Labour Analgesia; Pain relief methods during labour

Normal labour and vaginal delivery is one of the most uniquely painful and at the same time a beautiful experience in a woman's life. Delivery of a newborn baby into the arms of a conscious and pain-free mother is one of the most rewarding moments of modern medicine.

Dr Sunil Eshwar, Lead Consultant, Obstetrics and Gynaecology, Aster RV Hospital said, "Pain relief during labour is surrounded with many myths and controversies. There are various methods available to provide a pain free and memorable experience during childbirth. These can be broadly classified into medical, non medical and regional techniques. Good labour analgesia aims not only to relieve pain and suffering of the mother but also to make the process of delivery safer for the mother and baby."

Inhalational analgesia technique

This method involves inhaling Entonox at the onset of contractions, that is, when the patient starts feeling the pain. Entonox is a mix of 50% nitrous oxide in oxygen.

It has been in use since a long time. It is not widely available in all the maternity units.

This method is very easy to use by self -administration, but around 30-40% of patients have found pain relief to be inadequate with Entonox alone. It is the most effective for short term pain relief (1 – 2 hrs). Onset of action is quick (within 1-2 mins) and the effect is short lasting (2-8 mins). This method requires monitoring by health care personnel.

Epidural analgesia

This is an extremely effective and popular method of pain relief during labour. It is also considered to be the gold standard technique. This method involves injecting local anaesthetic agent through the spine, close to the nerves that transmit pain. Following the injection, it takes between 5 and 30 mins for the pain to be relieved. The advantage of this method is that the patient is able to move around with the epidural catheter in place.

It is a very effective method providing 80-90% pain relief. This method is available at all hospitals with anaesthesiologists available round the clock.

The analgesic effect is maintained by continuous infusion of the anaesthetic agent and hence effect lasts till the infusion is discontinued. The side effect of this method includes the increased incidence of instrumental delivery using either vacuum or forceps. Some patients may need catheterisation to pass urine following an epidural.

Transcutaneous electric nerve stimulation

It is a non medical form of pain relief. In this technique, two electrodes are stuck to the skin on your back and the machine delivers small pulses of electric current to the body. These pulses feel like a tingling sensation on the skin. By stimulating different nerves on the spinal cord, it blocks the pain signals.

This method is not available at all hospitals. It does not provide pain relief for all patients and most often requires additional methods of pain relief to be used along with it.

Relaxation or Breathing techniques

Using breathing techniques and focusing attention on your breath activates mental processes in the brain that makes labour sensation seem less unpleasant. This method involves practising these techniques in your third trimester. These are taught in all childbirth classes at most hospitals. The goal of relaxation techniques is to learn to relax your entire body when one group of muscles contract. This method is particularly helpful in early labour. Involving your birthing partner or spouse during the pregnancy classes is very important as they could help with various paced breathing techniques during labour.

Acupuncture

Acupuncture techniques for labour pain relief involves puncturing skin with thin sterile needles at certain defined acupuncture points. This technique also requires training in the third trimester at least 4 weeks prior to the expected date of delivery. It also requires trained personnel to be present during labour. It is not widely used or widely available method.