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Different methods are available to relieve labour pain. Effectiveness varies among individuals, but it is helpful to familiarise yourself with the more common methods before you go into labour, so you will be able to come to a quick decision when necessary.
Breathing and relaxation
These refer to the breathing exercises and relaxation techniques which you will probably practise during your antenatal class. When labour starts and you begin to feel pain, concentrating on your breathing rate and breathing out loud will help you to relax. With the help of your partner, your discomfort may also be relieved by gentle massage on your back. You may find this adequate in early labour, but many mothers may have to seek other methods of pain relief when contraction pain becomes more severe.
Nitrous oxide gas
This gas, commonly known as "laughing gas", is mixed with oxygen. In this method, a mask or mouth piece draws gas from a machine beside the bed. You need to take deep and steady breaths before each contraction becomes painful as it takes about 20 to 30 seconds for the gas to be effective. Since the gas will neither build up in your body nor your baby's, it is safe. However, the gas may make you feel light-headed, drowsy or nauseated and not all mothers find this method of pain relief effective.
Injection of drugs
Pain-relieving drugs such as Pethidine (which is the most commonly used) can be injected into the muscles to reduce your labour pain, but their efficacy varies among individuals. They tend to make some nauseated or drowsy and reduce the mother's cooperation in pushing. In addition, these drugs cross the placenta to the baby and make it drowsy and depress its breathing after it is born. If this happens, an "antidote" can be given to your baby to reverse these side effects.
Epidural analgesia
Analgesia means pain relief. The anaesthesiologist will place a very fine plastic tube into your epidural space by passing it through a needle which is inserted in your back at about waist level. After the needle is removed and the tube in place, local anaesthesia is then injected to provide pain relief. This normally takes about 10 minutes to perform and another 10 to 15 minutes for the drugs to work. Each dose may last for about 2 hours before it is necessary to inject more drugs down the plastic tube. Alternatively, a continuous slow infusion of local anaesthetics is sometimes used.
Epidural analgesia is the only method that is capable of providing pain relief in labour, and let you stay awake at all times. The local anaesthetics have the tendency to numb your legs but have minimal effect on your baby. With the help of your obstetrician, you should still be able to push during the 2nd stage of labour. The tube also allows administration of surgical anaesthesia, should an urgent Caesarean section or assisted delivery is required. It may also be used to provide post-operative pain management. Epidural analgesia is particularly valuable when labour is long and difficult.
Combined spinal epidural analgesia (CSE)
Combined spinal-epidural analgesia resembles the epidural analgesia procedure described earlier. However, after putting the needle in your back and before placing the plastic tube, your anaesthesiologist will insert another finer needle through the first needle to puncture the dura (the tough membrane around your spinal cord) for injection of a small amount of anaesthetics. After that, this needle will be removed, and the plastic tube will be put in the epidural space as described earlier. One of the major advantages of combined spinal-epidural analgesia is that it is one of the better and quicker ways to relieve your pain and you can still maintain your mobility.
