Labour is classically broken down into 3 stages. The second stage is the actual delivery process, and the third stage is delivery of the placenta. It is the first stage that requires good pain management.
As contractions begin it is natural for a woman to start walking and pacing, rubbing her tummy and arching her back. The baby’s head will be moving down in the pelvis and pressing on nerves which create pains different from the actual uterine contraction. At this early stage, simple positioning, movement and gentle massage of the tummy and the lower back may provide significant pain control.
As contractions become longer and stronger the option of water immersion can be explored. How this works is probably as much relaxation as well as the gentle heat that soothes. The feeling of weightlessness is very soothing.
If there is insufficient pain control with these techniques, then a neuromodulator comb – see our shop or a TENS machine may be a good option. The comb works similarly to the TENS machine (Transcutaneous Electrical Nerve Stimulator). The comb is simply held in the palm and squeezed with contractions so that the teeth of the comb press into the palm and this ‘distracts’ the pain fibres. A TENS machine with pads attached over the lower back will achieve the same through a light electrical impulse – except that, for obvious reasons, electrical stimulation whilst immersed in water is not possible.
Beyond these ‘drug-free’ methods there is the option of an epidural if the facilities exist and the labour is suitable. A trained anaesthetist will inject local anaesthetic into the lower back into the epidural space – an area just outside the nerves of the spinal cord. An epidural requires an intravenous drip for the mum and an infusion of the local anaesthetic until delivery is completed. The numbness that it can achieve is profound. The idea is that the contractions are no longer felt as painful and this brings relief to the labouring mum and often to her partner as well! It does mean, however, that walking is no longer possible because it leads to complete numbness from the waist downwards.
Less commonly used these days are the opiate injections like morphine. These tend to have side effects for the mum of nausea and sleepiness and are in part transmitted into the foetal circulation.
Nitrous Oxide gas is used as an inhalational agent almost as a ‘stand in’ for short spells when moving from one pain management option to another or just before the actual delivery.All labours will be different, but options are many and varied and the first prize is a labour which is safe for baby and mum and leaves mum feeling in control and content that it was a worthwhile experience.