If birth needs a helping hand
Sometimes, despite yours and our best efforts, a helping hand may be needed. It is important to understand what your options are. Ask about the benefits, risks and alternatives to treatment so that you can make an informed choice for you and your baby.
Pain relief—drugs
Good physical and emotional preparation for labour and birth, as well as being as active as possible during labour, may reduce the need for pain relief medication. Pain relief medication may be a welcome relief if labour is particularly long or difficult. It is important to be aware that alongside the benefits of pain relief, there may also be risks that you need to be aware of. In some cases, the use of one kind of pain relief or intervention can increase the likelihood or you needing another.
Nitrous oxide
Entonox is a mixture of oxygen and nitrous oxide (laughing gas). It is designed to provide as good a pain relief as possible without causing undue sleepiness. The gas is delivered via a mouth piece and takes about 30 to 45 seconds to have an effect. To gain maximum benefit you need to start breathing it as soon as you feel a contraction starting. This means the maximum action is being achieved at the height of the contraction. It also assists with relaxation and your breathing rhythm. Entonox only works when you breath it in, so its effects wear off very quickly once you stop breathing on the gas, normally within a minute.
Benefits
- Entonox can be used throughout both the early and late stages of labour
- Entonox crosses the placenta but is not known to have any effect on your baby and is not known to have any negative impact on breastfeeding
- If you don't like the feeling from the Entonox, you can stop using it and you will have no lasting effect
- Increase or decrease the dose of nitrous oxide to suit your needs
Considerations
- Need to ensure you start breathing on the Entonox as soon as you feel a contraction coming to ensure the peak effect coincides with the peak of the contraction
- Is designed to take the edge off the peak of the pain
- May make your mouth and throat feel dry - you may wish to have a glass of water to sip or small ice cubes to suck
- You may experience a tingling in your fingers. This is due to over breathing. Your midwife will know when you are doing this and remind you to slow your breathing down
- It is important to remove the mouth piece from your mouth when the contraction has finished ensuring you breathe normal room air. This will prevent you over breathing on the gas which can cause undue loss of consciousness
Disadvantages
- You may experience a feeling of light headedness or a little disorientation
- You may experience nausea or vomiting
Opiates—pethidine and morphine
Opiate painkilling drugs available include pethidine or morphine. These are used when you request them to relieve pain during labour. They are administered with an injection into the muscle of the thigh or buttock. The drugs can sometimes be given directly into the bloodstream, however the effect is not as long lasting. When given by injection into a muscle, it normally takes 15-20 minutes to take effect. When given directly into the bloodstream via a drip, it normally takes 5-10 minutes to take effect.
Benefits
- The effect of opiates are that they take the edge off the pain and help with relaxation for 2 to 3 hours
- You can have a second dose in labour if necessary.
Considerations
- Needs to be given as an injection
- Recommended to have a vaginal examination prior to administration to check on your cervical dilation
Disadvantages
- Feeling of drowsiness / disorientation that has a lasting effect of 2 to 3 hours
- Nausea or vomiting - therefore an anti-nausea drug is often given to help prevent this occurring.
- If given in large doses or too close to the birth of the baby, opiates can make you and your baby sleepy and can slow down the baby's breathing at birth. The baby may require some resuscitation methods and can delay successful breastfeeding.
- Can slow the progress of labour if given too early in labour, therefore it is usually given after your cervix is 4cm dilated. If this occurs, you may require a drip to get your labour going again.
Epidural block
This is given in the form of an injection into the epidural space near the spine through a fine plastic tube. It takes 15-20 minutes to take effect. The local anaesthetic can be pumped slowly and continuously or "topped up" as required. A Patient Controlled Analgesia (PCA) will be programmed to allow you to administer the drug yourself by pushing a button that releases a controlled amount of drug into the epidural space. Doses can be added until you are comfortable and should enable you to rest as needed throughout labour. For further information, including all the benefits, risks and side effects, please read Consent Information - Patient Copy Epidural Pain Relief for Your Labour. Also ask at Antenatal Classes, or discuss this with your midwife or doctor during your antenatal clinic visit.
Induction of labour
If you have not gone into labour 7-10 days after your due date, or we think that baby needs to be delivered because of complications, we may discuss inducing your labour. This means using one or more of the methods outlined in the Induction of Labour - Parent Information Sheet and is available for you to review. It is important to consider your choices, the benefits and the risks associated with these methods.
Assisted birth
Sometimes a birth without assistance is not possible, despite your and our best efforts. Assisted birth can include the doctor having to help baby's birth by a vacuum cup or forceps. This can happen if baby is in distress (abnormal heart rate telling us baby is not coping) and needs to be delivered quickly or if you are too tired to be able to push baby out. Find additional brochures and further information.
Caesarean section
Occasionally some women require a caesarean section, or c-section. We will explain whatever is happening to you and your baby at the time if this is needed and answer any questions you may have. Our most important aim is for a healthy mum and baby.
There are two types of c-section; a planned c-section (otherwise known as an elective c-section) and an unplanned c-section (otherwise known as an emergency c-section).
It is a good idea to research what might happen if a c-section is recommended and the decisions you may need to make in this situation:
Please remember the information contained in these links are specific to the Mater Mother's hospital and so not all the information is applicable to you—please use this as a guide only.