ladies! I'm hoping for the best, but def keeping an open mind :)