Pain management during labour

Do you want to give birth using natural pain relief such as massage, acupuncture and sterile water injections as much as possible? Or do you know already that you are prepared to have maximum pain relief if necessary, e.g. an epidural? Don't feel you have to be a hero and go without pain relief. Ask for the help you feel you need.

If the woman feels well-prepared and confident in her ability to give birth, she will find it easier to manage the contractions and labour pain. For this reason, you might want to read up about different types of pain relief in advance so you know what options are available to you when the time comes.

The most common types of pain relief are described briefly below. Speak to your midwife to find out more about the advantages and disadvantages.

Natural, medicine-free pain relief
Massage. Many women find relief from having their lower back massaged during labour. This is something your partner can do to help. Massage can be used during the whole of your labour to help you relax.

Endorphins. The body produces its own natural painkillers, which are released when we are subjected to severe stress or injury. Endorphins are sometimes referred to as the body's own morphine, and they work in roughly the same way. Endorphins also reduce stress and increase our feeling of well-being. They have the strongest effect if you are upright and walk around during your labour.

TENS(transcutaneous electrical nerve stimulation). This little machine generates light vibrations which stimulate the nerves in your back via four electrodes. It can alleviate the pain and reduce the intensity of your contractions.

Heat. A heat pad or hot water bottle can provide effective pain relief during the initial part of labour.

Sterile water injections that induce natural endorphins.
A minute amount of sterile water is injected under your skin with a syringe and file needle. Four to five small injections are usually administered around the most painful area, usually on the lower back or near the groin. This activates the production of endorphins, the body's natural painkiller. and reduces the pain from the contractions. The effect lasts for up to an hour and a half, and the treatment can be repeated as needed. This method has no negative impact on the labour process or the baby.

Warm water. Floating almost weightlessly in warm water soothes the pain and helps the body relax. You can also stand or sit under a warm shower.

Acupuncture. Research has shown that women who have acupuncture are less likely to ask for an epidural and feel more relaxed. Acupuncture has no side effects and does not affect the baby.

Are you considering giving birth at home? Read about home birth.

Medical pain relief

Laughing gas. The pregnant woman controls the gas supply and breathes in the gas through a mouthpiece at the start of each contraction. Laughing gas has a pain-relieving and relaxing effect and temporarily makes you feel intoxicated. It is a chemical compound of oxygen and nitrogen. Its concentration is adapted to the woman's needs. The gas does not affect the baby. It takes effect quickly and wears off equally fast.

Morphine preparation. Morphine preparation is administered in tablet form or via injection, either under the skin for slow pain relief or into a vein for faster relief. It lessens the pain during contractions and helps the woman relax during labour. Because the active substance passes through the placenta, doctors advise against taking it less than an hour before delivery, because it can make the baby drowsy and unable to establish a regular breathing pattern. Morphine preparation is sometimes given when the woman has had a lot of pre-labour contractions and needs to sleep to regain her strength.

Epidural. An epidural is a local anaesthetic injected into the small of the back, and is a common form of pain relief today. It can almost completely take away the pain during labour. Its effect normally wears off after a few hours as the contractions grow in intensity. This anaesthetic does not pass through the placenta so does not directly affect the baby. If an epidural is given, the baby's condition is constantly monitored via CTG.

Spinal anaesthesia. Spinal anaesthesia is administered as a single injection of local anaesthetic into the back. It is commonly used for C-sections or if the labour is not expected to last long, for instance if the woman has given birth previously. Spinal anaesthesia involves a larger area than an epidural, numbing the body from the chest to the thighs. If spinal anaesthesia is used, the baby's condition is constantly monitored via CTG.

PDB (pudendal block). This anaesthetic is becoming less and less common. It is administered by injecting a local anaesthetic high up into the vaginal wall on both sides. The nerves in the whole area are numbed so that the woman feels less pain when pushing the baby out. The disadvantage of a PDB is that it can prolong the pushing stage of labour because the woman cannot clearly feel what she is doing. However, a PDB is useful if the midwife needs to stitch large tears in the vagina and perineum.

General anaesthetic. A general anaesthetic induces a complete loss of consciousness. General anaesthetic is used for very urgent C-sections where there is not enough time to give an epidural. It is commonly used if the placenta needs to quickly be removed and is not detaching by itself. It is sometimes also used if a severe haemorrhage needs to be stopped quickly.
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