Bring on the drugs! Pain relief options in childbirth

This article first appeared in the June/July 2016 issue of Your Pregnancy magazine. 

Medicated pain relief in labour comes either in the form of an anaesthetic, where there is a complete loss of sensation, a pain reliever (analgesic), which helps you cope with the pain by distancing you from it, or tranquilisers, which change your perception of the pain by inducing relaxation.

This goes to show how important relaxation is in enhancing the progress of labour and there are many things you can do yourself to keep tension at bay (muscle tension has potential to inhibit labour). But if you prefer medicated forms of pain relief, you do have a few options.

The drug that is given depends on how far into your labour you are, how far dilated you are, what type of medical history you have, your present health and that of your baby or the obstetrician’s or anaesthetist’s preference and expertise.

You may have some say over what you want depending on the situation. How effective the drug is depends on the type of medication, the timing, the route that it is given (into the muscle, or the vein) and the mother’s tolerance of the medication.  

• Also see: Pain management: epidural

Epidural

An epidural is the administration of local anaesthetic, into the epidural space, causing numbness to the areas affected during caesarean/childbirth. It has become safer and more effective in recent years because technology has enhanced the level of anaesthesia/pain relief and minimised the risk of major side effects.

An epidural is performed under sterile conditions by an anaesthetist for caesarean or for vaginal birth. In some instances, an obstetrician will administer the epidural for labour.

You will be given a drip to make sure you have a line/vein open in case of an emergency. Often you will be given fluids via the drip in case you experience a drop in blood pressure, a possible side effect.

A catheter is inserted into the bladder just before or after administration of the epidural and stays in place because you won’t feel the urge to urinate. To administer the epidural, a small area of the back is numbed with a local anaesthetic.

A larger needle is placed through the numbed area into the epidural space of the spine. It can be felt as a little pressure or tingling. The needle is removed, leaving a fine tube in place. The medication numbs the nerves supplying the lower part of the body and you can feel the full effect in about 30 minutes. 

Labour with an epidural may be longer because it can slow the contractions and, because you have no feeling, you may not have the urge to push or be able to push effectively. A well-timed epidural can be allowed to wear off just before pushing starts.

An epidural is sometimes associated with a slowing of the foetal heart rate so continuous foetal monitoring is sometimes required. Other possible side effects for the mother are shivering, numbness on only one side of the body or headaches after the birth.

If you want an epidural, make sure it is given after active labour begins and your cervix has dilated to 3-4cm.

• Also see: Giving birth at a government hospital: what to expect  

Pethidine

This drug is a narcotic and a strong painkiller. It’s given as an injection and starts to take effect in 5 minutes. Timing of the administration of this drug is very important as it may affect the baby’s respiratory centre in the brain, causing breathing difficulties at birth.

There are other drugs available to reverse these effects. Pethidine should be given in the active stage of the first stage of labour and depending on the dose may last from two to four hours. A small dose may be enough if you have it as soon as you need it instead of waiting until you need a larger dose.

The down side is that pethidine can make you and your baby drowsy and disorientated, even depressing the baby’s sucking reflex and breathing. Other possible side effects include nausea and vomiting and lowered blood pressure.

• Also see: How to beat your labour fears  

Aterax

This is a tranquiliser. It is sometimes given together with pethidine, although it can be very effective on its own, especially if you are almost fully dilated. Aterax relaxes you and so it increases your pain threshold.

It has fewer side effects than pethidine and does not influence the baby. But it can cause drowsiness, blurred vision, a dry mouth and lowered blood pressure. Timing of the administration of the drug is very important.

• Also see: Pain relief drugs in labour  

Entonox

This is a 50/50 mix of two gases – nitrous oxide and oxygen and is breathed in through a mask or mouthpiece. It doesn’t take away the pain. It distances and detaches you from the pain. It’s often compared to feeling ‘tipsy’ the way you would normally feel after a few gin and tonics.

It can be used in late labour when it may be too late to use pethidine, or from earlier on when a mother does not wish to use a narcotic. The advantage of entonox is that it has very little effect on your baby and you can control how much you inhale.

It can be used in a bath or birthing pool. It also does not accumulate in the body and is blown off immediately. It’s short acting and lasts a few minutes each time you inhale. The secret is to start inhaling at the precise time the contraction starts as it has a 30 second time lag from inhalation to full effect.

The down side is that it may have very little pain-relieving properties for you – different people are affected differently. You may feel like your breathing is restricted, and it can cause a dry mouth or make you nauseous.

• Also see: TENS: Alternative pain relief during labour 

Spinal block

Where possible, a spinal block would be the procedure of choice for a woman about to undergo a caesarean section.

The procedure is identical to an epidural in terms of positioning, but the drug is injected directly into the spinal fluid (instead of the epidural space) and there’s no residual catheter.

The advantage is that the drug acts immediately and offers a more reliable form of anaesthesia, unlike the epidural where patchy areas of pain may occur. The effect of the drugs given via the spinal route lasts about one and a half hours as opposed to the four hours from the epidural.

Some anaesthetists do a combination of a spinal and epidural in order to gain the quick action and reliability of the spinal combined with the longer-lasting effects of the epidural as well as being able to top up the epidural when necessary. Spinal block is only performed when a mother is undergoing a caesarean.

You’re less likely to get an epidural in a state hospital if you’re going through a normal labour. The use of pethidine and Aterax remain the medications of choice in such situations.

Are you getting ready for labour? What are your fears and what pain relief options are you considering? Tell us by emailing to chatback@parent24.com and we could publish your letter. Do let us know if you'd like to stay anonymous.  

Do you have a question about your pregnancy health that you'd like an expert's feedback on? Email to problems@yourpregnancy.co.za and we may publish your question along with advice from a specialist. Please note that we cannot supply personalised advice.

Read more:    

• 10 tips for an easy labour  
• Alternative pain relief for natural birth
• What is back labour?  
• Coping with labour pain

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