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Drug options for labour pain management

If you’re prepping for your upcoming labour and birth, educating yourself on pain management options is a FAB idea. 

Pain is a natural part of giving birth. There’s no reason to be scared of it, and it’s actually a good thing (we know, it sounds crazy). You’re potentially an old hack at pain by now anyway if you’re currently pregnant. Pregnancy isn’t exactly a walk in the park for your body. (Psst… a women’s health physio may be able to help!)

Most birth classes equip you with natural pain management methods, and give you a rundown on your pharmaceutical options (aka drugs) too. But it can help to do your own research outside of that.

We got the inside scoop from Bernadette Lack – midwife, personal trainer and Founder of Core & Floor Restore – about pharmaceutical pain management options for labour. She said:

“If you’ll be labouring in a hospital, the following options should be available to you. They might be available in some birth centres too, so check with your care provider as to what you can access for your labour.”

So, let’s talk drugs.

Nitrous Oxide

Also known as ‘gas’, this mixture of nitrous oxide and oxygen doesn’t straight up take your labour pain away. BUT, it can still be really useful in managing the pain. 

It helps you focus on breathing and relaxing, which will keep you ‘in the zone’ for popping a baby out. The machine makes a rattling noise (Darth Vader style) when you inhale, and a lot of people focus on that during contractions. It sounds simple enough, but it’s a good distraction in the same way other techniques like horses’ breath are.

The gas doesn’t affect your baby, but it may make you feel a little nauseous, drowsy or dizzy. In some cases women experience vomiting or a dry mouth. It can also give you a sense of detachment, a feeling as though you’re not really present or a bit ‘out of it’… not that you’re exactly fit for engaging in philosophical discussion during labour anyway.

If you request to use gas during your labour, you’ll be in control of when you use it. You’ll be given a mouthpiece or mask, which is attached to a tube that extends from a portable machine or the wall. You can hold it in your hand and use as needed – possibly even in the shower or bath if your hospital has a portable machine! It can also be handy post-birth if you need your ‘down there’ area stitched back up.  

Nitrous oxide is quick-acting, non-invasive and doesn’t require monitoring like an epidural does. 

Morphine 

While having morphine administered during labour can help reduce the severity of pain, again, it won’t take the pain away completely

If you decide to give it a go, it will be most effective in early active labour (from 4cm dilation). It can take up to 20 minutes to kick in and generally lasts 3+ hours.

After 7cm dilation it probably won’t do much for you. Plus, it can cause breathing and temperature issues in newborns if given within four hours of the birth – another reason why it’s typically only used earlier in labour. 

Like with gas, morphine may make you feel a tad loopy (‘out of it’). You may struggle to make decisions, feel really sleepy, or experience anything from euphoria, nausea and vomiting to being unable to poop or wee. Fun! But if it relieves your labour pain a bit, it may be worth it for you. Another potential benefit of morphine is that you don’t need to have an IV (intravenous) drip, a catheter or continuous fetal monitoring like you do with an epidural.

Epidural 

Bernadette says, “the key benefit of an epidural is that it takes away the pain of contractions.” So… that’d be why around 35% of Australian women choose to have an epidural during labour. 

It’s usually given when you’re in active labour, meaning you’re dilated more than 4cm and having four contractions in ten minutes. If you choose to have an epidural, an anaesthetist will inject a local anaesthetic into your back, which alters sensation from the waist down. You may see your new BFF (the anaesthetist) a few times as they work to get your dose right. They’ll leave a very thin tube in your back so the anaesthetic can be topped up if needed (if it starts to wear off or if you require a c-section).

Most people can’t walk or move their legs after having an epidural, but you’ll still be awake and alert. Once it kicks in, you’ll probably be able to have conversations and maybe even squeeze in a cheeky sleep if your labour is taking its merry time.

Most hospitals will want you to stay on a bed, even if you’re able to move (yep, a lucky few can move around after an epidural). You’ll also require:

  • An IV (intravenous) cannula inserted into your arm/hand
  • Close blood pressure monitoring
  • Continuous fetal monitoring (CTG machine)
  • Urinary catheter insertion.

If your contractions slow right down or stop altogether, which is pretty common with an epidural, you may also need a synthetic oxytocin (syntocinon) drip to keep them going. 

When it comes to pushing your babe out, you may still feel the urge to push, but the sensation will be reduced. Your midwife can guide you at this stage (think: “PUSH NOW!”), and they may help you get into different birthing positions if you have control and use of your body. If your cheeky baby doesn’t want to leave the safety of your womb through pushing alone, you might need help with an instrumental birth (vacuum or forceps). 

Your birth team will discuss the risks of an epidural with you before it happens. These may include severe headaches or back pain after birth, fetal distress and some studies suggest decreased breastfeeding success

Talk to your obstetrician and birth team about what pain management options will work best for you. And remember, you don’t need to use pharmaceutical pain management during labour if you don’t want to. Every woman doubts herself at some point. It’s HARD! But you can do it, mama. You’re so much stronger than you know.

If you’re fearful of giving birth, Bernadette suggests working closely with a counsellor and birth educator during your pregnancy so you can feel empowered and calm heading into labour. 

Share your thoughts and questions about labour drugs in the comments below.


Expert contributor: Bernadette Lack

Bernadette is a midwife, personal trainer and Founder of Core & Floor Restore. Get more excellent information on labour techniques by following her on Instagram and checking out her FREE and very helpful online antenatal classes.

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