Pain Management in Labour:

Early Labour

Labour occurs in two stages, the early or latent stage of labour involves the onset of contractions (uterine tightenings) that are mildly to moderately painful and occur irregularly at first and then become more regular over time. This stage of labour can last for hours or sometimes even for days in a start and stop fashion. In this stage of labour the cervix is starting to soften, shorten and is beginning to dilate or open up. You may notice some mucous (mucous plug or bloody show). 


Early labour usually takes place at home and you are encouraged to move around, change positions frequently, stay hydrated, eat small protein dense meals and rest as much as you are able. 


To manage pain in the early stages of labour you can try soaking in a warm bath or shower and getting your partner to massage your back and squeeze your hips. 


Morphine:

If you are finding the contractions very painful feel free to contact your physician or go to the hospital for assessment. You may be offered an injection in your arm muscle of morphine which is an opioid pain medication that can be very helpful in early labour. It usually lasts about 4-6 hours so it will typically have worn off long before your baby is born. The morphine is usually given alongside a dose of gravol to reduce the chance of becoming nauseous which is a side effect of the medication. 


Active Labour:

Active labour is when the contractions are moderately to intensely painful and are occurring regularly every 3-4 minutes, lasting at least 45 seconds each. In active labour, the cervix is dilating from a small opening to eventually 10cm or full dilation. This stage of labour typically lasts from 6- 12 hours. In active labour you will be admitted to hospital and moved to your labour and delivery room. 


Non medication strategies to manage pain in the active stage of labour are:

  • Changing positions frequently

  • Use the bath tub

  • Use birthing balls

  • Use breathing techniques or meditation


Nitrous oxide:

This is a gas inhaled through a mouth piece that can reduce the intensity of the contraction pain. It clears out of your body very quickly after inhaled. It can make you feel a bit light headed and nauseous but this typically resolves quite quickly. 


Fentanyl:

Another option is the use of IV (intravenous) fentanyl. This is an opioid medication that is a very effective pain reliever however it only lasts a short time, 10 or 15 minutes or so. It will often have to be given multiple times to provide adequate pain control and there is a maximum amount that can safely be given.


Epidurals:

You can request an epidural anytime during the active stage of labour, once you have been admitted to the hospital and are in your labouring room. An experienced anesthesiologist will discuss the risks and benefits with you and perform the procedure. An epidural involves inserting a small thin tube into the epidural space in your spinal cord through your lower back and delivering small doses of pain medication continuously throughout your labour. It is the most effective way to significantly reduce the contraction pain during labour. You will remain awake and alert but feel little to no pain in your lower body. The dosage can be easily adjusted and if an unplanned C section is required the epidural can be used for stronger pain control during the surgery. 


Risks and Side Effects:

  • Epidurals can temporarily lower your blood pressure. This can be treated by giving you fluids through the IV and sometimes with medication to increase your blood pressure. 

  • Epidurals can result in a temporary decrease in your lower body strength making it difficult to walk or squat while the epidural is running.

  • As you may have difficulty walking to the bathroom while your epidural is running, you may require a catheter in your bladder to help you pee.

  • In about 1% of cases, you may experience a severe headache after the epidural. This can be effectively treated with oral pain medication and occasionally with an injection in the epidural site called a blood patch. 

  • Other common side effects are shivering, itching and nausea. These are usually manageable with medications. 

  • Serious complications such as permanent nerve damage or infection are extremely rare, about 1 in 240 000.

  • Epidurals can increase the duration of your labour and the time it takes to push your baby out. 

  • Epidurals increase the chances of requiring a procedure to help deliver your baby vaginally, for example requiring the use of a vacuum or forceps.

  • Epidurals do not increase your chance of requiring an emergency C section.