Pain relief during labor

Pain relief during labor

Everything you need to know about pain relief during labor

Labor pain is unique and unlike any other pain. Normally, pain is a sign that something is wrong, but in this case, it leads to something wonderful: the birth of your child. Labor pain has a clear beginning and end, and contractions come in a steady rhythm. The pain comes and goes, as they say. Every woman experiences this in her own way and handles it differently. We are here to support you every step of the way.

Natural pain relief.

How you experience pain and how you react to it are closely linked to relaxing your body and mind. Just follow your feelings and do whatever feels good to you. There are lots of ways to help you feel as comfortable as possible, such as massages, trying different positions, a warm bath or shower, positive thoughts, and a nice environment. Sometimes it takes a little experimenting to find out what works best for you.

During labor, your body produces its own natural painkillers. One of the main pain-relieving hormones released is endorphins. They take the edge off the pain and help you relax, which in turn helps your body produce oxytocin. Oxytocin helps create strong, effective contractions. Fear can get in the way of this process. If you're feeling very anxious or scared, please let us know so we can figure out together where it's coming from and how we can help.

TENS

The TENS machine is a small device that you attach to your back with sticky pads. It gives a continuous flow of tiny electrical pulses. During contractions, you can give yourself an extra boost. This helps you feel more in control. The pulses disrupt the pain signals heading to your brain and help the muscles in your lower back relax. TENS is most effective during the early stages of labor. Experiences vary; some women find it really helpful, while others barely notice a difference. Let us know if you're interested. You can buy the device and pads through your health insurance or rent it from us for a small fee.

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Medication for pain relief during labor

During labor, we won't actively offer pain relief medication right away, but if you ask for it, we will gladly discuss the options along with the pros and cons. Keep in mind that not all types of pain relief can be started immediately. Nitrous oxide (laughing gas) is a form of pain relief that we as midwives are allowed and able to administer (at the Sophia Birth Centre). For other types of medical pain relief, we will need to transfer your care to the hospital doctors and/or clinical midwives. They will want to continuously monitor your baby's heartbeat using a CTG scan.

The epidural

For an epidural, an anesthesiologist places a thin, flexible tube in your back. Your back is numbed and punctured with a needle. The small tube is slipped through the hollow needle and is the only thing that stays behind in your back. A mix of pain-relieving medication is delivered through this tube into the space around your spinal cord. The medicine temporarily numbs the nerves in this area. If the epidural is placed correctly, you might not feel the contractions at all. You will also have less control over your lower body; you can still move your legs, but they will feel quite weak. Because of this, you'll need to stay in bed and have a catheter placed in your bladder.

The epidural keeps working throughout your entire labor. You can get this type of pain relief starting from 3 centimeters of dilation, provided you are having frequent and regular contractions. If labor progresses very quickly or if you request it at a very late stage, it might no longer be possible to get an epidural. Epidurals are available at both Franciscus Gasthuis and Erasmus MC.

When it's time to start pushing, the doctor might decide to turn off the epidural. This helps you push your baby out more effectively. It takes a little while for the medication to fully wear off.

Pros of an epidural:
  • Most effective form of pain relief (little to no pain during contractions)
  • Long-lasting effect
  • Fully conscious: you won't feel sleepy or groggy from the medicine
Cons of an epidural:
  • Transfer of care: the hospital/gynecologist will take over managing your labor. Your baby's heartbeat will be monitored continuously
  • In 5-10% of women, the epidural doesn't work well enough. Sometimes it is placed again
  • Your blood pressure can drop, and your baby's heartbeat might react to this. To prevent this, extra fluids are given through an IV. Occasionally, extra medication is given to raise your blood pressure.
  • Higher chance of developing a fever. In these cases, it's not always clear whether it's caused by an infection or the epidural itself. Sometimes doctors decide to start antibiotics as a precaution. It also slightly increases the chance that your baby will need to be admitted to the neonatal ward
  • Less freedom of movement because you have to stay in bed
  • Contractions can slow down, which might make your labor take longer. If this happens, oxytocin (a hormone that stimulates contractions) will be given through an IV.
  • The pushing stage may take longer. You have a higher chance of needing an assisted delivery (vacuum pump)
  • The catheter slightly increases the risk of getting a bladder infection in the week after birth
  • Risk of post-dural puncture headache. When placing the epidural, a tiny hole can form in the membrane surrounding the spinal cord. Fluid can leak out, causing severe headaches (especially when sitting or standing). Sometimes a small procedure is needed after birth or during the first week to patch the hole.
  • Other side effects: itching

Remifentanil (PCA pump)

Remifentanil is a morphine-like medication given through an IV. A special pump allows you to control the doses yourself using a button. Naturally, the device is set up so you can never give yourself too much. It takes the edge off the pain during the peak of a contraction and helps you relax better during the breaks. Over time, your body gets used to the medication, making it less effective—usually about 4 to 5 hours after starting. For this reason, we don't recommend choosing this pain relief before 5 centimeters of dilation. Otherwise, it won't help you during the final phase of dilation when you need it most. The pump is only available at Franciscus Gasthuis, not at Erasmus MC. When it's time to start pushing, the pump will be stopped so you can regain your full focus.

Pros of PCA (patient-controlled analgesia):
  • Works quickly, often within a few minutes
  • You control it yourself with a button (overdose is not possible)
  • Morphine leaves your body quickly after you stop 
Cons of PCA:
  • Transfer of care: the hospital/gynecologist will take over managing your labor. Your baby's heartbeat will be monitored continuously
  • The medicine can affect your breathing and oxygen levels. We keep a close eye on this. Sometimes it's necessary to provide extra oxygen temporarily using a nasal cannula or mask.
  • The effect of remifentanil on breastfeeding hasn't been thoroughly researched yet.
  • Other side effects: drowsy, fuzzy, nauseous

Laughing gas

Nitrous oxide is a mixture of dinitrogen oxide and oxygen. You inhale the gas through a mouth-and-face mask. This is most effective if you start inhaling as soon as a contraction begins. Once the contraction has passed, you remove the mask from your face. This means you can regulate it yourself. The gas remains effective for 2 hours. Therefore, depending on the expected duration until delivery, it’s possible to start using it once you’re about 7 centimeters dilated (this also depends on whether you’re expecting your first child or a subsequent one). The pain you experience during the peak of a contraction will decrease, and you’ll be able to relax more easily during the breaks between contractions. It’s a form of pain relief that we, as midwives, are authorized to administer. There’s no need to be referred to an obstetrician. Nitrous oxide is available at the Franciscus Gasthuis, the Sophia Birth Center, and the IJsselland Hospital.

 Pros of laughing gas:
  • No transfer of care: administered by your own midwife
  • Laughing gas works after just 1 minute
  • Helps you relax and makes contractions easier to handle
  • No risk to you or the baby
  • Once you stop inhaling, laughing gas leaves your body quickly
Cons of laughing gas:
  • You have to stay in bed
  • The mask can feel a bit uncomfortable (it needs to stay on for up to 20 minutes after you stop using the laughing gas)
  • Side effects: nausea, dizziness, sleepiness. These disappear almost immediately after you stop using the laughing gas