The Pain Relief Ladder - Preparing For Birth Manual

Having a positive attitude to the sensations of labour really helps you manage your perception and response to any pain. Try to focus on the mind-blowing work your body is doing to birth your baby - it really is incredible. You are completely designed to do this!

Much of what we have covered in this course, such as the birth breathing techniques we teach, the sound work (oooohs) and the movements, will all help your nervous system to stay calm. This will really help you lower your perception of any pain sensations you may experience during labour. This alone helps many women with labour and birth.

However, there is of course a range of pain relief options available to you, both medical and natural. And it may be that you decide to use one or more of them - and that’s fine too. Understanding all the options in advance of your labour, and the pros and cons attached, will give you the confidence to make an informed decision should you choose to have additional pain relief during your labour.

Once you begin to use any of these helpful options, it is likely you will continue to do so and / or progress up the ladder. Remember, everything has its place and it is always your choice.

KEY TIPS

▪ Familiarise yourself with all options for pain relief; ensure you understand the terminology and the pros and cons for each

▪ Give yourself plenty of time to mentally and emotional prepare

▪ Understand the physical effects of fear and anxiety - and how breathing and staying calm is a great way to reduce pain sensations anyway.

▪ Listen to the advice you are given by your midwife and healthcare team, and tune in and listen to your own body. You’ll know what you need to do and will make the best decisions in the moment.

▪ Academic sources suggest that too much casual use of complementary therapies is occurring more in the last 5years with most people thinking that as natural - and cannot harm.

Yoga - helps prepare you mentally, emotionally and spiritually for pregnancy, birth and beyond. Teaches you breathing, movement, relaxation, mediation and mindfulness techniques to help you tune in with your body, enabling you to respond to its needs more calmly. The breathing practices are also one of the quickest and most effective ways to calm your nervous system and this in turn maintains the positive feedback loop.

Acupuncture - Can be used for many pregnancy ailments, for repositioning breach babies, to induce labour and for pain relief during birth (an acupuncturist can be present at home or in the hospital). Also used during the postnatal period to help with mood, sleeping, breastfeeding and helping to bring mum back into balance.

Bach Rescue Remedy - Only to be used once labour established, to help keep calm. Available as a spray, or drops to be placed on the tongue or in a bottle of water that can then be sipped. Birth pool - available to hire for the home. Also available at some hospitals and birthing units. Best to enter after 5-7cm dilated as in the short term (1-1.5hours) it increases oxytocin - the hormone that stimulates the surges. Keep pool at body temperature - always below 37 degrees, but not cold, as that will increase adrenalin levels. Delay entering the pool by using shower on nipples (to stimulate oxytocin) and lumber spine (pain relief).

Heat – Apply a hot water bottle / wheat bags with lavender (that you can heat in the microwave) / warm towels or flannels for localised pain relief, i.e. applied to lower back to relieve backache.

Homeopathic remedies - Birthing kits are available from the Dolphin House Clinic, Brighton (01273 721720) or from Helios or www.ainsworth.com. I have heard that some NHS midwives have them available to lend out. Can be used to induce labour, or for pain relief, emotional balancing and to aid a speedy recovery postnatally (such as arnica for brushing and shock).

Massage - By birth partner during contractions. Simplest and most time-honoured way of relieving pain by dissipating tension. Be rhythmical but vary the speed - slow to calm, brisk to stimulate. At least 20 mins will help release of endorphins. Some people recommend using wooden hand held massage tools. Can be combined with aromatherapy oils (see above).

Reflexology - reflex points on the ankle bones correspond to the uterus and pelvis. These can be stimulated to relieve pain and regulate contractions. Make sure you see a qualified practitioner.

TENS machine – This battery operated device with sticky pads which you place on your body (i.e. lower back) delivers small electrical impulses. This stimulates the nerves and helps raise the level of your own pain relieving chemicals, endorphins. Can be bought or hired at Boots.It can be really useful for lots of women - best to get it on early.

Water - immersion in a bath soothes nerve endings, relaxes muscles and reduces stress. Lavender oil can be added once labour is established. During labour a water spray or cool flannel is helpful to cool face and revive. Stay hydrated by sucking on ice cubes. Use water postnatally, to rest in the bath and feel rejuvenated. All these natural options are worth exploring. There are also medical pain relief options available to you;

Gas & Air - also known as entonox or laughing gas. A mixture of 50% nitrous oxide and 50% oxygen delivered from a cylinder via special breathing apparatus.

Advantages – provides quick relief, and wears off quickly.

Disadvantages - may cause dizziness and nausea. To be used with contractions only. Many women comment on the ‘Darth Vadar’ sound it makes and that listening to that keeps them focused as well.

Pethidine – a sedative and muscle relaxant, this is an opiate administered via an injection into the thigh.

Advantages - effective in relaxing and calming a stressed or exhausted woman or perhaps someone who has had a long latent phase and needs to rest. Does not affect mobility as with an epidural.

Disadvantages - can cause nausea and vomiting and takes several hours to wear off. It is not recommended for the later stages of labour as it crosses the placenta. If it is administered too close to delivery the baby could be born groggy and drowsy, affecting its responses and ability to feed immediately.

Epidural - a local anaesthetic is injected into the epidural space between the second and third lumbar vertebrae. The drug acts on the spinal nerves to produce a sensory and partial motor block, and numbs your tummy.

Advantages - pain free, women can sleep, giving them energy for later on. Good for long labours and complicated deliveries. Does not affect the baby.

Disadvantages - mobility is restricted and the risk of having further medical intervention and assisted birth is increased. Complementary therapies in pregnancy. There are many possibilities to use complementary therapies in pregnancy as extra support and relaxation and even induction, especially in Brighton. It is a good idea to consult a trained therapist whatever the therapy just in case it is not appropriate for you and your pregnancy.

Aromatherapy - once labour is established, lavender, jasmine or rose oil can be used in the bath, in a room diffuser or mixed with a carrier oil for massage. Particular oils are only to be used during labour, such as Clary Sage and Rosemary and not during pregnancy as are said to stimulate labour. Please consult a specialist aromatherapist or contact Neal’s Yard (www.nealsyardremedies.com)

More About Aromatherapy:

It is the therapeutic use of concentrated plant extracts to help balance the body. These plant extracts are called essential oils and when absorbed or inhaled, can create changes both in your physical body and in your emotional wellbeing.

This makes them really useful in pregnancy and labour for things such as relaxation, helping you to feel positive and even encouraging contractions. They can have a potent effect. Many women use them in combination with massage (another useful therapy to keep you relaxed), or by using a couple of drops on a tissue and smelling them intermittently). Anything that can help reduce your stress in labour is so useful!.

Some important points to consider for using aromatherapy in labour.

• Limit the time that an oil burner/diffuser is on to about 15 mins.

• Many midwives in Brighton are now trained in the use of aromatherapy for labour and we have the stock in both the admissions area and on labour ward, and even for home birth so do ask.

• Never use neat on your skin (apart from tea-tree and lavender for medicinal purposes). If in a massage oil e.g. grapeseed oil, 2% is the maximum dilution in labour, this means for 10ml of grape-seed oil , only 4 drops of essential oil. If used before labour, half this again (1%)

• Although naturally derived, the essential oils can potentially irritate your skin if not diluted in oil or water, can have the opposite effect from what you are aiming for or give you a headache or nausea.

• It is not recommended to put directly in the birthing pool where you are going to have your baby, reason being that we don’t really know the potential effects on a baby’s skin.

• Be cautious if using contraction promoting essential oils such as clary sage or jasmine. Always think ; “If I am already contracting, do I need to stimulate the labour any more?” Better maybe to concentrate on aiming for relaxation.

• Your sense of smell is a very strong promoter of memories, so for this reason, consider a blend of three oils, not just one.

• Consult an aromatherapist if in doubt, or even the midwives at Brighton.

• If you have already had a pessary of artificial hormone to start your labour at home, no need to do clary sage or jasmine as well as this can overstimulate your body Further research can be found on the AIMS website: http://www.aims.org.uk/effectDrugsOnBabies.htm