Active labour, especially in first-time mothers, can stretch up to 18 hours. Pain management during labour is important because pain can contribute to maternal fatigue which is linked to emotional responses such as anxiety and tension. The physiological stress response of adrenaline production comes with harmful effects on the body and may retard the progression of labour. So, what are the ways to make labour more manageable?
If D-day is in a few months or weeks from now, it’s important that you get acquainted with the options available to you. Here’s an easy guide on pain management while in labour.
The non-pharmacologic approach to pain comes with a variety of techniques. While addressing the physical sensations of pain, it also enhances the psycho-emotional and spiritual components of care.
Proponents perceive pain as a side effect of a normal process, not a sign of injury, damage or any abnormality. Instead of making pain disappear, the caregiver assists the woman to cope with it, build self-confidence, and instill a sense of mastery and well-being.
Here are the non-pharmacologic techniques in pain management during labour.
1. Breathing Exercises
We generally benefit from breathing exercises, but it is particularly helpful for women who are in active labour. Also referred to as patterned or conscious breathing, this exercise is the act of breathing at any number of possible rates and depths. It is considered as one of the commonly used methods for natural pain relief during labour and even in delivery.
Some women prefer light or pursed breathing exercise where one inhales through pursed lips and takes in just enough oxygen to fill the chest. Others prefer deep breathing using the diaphragm to breathe in more air. Regardless of technique, the goal is to find a breathing pattern that has a calming and relaxing effect.
Patterned breathing can help you cope with various types of pain, anxiety and fear. In the first stage of labour, these breathing techniques can promote physical relaxation by reducing muscle tension. Consequently, this also promotes emotional relaxation. One study even states that “breathing techniques in labour have a positive influence in the development of confidence and feeling of empowerment in the expectant mother.” Effective use of these techniques contributes to better outcomes and higher patient satisfaction during the birth experience.
2. Warm and Cold Therapy
Warm and cold therapies are basic measures for pain management. Both provide pain relief but in different ways. They may both be applied on the same area intermittently or be used at the same time but in different areas where the mother feels discomfort.
Warm compresses can be dry and wet. A dry warm compress can be through a hot water bag or electric heating, while wet warm compresses can be through gauze compresses, packaged heating and bathing/showers. Warm compresses are applied in the lower back, waist, groin and perineum. According to a study, warm compresses help the muscles relax thereby decreasing or eliminating the pain. It can also facilitate the supply of blood flow.
Local cold therapy also comes in dry and wet forms. Dry cold compresses can be in the form of ice or gel packs and wrap-around packs that come with a Velcro belt. Meanwhile, a cold washcloth is used for wet cold compresses. Application can decrease muscle spasms and muscle temperature. It also creates a numbing effect that decreases sensation and pain awareness.
3. Acupuncture and Acupressure
Acupuncture involves the insertion of fine needles into specific points in the body to correct the imbalance of energy, while acupressure uses pressure applied on similar points. As part of Chinese complementary therapies, these two have been practised for thousands of years, and are now backed by scientific studies. Acupuncture and acupressure have become widely recognized as effective methods of pain relief.
A Cochrane review showed that acupuncture during labour can limit the use of pharmacological analgesia and epidural anaesthesia. It can also trigger the release of several brain chemicals, such as endorphins which block pain signals. Furthermore, women receiving acupuncture in labour appear to experience additional benefits such as shorter labours and reduced rates for instrumental vaginal birth. However, most labour wards in Singapore are not open to acupuncture conducted during labour.
Alternatively, certain pressure points are also found to significantly reduce pain intensity during labour. A study suggests that the LI4 (Large Intestine 4) pressure point can alleviate the pain without causing adverse effects on you and your baby. A randomised trial also showed that applying pressure on BL34 (Bladder 32) can alsoimprove labour pain and even delivery outcome.
4. TENS (Transcutaneous Electrical Nerve Stimulation)
It is nerve stimulation through a device that delivers safe pulses of electrical currents that can help control labour pain. The electrode pads are placed on acupuncture points on the lower back. The currents block the pain signals at it passes through the nerves to your brain. It can reduce the severity of labour pain and it can delay your need for pharmacological analgesia. The gate control theory of pain asserts that non-painful input closes the “gates” to painful input, which prevents pain sensation from traveling to the central nervous system. Therefore, stimulation of the nerves in another mechanism may be able to suppress pain. The TENS machine eg babycareTENS for labour may be available online or rental from some antenatal or obstetric providers. It may be particularly helpful for early labour and back pain in labour caused by the baby’s position pressing on the sacral nerves. Alternatively, strong counter pressure in the back with massage may also help.
Hydrotherapy means immersion in water and come out of the tub to birth. It should not be confused with a water birth, which means to labour and birth in the water. This pain relief option provides physiological and psychological benefits which is highly sought after by mothers who plan to have a natural birth.
For some people, water can be a calming presence. It is also an evidenced-based intervention for pain and anxiety management, which explains why hydrotherapy is introduced in several healthcare institutions in Singapore as an option for pain management during labour.
One study finds that as the mother relaxes through this method it helps reduce the duration of labour and decreases the need for epidural analgesia.
6. Continuous Labour Support
A trained birth attendant (Doula) or partner can provide non-medical labour support to assist with pain management. While you can enlist the help of a doula, your partner can also learn how to provide effective emotional and physical support through the Bradley method in pre-natal classes. Having a birth coach has been shown to reduce the use of epidural analgesia.
Your social environment plays a powerful role in influencing your thoughts and emotions. Your support system can help you look at labour pain as a productive and purposeful pain. With pain intensity increasing by the minute, dealing with it can be hard while you are in labour. But with continuous labour support you become empowered to use your inner capacity to cope. Research shows that this can decrease your need for pain interventions. When done correctly, this can improve your experience with labour pain.
Mental imagery is also a powerful tool in managing labour pain. By applying this method, you can prepare your mind to respond the way you want in situations that you can’t control. Through this you can rehearse the stages of labour, train your mind to stay calm during contractions, and stay focused and alert for long periods of time. The Mongan method is a common hypnobirthing method which involves self-hypnosis and guided imagery techniques which aims to achieve a deeply relaxed state. There are several antenatal classes that teach this technique.
Mentally rehearsing an event with emotional, visual, and auditory detail rewires your brain. It cannot tell if you have physically done it or just imagined it. So, when the event comes, your brain goes on autopilot and recollects how you have mentally rehearsed things to happen and goes about getting it done.
While it is true that labour may not always go the way you have rehearsed it, this technique can better equip you to deal with any necessary intervention with strength and clarity. This can be possible after you have fostered a connection with your internal strengths and resources.
8. Music Therapy and Aromatherapy
Music therapy is found to reduce pain and anxiety during labour. It is a cost-effective intervention that doesn’t need any training to be used.
A person’s familiarity with music and preference is strongly linked to how relaxed they feel when listening to music. One study showed that people who listen to music that they enjoy experience increased levels of natural “feel good” hormones. These are also referred to as the body’s “pleasure hormones” because it can improve your mood and happiness.
Another research also claims that music can affect a woman’s perception of pain and anxiety during the active and latent phase of labour. This study revealed that the active phase and second stage of labour were significantly shorter for participants that were subjected to music.
If you consider music as part of your birth plan, now would be the time to start making that feel-good playlist to serve as a soothing soundtrack to help you manage labour pains.
Similarly, calming smells using essential oils like lavender, chamomile and bergamot can help relax the body during labour while peppermint is good for reducing nausea. Most labour wards will permit gentle calming music and aromatherapy.
Medical Pain Management Techniques
There are two type of medication that can a help ease labour pain: Analgesics and Anaesthetics. Analgesics lessen the pain, while maintaining feeling or muscle movement. Anaesthetics relieve the pain by blocking all sensation of it.
Furthermore, the pain relief provided by these medications can either be systemic, regional, or local. Systemic medications affect the entire body, while local medications affect a small area. Regional medications, on the other hand, affect a region of the body, like the waist down.
Under the two main classifications are different pain relief options which include the following:
Labour epidural is a common method used in labour analgesia because of its extent of action. It also gives the mother time to rest before the pushing stage of labour. It is administered as an infusion of local anaesthetic into the epidural space in the spine. It is normally given when you enter active labour the effects are felt within 5-20 minutes.
You will experience some loss of feeling in the lower areas of your body so you will no longer be mobile, but you remain awake and alert to be able to bear down or push your baby out. Often you will have a urinary catheter inserted to drain the urine passively as you will not feel when your bladder is full.
It does not increase your risk of having a caesarean section but may prolong the second stage of labour as there is decreased sensation that the cervix is fully dilated and reduces the urge to push. Occasionally, the epidural dosage is reduced during this time so that pushing is more effective and that reduces the chance of an instrumental forceps or vacuum delivery. Some patients have a drop in blood pressure or develop shivering or fever while on the epidural. Very rarely do patients get a headache or suffer nerve injury (less than 0.1%). Contrary to popular belief, epidurals do not cause back ache but backache is common after any pregnancy irregardless of epidural usage.
2. Laughing Gas
It is made up of sedating gas that is mixed with oxygen. It will not eliminate labour pains, but it can make it more bearable. Since the effects are mild and short-acting, it is considered a very safe option. You can use it through a tight-fitting mask or mouthpiece when you feel that you need it. Right at the start of the contraction, deep inhalations of this “laughing gas” are used until the contraction starts to subside. However, it can make you drowsy, light-headed or nauseous if inhaled too rapidly or too long hence you are advised to stop once you feel light headed and in between contractions.
3. Opioid Injections
Upon request, opioid injections are often administered into the thigh or buttock to block the pain receptors to your brain. It will take 10-20 minutes before you can feel any effect.
The drug can potentially cause the baby’s heart rate to drop. Rarely, it can even cause drowsiness or breathing problems in the newborn if birth occurs close to the time of administration and in some cases, an antidote is needed to reverse the side effects. Hence it is usually not given when the patient is more than 5 cm dilated.
Isn’t it fortunate that you are now giving birth at a time where you can make the labour experience less stressful than movies make it out to be? However, even with all these pain management options at your disposal, it is still important that you work closely with your doctor in finding one that suits you.
Dr Pamela Tan is a board certified obstetrician and gynecologist in Singapore. She finished her undergraduate studies at the National University of Singapore and earned her post-graduate degree at the Royal College of Obstetricians and Gynaecologists in the UK. She is an accredited specialist by the Specialist Accreditation Board (Ministry of Health), and a fellow of the Academy of Medicine, Singapore. She subspecialises in colposcopy and is certified to perform Level 3 minimally invasive keyhole surgeries such as laparoscopic hysterectomy, myomectomy and cystectomy. Dr Pam also supports the natural birthing method and she strives to provide a personalised care and treatment for each patient.