Pain relief during labour

OK, it's a long way off, but I'm filling out my little booklet and it asks to list the pain relief options I want. What to choose?!

I definitely want the relaxation etc, and would prefer not to use epidural if I can. The other options are pethidine and nitrous oxide. I guess I'm OK with nitrous, even though I've never had it before. Has anyone else ever had gas? What's it like?

Pethidine I'm less sure about. Codeine makes me vomit if I have it on an empty stomach, and as far as I'm concerned, the less vomiting the better. Has anyone had pethidine? I hate feeling "out of it", it kind of scares me.

I have an appointment with my GP later this week anyway so will be discussing these options with her, but just would like some stories of first hand experiences as well...

tia,
bec

I definitely felt out of it and nauseous with the pethidine, but LOVED THE GAS!!! Heaps of people hate it though, but i loved it. It relaxed me and made me concentrate on the breathing better.

Here's something else to add about pethidine... apparently at a conference in NSW (I think) there was a speaker who is one of the world experts in breastfeeding and medications ... anyway he urged everyone to think twice about using it, as he said that it's actually one of the two worst drugs contraindicated for breastfeeding. It's a narcotic, and while the adult body can get it out of our system in a few hours, it can take a baby days... I will see if I can get more info. All I could find below was from PubMed, the US Medical Library...

:

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Effects of maternal pethidine on infants' developing breast feeding behaviour.

Nissen E, Lilja G, Matthiesen AS, Ransjo-Arvidsson AB, Uvnas-Moberg K, Widstrom AM.

Department of Woman and Child Health, Karolinska Hospital, Karolinska Institute, Stockholm, Sweden.

The aim of this quasi-experimental study was to examine the effects of maternal pethidine during labour on the developing breast feeding behaviour in infants in the first 2 h after birth compared with infants not exposed to pethidine. Forty-four healthy infants were observed immediately after birth. They were placed skin-to-skin on their mothers' chests. The development of mouth and sucking movements as well as rooting behaviour and state of sleep/wakefulness were noted. The observer was blind as to the pain relief the mother had received during labour. Of the 44 mothers 18 had received pethidine. The main findings were that infants exposed to pethidine had delayed and depressed sucking and rooting behaviour. In addition, a smaller proportion of infants exposed to pethidine started to suckle the breast. Rooting movements which are expected to be vigorous at 30 min after birth were affected both by administration of pethidine and a longer second stage of labour. It is suggested that the differences found in sucking behaviour may be a central effect of pethidine. Depression of rooting movements in the pethidine group may be caused by exhaustion due to a longer second stage of labour and administration of pethidine. It is recommended that pethidine-exposed mother-infant couples stay together after birth long enough to enable the infant to make the choice to attach or not to attach to the nipple without the forceful helping hand of the health staff.

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Sasha, I loved the gas with both of mine as well - as much for the focus on breathing as anything else. It helped me to get into pattern with my breathing.

I had an epidural with the 1st one but it was not working completely when it came time to have a forcep delivery. I felt that it slowed my labour down and decreased my ability to push effectively resulting in forceps.

I have however heard people absolutely rave about epidural and want them in as soon as their labour starts. It really is a personal choice though and you don't really know how you are going to react to the pain, or how effective the drugs will be on your body.

My suggestion would be to do alot of reading up (more than the stock standard books) Kelly has listed some good ones on BB and have in depth discussions with your GP/OBS about your options and preferences.

Goodluck with it !

My first pregnancy I had gas and it did nothing for me atall.After hours of pushing,they decided to use Forceps and boy do they hurt.

My second pregnancy I had Epidural and like Relle said,its personal preference and i can honestly say its great.The contractions are still painful,but the downfall is you cant feel when to push and the fact you have to use a bedpan to go to the toilet in after as you are numb for hours after and cant walk to the toilet.

This time I am going to try gas again and see how it is for me.But if it comes to it,i will opt for an Epidural again,and i am not too ashamed to admit that i am a chicken when it comes to pain.

Skorpy, I totally hear you when you say they hurt! Like I said, my epidural wasn't working by the time we got to the forceps, and I can categorically say, the forceps stuffed me up physically and emotionally for a good year!:(

It's the lack of control over my body which puts me off the epidural, I guess. I know that lots of women have it and love it, and I haven't completely disregarded it as an option, but I just would rather not, you know?

Thanks for the extra info about pethidine, Kelly. I think I heard that it also causes the baby to be floppy afterwards - perhaps that was another drug I'm thinking of?

It's good to have all your input, and I'm trying to get as much info at this early stage so that I can feel I'm making the best informed decision that I can. At this stage I think I might steer away from pethidine, though!

Thanks again :)

RE: pethidine...

The pain team at the hospital I work at has completely stopped using pethidine, and removed it from all wards. They have a limited supply for those obstetricians that insist on using it, but even that is locked away. The problem with pethidine is that the by-product of the drug when it is broken down in the body (a substance called norpethidine) can build up and cause lots of problems, including convulsions (fits). A lot of hospitals are phasing it out in favour of morphine (or fentanyl, for people who are allergic or have other reactions to morphine). Of course, none of the opioid-type drugs (morphine, pethidine, fentanyl, hydromorphone) are good for the baby - they all cross the placenta and will all sedate the baby if they are given during labour.

For more info, the TGA highlighted the problems associated with using pethidine as far back as 1997: http://www.tga.gov.au/docs/html/aadrbltn/aadr9708.htm (part way down the page).

If you feel you need an opioid drug to assist with pain relief, I'd suggest asking for something other than pethidine.

One doesn't wish to be a wet blanket, but all forms of chemical pain relief have some nasty side-effects with epidurals being potentially the worst. From Wikipedia comes the following information regarding side effects:

These include:
Accidental dural puncture (about 1 in 100 insertions). The epidural space in the adult lumbar spine is only 3-5mm deep, which means it is comparatively easy to cross it and accidentally puncture the dura (and arachnoid) with the needle. This may cause cerebrospinal fluid (CSF) to leak out into the epidural space, which may in turn cause the post dural puncture headache (PDPH). This can be severe and last several days, and in some cases weeks or months. It is caused by a reduction in CSF pressure and is characterised by exacerbation when the patient raises their head above the lying position. If severe it may be successfully treated with a "blood patch" (a small amount of the patient's own blood given into the epidural space via another epidural needle). Most cases resolve spontaneously with time.

Bloody tap (about 1 in 30-50). It is easy to injure an epidural vein with the needle. In patients who have normal blood clotting, it is extremely rare (e.g. 1 in 100,000) for problems to develop. However, in a patient who has a coagulopathy, the patient may be at risk of epidural hematoma. If blood comes back down the needle, the anesthesiologist will normally site the epidural at another level.
Block failure (about 1 in 20). Partial failure may still give satisfactory pain relief. However, if pain relief is inadequate, another epidural may have to be performed.

Catheter misplaced into a vein (uncommon, less than 1 in 300). Occasionally the catheter may be misplaced into an epidural vein, which results in all the anaesthetic being injected intravenously, where it can be toxic in large doses. This also results in block failure.

High block, as described above (uncommon, less than 1 in 500).

Catheter misplaced into the subarachnoid space (rare, less than 1 in 1000). If the catheter is accidentally misplaced into the subarachnoid space (e.g. after an unrecognised accidental dural puncture), normally cerebrospinal fluid can be freely aspirated from the catheter (which would usually prompt the anaesthetist to withdraw the catheter and resite it elsewhere). If, however, this is not recognised, large doses of anaesthetic may be delivered directly into the cerebrospinal fluid. This may result in a high block, or, more rarely, a total spinal, where anaesthetic is delivered directly to the brainstem, causing unconsciousness and sometimes seizures.

Significant damage to a single nerve (very rare, less than 1:10,000).

Epidural abscess formation (very rare, about 1 in 50,000-75,000). The risk increases greatly with catheters which are left in place longer than 72 hours.

Paraplegia (extremely rare, less than 1:100,000).

Death (extremely rare, less than 1:100,000).

Non-chemical pain relief should be researched (and in some case practiced) well before birth, including active birth (moving around lots), massage, 'calm-birth' techniques, hot compresses etc. Most chemical pain relief should be considered as a last resort.

Best wishes,

David

I think everything has a risk to it the same % at what Epidural has. I read of these before

It all sounds a bit scary doesn't it? I guess no intervention is the best, but only you can know and decide what you will need/want/be comfortable with.
Read reliable sources and definitely give your GP the 3rd degree about the effects and risks of each drug. I think each has its pros and cons, and you will just need to decide what is important to you, and what will make you comfortable with the idea of birth.

All the best, and you're totally right, you do still have a fair bit of time to decide what options you would consider :)

For my first I had epidural and it was brilliant. For the second I had nothing but a TENS machine (worth looking into). However, I had a quick labour and Im sure if it went too long I wouldve called for the epidural again. I think there's risk with everything, there's risk in childbirth with no drugs as well.
Do your research and then be open to whatever happens. I wanted no drugs, but I was open to whatever may have come my way.
Also they say it takes a while to get the drugs out of bubs system, but my labour was so fast, I think it took her days to recover from that anyway! xoxo

I had the gas and pethidine with my first child.The gas made me vomit and the pethidine made me too woozy and out of it. They gave the pethidine to me too close too my son being born and when he came out he was not breathing and he was a purple,black colour and they tried three things to get him breathing and thank god they did and he was fine but it is very scary when I think about it.
Because of the pethidine I didn't know what was going on but I kept asking why isn't he crying and I could hear my mum and my sister crying and thought whats wrong with them?
It wasn't until later when I was back to normal they told me but we didn't know why until I read a book when I was expecting my 2nd child and it explains what can happen if pethidine is given to close to the baby being born.
So the last 4 births have been drug free and this last one will be drug free and there is such a difference in the babies when they are born.
I hope this has helped.Whatever you decide to do just research thouroughly.
Michelle

My teacher and also myself find that those who tend to be less likely to use pain relief not only have good support, but also have done their research and know exactly why they don't want all or a certain drug (usually epidural) in labour. They do it for specific reasons that keep them motivated and they remind themselves during childbirth. I think just 'waiting and seeing' can sometimes make it too easy to accept it - this is where the confusion lies with midwives and birth plans where a plan is written saying we dont want an epidural etc, but you really aren't motivated to avoid one, iykwim? You can have one if you want, but I think it's very important to be honest about it and inform yourself with good sources - again books like 'what to expect when you are expecting' aren't very empowering in that sense. It does have some good reassurances in it, but you need to know more than that.

I really don't like "What to expect" - it's so preachy! :p

I don't have to decide yet, and it's not set in stone, but that's why I'm doing all the research now. The reason I wasn't considering TENS is it says you need to hire and practise before hand, and I guess that put me off. A friend recommended it and said it was great, though.

Thanks again for all your input, the varied advice and stories help me to think about what I really want, and DH is completely supportive whatever I decide, to the point that if I'm not making myself clear he will insist they listen to me, lol!

I used the gas for Mackenzie as I was too far gone to go for the epidural. (I was 9cm by the time I got to the hospital). The gas worked well for me as it helped with my breathing and gave me something else to focus on, mind you when they took it off me they had to tear it out of my hands! After a lot of pushing they used forceps and boy do they kill and then I had an e/c so ended up with a spinal. At our antenatal class they went thru all the options with the side effects so you just need to be aware of each side effect and then choose accordingly.

Kelly i really thought ur last post in here was great...really made me think about doing more research and avoiding drugs all together in my next preg rather than "see how i go" - it's true that if u make an informed and determined decision u r more likely to not 'give in'. It's definately worth considering :)

Awwww thats great to hear :) Nice to know :)

A note about TENS - most women wont get much out of this unless they have back labour (posterior bub). It's nice to have a natural alternative, but some women want to use water and have to take it on and off all the time, some find it does nothing (unless it distracts them from back labour) and the only woman who I have seen use it in labour (posterior bub) didn't find it helpful - but thats just them. Heat on the back is great for back labour, some women like firm pressure - hahah ask Cailin about that - yes or no?? and others dont want the area touched at all. So have some back-up plans too for natural pain relief :)

I didn't want anything, was happy to opt for heat and massage, but ended up trying gas (absolutely hated it - it took the good bit of coming down after each contraction) and then had an epidural. I had a great epi, had some side effects (the dreaded shakes) but everything else was fine after an OK forceps delivery.
I found heat and massage VERY effective, and would more than likely have been able to go for another couple of hours if my contractions hadn't been 90secs apart for 2-3 hrs.

Whatever you choose has its consequences. Even the rubbing - well I sported a MASSIVE bruise on my sciatic (upper right bum) spot for about 10 days because of all the rubbing I had. LMAO!!

My sister used a TENS machine, and didn't get too much out of it, and she did hire it beforehand and practise with it.
My SIL has a TENS machine installed in her back and finds the pain relief wonderful. She has a very bad back and is now virtually pain medication free (had spent considerable amounts of time on morphine so is good ;) )

The thing with the gas is that it takes a little while to work. You have to start before the pain so as soon as you feel the contraction - start sucking. Dont wait for the bad pain or you'll be feeling the effects of the gas when the contraction is finished. If you feel that you COULD use it during your labour, you should learn how to use it properly. Dont wait until you're in too much pain to learn.

Rae, I totally agree. I had certain things that I was going to avoid at all costs, simply because I had been there and done that and knew the flip side of some of those interventions. If you are able to become more informed then it gives you the added stamina to avoid those things.

I was actually able to remember and use these things while in labour (Well up until transition anyway, when the midwives and OBS reminded me that I did not need them! lol!!!