Medicated Pain Relief Methods

Medicated Pain Relief Methods during Childbirth

Entonox (Gas and Air)

Entenox is basically 50% Nitrous Oxide (laughing gas) and 50% air (oxygen, nitrogen, carbon dioxide etc)
The benefits of gas and air are that although it does cross the placental barrier to the baby the effects are very short lived and therefore there are not known to be any serious side effects with its use for the baby.
However with gas and air there is about a one-minute time lag between starting breathing it and the gas having any effect. This means that if you start breathing it when the contraction starts you will not actually get the benefit of the gas for that contraction as they only generally last a minute or so.
Nitrous Oxide is also a sedative so it can make you feel very woozy and dizzy. It can also make you feel very nauseous and given that women often feel sick during labour anyway you may feel that you would want to use another method other than gas and air. The nice thing about gas and air is that you control it so you can simply choose not to use it anymore if you do find it unhelpful. This method can be used both with home and hospital births.

Opiate based painkillers (Pethidine)

Opiate based pain killers are related to morphine. They are falling out of favour in the west because they cross the placental barrier to the baby. They are effective as painkillers but they do have some unwanted side effects. They affect the breathing of the mother and the baby and are sedative, so both mum and baby will often appear very sleepy. Because this is not really conducive to a healthy birth (a sedate mum won’t feel like getting actively involved in the birth), forceps interventions for vaginal delivery may well be employed. This is far from the natural birthing experience that most women hope for and these methods of assisted delivery can lead to increased perineal trauma.
Babies born after the mum has had Pethidine are often very sedate for several days after the birth and a big disadvantage is that they do not readily breast feed which can be distressing for the mother and partner.
Although all mothers and babies do not experience these side effects you may wish to consider the risk/ benefit ratio before allowing Pethidine to be administered. Many mothers report that Pethidine does not alleviate the pain to the extend they wished for, but you end up so sleepy that you don’t seem to care!
The amazing thing about the human body is that it already creates a naturally occurring opiate type painkiller, which will work well when it is allowed to. It is incredibly potent (200 time stronger than morphine) and the are called endorphins.

Epidural analgesiadoctorgivingepidural

Different variations: To begin with, what is popularly known as an epidural is correctly termed epidural analgesia. The term epidural properly refers to the space into which the anaesthetist delivers the medication rather than an agent or technique.

The epidural/spinal family covers a variety of medications and ways of administering them:

 Epidural: The anaesthetist inserts a needle into the epidural space, which lies between the tough, outer membrane that covers the spinal cord and the next deeper membrane. A tiny tube or catheter is threaded through the needle. The needle is removed and the anaesthetist injects an anaesthetic similar to those used in dentistry or, in most hospitals today, a mixture of anaesthetic and narcotic (narcotic epidural) into the catheter.

  • Continuous infusion: The catheter is attached to a syringe driven by a pump that gradually delivers a continuous dose. This technique is the standard because it provides steady labour pain relief.
  • Intermittent top-ups: The anaesthetist returns to inject more pain medication into the catheter when the dose wears off.
  •  “Walking” or “light” epidural: The anaesthetist may inject narcotic only, a very low dose of anaesthetic, or a combination of the two in an attempt to achieve complete mobility with good labour pain relief. These variations are intended to leave some sensation and ability to move the legs. However, many women with such epidurals never walk, even when encouraged to do so. It was hoped that these innovations would achieve equally good labour pain relief while reducing adverse effects, but many women still experience undesired effects.
  • Combined spinal-epidural: The anaesthetist injects pain medication (usually a narcotic, occasionally an anaesthetic) into the space that lies deeper than the epidural space (“spinal”). The anaesthetist then pulls outward into the epidural space; a thread a catheter into the epidural space, and removes the needle. The spinal cannot be repeated, but the catheter remains for an epidural should you want additional labour pain relief later.

What is involved in having an epidural or combined spinal-epidural?

You will be asked to curl up on your side or sit up with your back arched outward. Your back will be washed with antiseptic and covered with a sterile drape. The anaesthetist will numb the skin before inserting the needle. You must remain absolutely still while the needle is in your back. One or more tests (such as pulling back on the syringe to see if blood flows in) will be performed to make sure the needle is in the right place. A catheter will be threaded through the needle and taped to your back to keep it from moving.

Other interventions are common with epidurals to monitor, prevent, or treat possible side effects. As part of epidural management, you will definitely have:

  • An IV (intravenous drip): you will be given about a quart of IV fluid before the epidural is administered
  • Continuous electronic foetal monitoring (EFM)
  • Frequent monitoring of blood pressure, usually with an automatic blood pressure cuff that periodically self-inflates and records the results.

 You are more likely to require:

  • IV Syntocynon, a drug to make contractions stronger
  • Drugs to combat a drop in blood pressure
  • A urinary catheter for inability to pass urine
  • A vacuum or a forceps delivery.
  • Controversy exists over whether you are also more likely to have a Caesarean section.

 What are the advantages of an epidural?

  • An epidural is the only labour pain relief technique that can completely eliminate pain
  • A plain epidural, without narcotics doesn’t affect consciousness.

 What are the drawbacks of an epidural?

An epidural:

  •  Requires the presence of an anaesthetist: this means an epidural may not be readily available when you want it
  • Involves delay in obtaining relief: even when the anaesthetist is in the hospital and not busy elsewhere, it can take an hour from your request to the time when the procedure is done and the medication takes effect
  • Changes the experience of labour: it converts labour and birth from a normal life experience in which you are an active agent to one in which the equipment (IV, Syntocynon pump, epidural pump, electronic foetal monitor, blood pressure cuff, etc.) is the centre of attention
  • May interfere with your ability to move about: it numbs much, if not all, sensation in the belly, genitals, and legs, and you may feel groggy if it contains narcotics; these effects can prevent you from activities that may help labour progress
  • Requires or increases the need for other procedures: Augmentation of labour, continuous foetal monitoring and blood pressure monitoring as just some of the procedures that could be introduced
  • Can cause episodes of low blood pressure: this is a problem because it reduces your baby’s oxygen supply
  • Can cause itching: this is a common, but generally mild, side effect if narcotics are given
  • May interfere with the pushing phase of labour: you may have difficulty pushing your baby out, and this phase may be lengthened and need interventions like a forceps of vacuum assisted birth
  • Can lead to the cutting (episiotomy) of the perineum: this is the cutting of the tissue between your vaginal and anal openings
  • Can cause life-threatening complications (dangerously low blood pressure, respiratory or cardiac arrest, severe allergic reaction, convulsion): the odds may be as high as 1 in 4,000 to 1 in 3,000 cases.
  • Can cause maternal fever: the longer you have the epidural, the more likely you are to run a fever, which can have its own consequences:
    Developing a fever appears to increase your likelihood of birth by caesarean section, vacuum extraction, or forceps
    Fever in the mother may be associated with more babies being born in poor condition and an increase in newborn seizures

 Because fever raises the possibility of infection, babies of mothers with fever are more likely to be evaluated for infection; this involves drawing blood, and may involve precautionary antibiotics through an IV (intravenous) line; mothers and babies may be separated during these procedures.
First-time mothers tend to have more difficulties with epidural side effects than women who have previously given birth.

Question: I haven’t heard anything about drawbacks to an epidural; in fact, the hospital, my doctor, and even my childbirth educator have nothing but good things to say. Why might this be?
In medicine, the desired effects of a drug or procedure often receive more attention than undesired effects. The unmatched effectiveness of epidurals at relieving labour pain has impressed both caregivers and women. Many caregivers also believe that new techniques and medications have minimized side effects. For these reasons, the disadvantages and potential complications are often under-recognized or seen as unimportant because they can be managed. They may also be considered an acceptable trade-off given the benefits of superior labour pain relief. Every woman needs to understand these trade-offs and make informed decisions according to her values, preferences, and options.

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