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Birthing Options - Pain Relief Options for Childbirth
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by Lana Peterson

Mention childbirth, and inevitably the subject of “pain” or rather what the best ways to avoid it, comes up.

There are VERY few women who will experience childbirth with relatively little to moderate pain as opposed to the rest of us who've been through it without the drugs that can only describe it as “a kinda pain that would kill a grown man”

So naturally we'll leave-no-stone-unturned in the search for safe pain relief!

However, it must be said that labour and childbirth cannot and should not be compared to any other sort of pain like breaking your leg or passing kidney stones!! This is something so completely different because it is a “pain with a special purpose” Contractions have a start and an ending, labour does eventually come to an end and those women who've gone through natural birth, will testify to how “quickly” you forget “how intense & challenging” it was. Instead it can leave you with a sense of immense satisfaction and victory by what you've been able to do. So please, don't wish this special “life-changing” event away. The birth is a part of your pregnancy – Embrace it, - welcome it, - it's what you were meant to do!

But by no means should you feel less of a woman for wanting and using some sort of pain relief, as long as you're well informed of the benefits and consequences of each method.

Water

Most women can attest to feeling more focused by merely being submerged in water along with the ability of being able to move around more agilely and having water poured over a contracting belly can be a huge relief to a lot of women.

If you're birthing at hospital, find out if they have a bath available if you think that using water would be beneficial for you. For homebirths, the bath in your home would be adequate for labouring purposes but if you're wanting more space and are perhaps attempting a water birth, it would be a good idea to hire a birth pool, which is specifically designed to hold more water, be accessible from all sides for the midwife and offer more space to move around in – your partner could even join you in the bath if you wish!! Using the shower could be another good method of relief – Seat yourself on a plastic chair or stool inside the shower for your comfort and direct the cascading waters over your belly or your lower back. Partners can also join you, if your shower is big enough!!

Alternatively, some baths come equipped with a hand held shower device that could be cascaded over your belly.

For birth pool hire, ask your independent midwife or contact: Karen Clark 082 776 3622 or checkout the birth works website for birthing equipment hire at http://www.birthworks.co.za/

Massage/aromatherapy

The benefit of touch, especially during labour, is infinitely underestimated. Massage connects the giver & receiver in a mutually beneficial way, and especially in labour, it offers the mother, the feeling of being supported & “companioned” which has a phenomenal impact on her sense of security and ultimately her perception of pain. It leaves the giver with a sense of purpose, and a feeling of empathy and can leave them feeling better about themselves at being able to provide the aforementioned benefits to the mother. The giver need not be skilled in how to massage but with the mothers direction and perhaps a little help from a midwife or doula, the birthing partner will realize that you don't need to be a professional masseuse to offer touch that gives the labouring woman something truly special – tender, loving care.

Added to touch/massage, the benefits of certain essential oils have proven highly effective as pain relief as well. Lavender massage oil has a wonderful fragrance that's pleasant to a labouring woman and helps relax her. Certain oils aid the uterine muscles to work more effectively and others, offer properties that assist with fear & anxiety. Consult a qualified aromatherapist to prepare a mixture of essential oils that is safe for pregnant women to use during labour if this is something you'd like to try.

For “blissful birth” labour oils, contact Suzanne Leighton at 021 794 2738.

Hypnobirthing

Hypnobirthing teaches mothers and their partners, techniques for a safe and satisfying birth through guided imagery, visualization and special breathing. The technique of learning deep relaxation, helps women to eliminate the FEAR-TENSION-PAIN cycle, unnecessarily associated with childbirth.

Having supported a couple using this method for the birth of their second child, I was amazed at how “in control” of this birth she was. No-one needed to coach her breathing and more importantly no shouting at her to PUSH-PUSH-PUSH. She managed to birth her 4kg baby without any tearing, despite shoulder dystocia!!!!!

Hypnobirthing is definitely not about getting mothers' to be in a trance or sleep state but instead she'll be aware and fully in control, but profoundly relaxed.

For more info on the Hypnobirthing technique or classes contact Robyn Sheldon 021-6742932.

TENS Machine

TENS stands for Transcutaneous Electrical Nerve Stimulation. This is a non-invasive form of pain relief that is completely controlled by the labouring mother. It's applied to the lower back area on the mother and when turned on, gives a tingly, buzzing sensation to the skin covered by the electrodes. Essentially this action causes your body to release it's own endorphins (natural pain killers) and acts as a gateway blocking deeper pain messages travelling to your brain. So the advantages of TENS is that it's controlled by the mother, assists with the release of the body's own painkillers is non-invasive and drug-free. It doesn't cause any drowsiness to the user, allows freedom of movement to any position and does not alter the course of labour. Lastly, it can also be used in conjunction with many other form of pain relief .

TENS does NOT completely eradicate labour pain and some women have a slight allergic reaction to the material of the electrode pads or the conductive gel or plaster used to hold the device in place.

A word of caution – DO NOT USE THE DEVICE IN WATER – Or you may be in for a shocking experience!

You can hire TENS machines from most independent midwives or call Karen Clark 082 776 3622 or visit http://www.birthworks.co.za/

Epidurals

This is an injection of anaesthetic given into the epidural space around the spinal cord, numbing the area below the injection site. Once administered by a skilled anaesthetist it takes effect within 10-15minutes. The advantages are that in some instances it can completely eradicate the sensation of pain, allowing the mother to relax more easily and possibly facilitate quicker cervical dilation. It can reduce high blood pressure in women with this condition and it allows the mother to be fully conscious during the birth. The disadvantages are possible partial numbness ie. The anaesthetic only takes effect in “patches” on the abdomen leaving areas exposed to the sensation of pain. It does confine the mother to the bed, therefore a urinary catheter will be necessary. In most instances, food intake will be discouraged so therefore an iv drip will be inserted for this purpose and as a counter measure to a rapid decline in blood pressure.

Sometimes the epidural can “slow-down” the process of labour so therefore labour-accelerant drugs may be needed to “move things along”. Most women do not experience the urge to push and may require an instrumental delivery with forceps or vacuum extraction, which would mean needing an episiotomy.

The effects of the epidural last between 3-4 hours. There is much debate about when the best time is to have the epidural administered : in early or active labour.

This should be the mothers' decision after being thoroughly counselled on the advantages and disadvantages of this method. TIP . You will NOT wish to be counselled when you are in the “throws of labour”!! Discuss this option of pain relief with your medical caregiver BEFORE your baby's birth.

Entonox (Gas & Air)

The combination of nitrous oxide & oxygen, is inhaled through a facemask or mouthpiece and deep breathing is required to activate the dispensing machine. It starts to take effect within 20 seconds and the maximum effect is felt after about 45-60 seconds. Inhalation must be started at the very beginning of each contraction and be continued until the peak of the contraction has passed. The effect wears off quickly and does not affect the baby. The mother controls the administration. This is a mild form of pain relief and can be used in conjunction with other methods (like being in the bath or with TENS machine, pethidine, etc.) The action of deep in and out breathing also helps the mom breathe more effectively during contractions.

Some women complain of becoming nauseas and others do not like the claustrophobic feeling of having a mask over their face. Generally it's advised to use this method during the late active or transition phase of labour.

Accupuncture

Accupuncture is thought to help stimulate the body's natural release of endorphins as well as interrupting the transmission of pain-stimuli. It is also commonly used to induce labour. Accupuncture for pregnant women must only be done by a skilled therapist as it's effects can be quite powerful.

This option may not be too readily accessible to women planning on a hospital birth, due to limited access in the labour wards and sometimes lack of understanding of alternative methods of pain relief by medical personnel.

Pethidine

Pethidine is a derivative of Morphine, which is given as a sedative during labour. It sedates the mother and has a secondary effect as a muscle relaxant, which lessens the pain and reduces muscle tension, allowing faster dilation. This method can have side effects that affect both the mother and the baby.

Some women experience nausea, vomiting, light-headedness and a feeling of being “high”. It crosses the placental barrier and can cause respiratory depression in the baby. It is important that this drug be administered timeously so as to allow it's effects to wear off before the baby's born. Should the baby be born with a high dose of pethidine in its system and antidote can be administered to the baby. Mum's should note that the baby might initially be lethargic and not interested in feeding until the drug has run its course. Pethidine can be administered by obstetricians and independent midwives. It can take between 10-20minutes to start working and remains in the system for 3-4hours.

Aterax

Is an antihistamine drug mainly used as pre-anaesthetic medication. It can also be used in labours where the cervix is slow in dilating, to calm an anxious mother. It appears to have no undesirable effect on the mother or baby and is in some cases given in combination with pethidine so as to offer pain relief and help normalise inco-ordinate uterine contractions.

The purpose of making women aware of the pros & cons of pain relief options is not to overwhelm them with more information but rather to facilitate open debate & discussion for you & your baby's well being.

There may be many other methods of pain relief that women have tried that might not have been mentioned here.

It is also important to note that access to certain methods of pain relief might be restricted to where you are having your baby (home, state hospital, private hospital or active birth unit) as well as what your medical caregiver is “familiar” with.

Discuss the options of pain relief that appeal to you with your caregiver well before the time as it could mean changing caregivers to get what you want.

Lana is a qualified Doula at Lalilu Doula Care. She can be contacted on 021 703 4291 or 073 514 9754. She can be emailed at lalilu@sybaweb.co.za.