Assert your own needs and wishes
How you experience pain is linked to many different factors, including how well your labour is progressing and your past experiences, including previous deliveries. It is therefore important that you assert your own needs and wishes, so that the healthcare professionals responsible for caring for you can take this into account as far as it is safe for your health and that of your baby.
Your midwife will also continuously assess and discuss your wishes and needs as regards pain relief with you during your labour.
Pain relief during birth without medication
During the first stage of labour (the latent stage), the shape of your cervix will change from long, firm and closed, to short, soft and slightly dilated (open). This process can take many hours, especially in the case of first-time mothers. It is important that you rest from time to time and take the time to eat and drink.
Once the latent stage is over, the active stage of labour and childbirth will begin. The cervix will become softer and more dilated, and your contractions will often be regular.
It is safe to use these measures throughout the childbirth process, but their effect can vary from person to person:
- Moving your body by walking or changing position can help to relieve pain, aid progress during labour, and reduce the need for medication-based pain relief.
- A birthing ball or birthing stool can help you keep moving and provide relief.
- A hot bath or shower can have a soothing effect, while a massage can reduce the intensity of the pain. You decide where and how you want the massage.
- A heat pack, such as a bag of rice or water, placed on your back or the base of your abdomen can help to relieve pain. The water must not be so hot that it burns your skin. Change the water more frequently instead.
- Breathing technique and relaxation can help to relieve pain.
- Local injections of small amounts of sterile water under the skin (steriltvannspapler) are another form of pain relief that is used. This causes a stinging sensation, a bit like a wasp sting, for about 20 seconds and can provide pain relief afterwards if you experience back pain later.
- TENS (Transcutaneous Electrical Nerve Stimulation) is a device that transmits a weak electrical current through gel plates attached to your back. You decide how strong you want the impulses to be. Many maternity wards offer TENS, but there is little evidence of its effect on labour pains.
- Acupuncture involves inserting needles into the skin. There is some uncertainty over the pain-relieving effect on labour pains.
Epidural and spinal anaesthesia
Regional anaesthesia (epidural or combined spinal/epidural anaesthesia) is used in about one in three deliveries in Norway and is available in the majority of birth settings. Many women benefit greatly from this type of pain relief when giving birth. The pain-relieving effect of epidural anaesthesia develops gradually and normally becomes effective around 15-20 minutes after being administered.
Healthcare professionals usually recommend epidural for:
- breach births (baby positioned rump first)
- multiple births (if you are pregnant with twins)
- hypertension (if you have high blood pressure)
- have pre-eclampsia/eclampsia
A doctor called an anaesthesiologist will be responsible for administering your anaesthesia. You will first be given a local anaesthetic in the area where the anaesthesia will be administered. Using a needle, a catheter will be inserted into the epidural space of your spine. The catheter will remain in situ until your baby is born. Pain medication is administered continuously to numb the nerve roots. The motor nerves generally remain largely unaffected by the medication, but some mothers experience a reduction in mobility while the medication is being administered and during the first few hours after giving birth. Epidural anaesthesia is particularly useful during the latent (dilation) stage.
Epidural anaesthesia is rarely associated with serious complications. Many mothers may find it difficult to urinate at first. A few experience headaches after giving birth, while some notice a temporary reduction in the nerve function in their legs after having an epidural. Headaches may be caused by spinal fluid leakage. Such spinal headaches can be treated by an anaesthesiologist.
You can have epidural anaesthesia at any time during the active birth stage, although if the baby is likely to arrive soon, it may be too late for it to work before the baby is actually born. Epidural anaesthesia is not recommended in some cases. Your midwife and anaesthesiologist will be able to help you consider your options, such as spinal anaesthesia.
Spinal anaesthesia is faster-acting than epidural anaesthesia and lasts about two hours. The anaesthesiologist will administer the spinal anaesthesia by giving you an injection in your back. Unlike an epidural, you will be given a single dose of medication, rather than a catheter in your back, which enables the medication to be administered regularly.
It is rare for mothers not to be able to have an epidural for pain relief. If you are taking blood-thinning medication or have a bleeding disorder, your epidural will need to be planned in advance. Low doses of blood-thinning medication need not stop you from having epidural anaesthesia, but it is important that you tell the anaesthesiologist if you are taking such medication. If you have an infection in the area where the epidural is to be administered, you will not be able to have the epidural.
Nitrous oxide and other anaesthetics
Nitrous oxide
Some maternity wards offer nitrous oxide. Nitrous oxide can be used throughout much of the childbirth process. You breathe in the nitrous oxide via a mask and use it during each contraction. It is important to breathe in the nitrous oxide during the contractions in order to maximise the effect. Some mothers may experience nausea and dizziness caused by the nitrous oxide, but this will quickly pass when you stop taking it.
Pudendal nerve block
Once your cervix is fully dilated and you have entered the pushing phase, you may find that you need more pain relief. Pudendal anaesthesia then becomes an option. You may need this even if you have an epidural.
The midwife or obstetrician will administer the pudendal anaesthesia via an injection on each side, internally in the vagina or from outside the body through the skin on the side of your vagina. It is fast-acting and numbs the nerves in the lower part of the vagina. This anaesthetic produces few side effects, but some mothers may not feel the urge to push quite as much. If this happens, your midwife or obstetrician will guide you through the pushing stage.
Opioids
Opioids are morphine and morphine-like medicines. They can be administered in tablet form or as an injection into a muscle. Opioids have a moderate pain-relieving effect during childbirth. Some people feel nauseous and tired after being given opioids. If opioids are administered immediately before childbirth, it may affect the newborn child’s breathing, and they are therefore normally administered at an early stage during labour as and when necessary.
Choosing the right pain relief
With so many pain relief options available, it can be difficult to choose the treatment that is best for you, or even to decide whether you need pain relief at all. You may want to discuss the various options with your midwife when you arrive at the hospital to give birth. Together, you can decide what would be best for you based on how much pain you are in and how far your labour has progressed.
Choose the right pain relief treatment for your childbirth
Here you will learn about pain relief during childbirth. You will learn the advantages and disadvantages of the various remedies. It can help you and the midwife or doctor find the best solution for you.