Pain relief during childbirth

Everything you need to know about pain management during childbirth

Parturition pain is a special pain and cannot be compared to anything. Normally, pain is a sign of something threatening. Now, on the contrary, it has a positive outcome: the birth of your child. Parturition pain has a clear beginning and end. The contractions have a rhythmic pattern. The pain comes and goes, as we say. Every woman experiences this in her own way and deals with it differently. We will support you in this.

Natural pain medication.

The (pain) experience and your -behavior is together with the relaxation of your body and mind. So above all, follow your feelings and what you are comfortable with. There are several options that can make you feel as comfortable as possible. Examples include massage, different postures, warmth from a bath or shower, positive thoughts and a pleasant environment. Sometimes it takes some searching to find what works best for you.

Your body produces natural pain-relieving substances during childbirth. One of the main pain-relieving hormones released is endorphins. It takes away the sharp pain and allows you to relax better. Your body is then better able to produce oxytocin. Oxytocin, in turn, ensures effective contractions. Anxiety can interfere with this process. Should you experience this to a (large) degree, please indicate this. Together we will investigate where it comes from and how we can solve it.

TENS

The TENS is a small device that you attach to your back with adhesives. It continuously emits small pulses of electricity. During contractions, it can give you an extra boost. This gives you a sense of control. The electric shocks disrupt the (pain) stimulus conduction to the brain and allow the muscles around your back to relax. The TENS is most effective during the latent phase. Experiences vary, some women benefit greatly while others hardly benefit at all. Should you be interested, please let us know. The device with stickers can be purchased through the health insurance company or rented through us at minimal cost.

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Medication for pain during childbirth

During childbirth, we will not actively offer the option of medicinal pain relief. If you request this, we will discuss the options and pros and cons with you. Keep in mind that not every form of pain relief can be used immediately. Nitrous oxide is a form of pain relief that we as midwives are allowed and able to administer (at the Sophia birthing center). With the other forms of medicated pain relief, we must hand over the care to the hospital physician and/or midwife. They will want to continuously monitor your child's heart action through a CTG.

The epidural

An epidural involves inserting a thin, flexible tube into the back. The anesthesiologist performs this. The back is numbed and punctured with a needle. The small tube he slides through the hollow needle is the only thing left in the back. Through this tube a combination of pain-relieving drugs is given. It then enters the space around the spinal cord membrane, in which the spinal cord runs. The nerves in this area will be temporarily numbed by the drug. If the epidural is placed properly, you may no longer feel the pain of labor in its entirety. You also have less control over your lower body. You can keep moving your legs, but there is little strength in them. Therefore, you must stay in bed and a catheter will be inserted into your bladder.

The epidural continues to work throughout labor. You can get this form of pain relief from 3 centimeters with the condition that you have frequent and regular contractions. With rapid progress or the desire at a late stage of labor, it is sometimes no longer possible to have an epidural. The epidural is available at both Franciscus Gasthuis and Erasmus MC.

When you start pushing, the doctor may decide to turn off the epidural. That way, you can give better direction to push your baby out. It takes a while for the medicine to fully wear off.

Benefits of the epidural:

Most effective form of pain relief (little to no pain during labor)
Long-term effect
Fully conscious: you do not become drowsy or drowsy from the drug

Disadvantages of the epidural:

Transfer of care: the hospital/gynecologist will continue to supervise the delivery. The baby's heart action is recorded continuously
In 5-10% of women, the epidural does not work adequately. Sometimes it is then reinserted
Your blood pressure may drop. Your baby's heart rate may react to this. To prevent this, extra fluids are given through an IV. Occasionally, extra medication is given to make the blood pressure rise.
Greater chance of developing a fever. In this case, it is not always clear whether this is due to an infection or as a result of the epidural. Sometimes it is decided to start antibiotics preventively. It gives an increased chance for admission to the baby ward of your baby
Less freedom of movement due to having to stay on the bed
The contractions may subside. Therefore, labor may take longer. In that case, oxytocin, a medication that stimulates contractions, will be administered through the IV.
The pressing phase may take longer. You are more likely to have an artificial delivery (vacuum pump)
The catheter presents a slightly increased risk of bladder infection during the maternity week
Risk of post spinal headache. When the epidural was inserted, a small hole may have appeared in the meninges. Fluid may leak from this, resulting in severe headaches (especially in a vertical position). Sometimes it is necessary to have the hole closed after delivery or in the postpartum week.
Other side effects: itching

Remifentanil (PCA)

Remifentanil is a morphine-like substance administered by infusion. A special infusion pump allows you to regulate the administration yourself through a button. Of course, the device is set so that you can never give yourself too much. The pain experience during the peak of the contraction will decrease and you can relax better during the contraction break. At some point your body gets used to the drug so it will be less effective. This often occurs 4 - 5 hours after starting. For this reason, we do not recommend opting for this form of medicinal pain relief before 5 centimeters of dilation. Otherwise, at the final stage of dilation, when you need it most, it will be of no use to you. The pump is only available at the Franciscus Gasthuis, not at Erasmus MC. If you start pushing, the administration will be stopped so that you regain your focus.

Benefits of PCA:

Fast action, often after just a few minutes
Self-regulate with a button (overdosing not possible)
Morphine quickly disappears from your body after quitting

Disadvantages of PCA:

Transfer of care: the hospital/gynecologist will continue to supervise the delivery. The baby's heart action is recorded continuously
The drug may affect your breathing and oxygen levels. This is monitored closely. Sometimes it is necessary to use nasal goggles or a mask to temporarily give extra oxygen.
The effect of remifentanil on breastfeeding has not yet been well studied.
Other side effects: drowsy, hazy, nausea

Nitrous oxide

Nitrous oxide is a mixture of di-nitrous oxide 50% and oxygen 50%. You get the gas through a mouth and face mask by breathing in. It works most effectively if you start inhaling at the onset of the contraction. When the contraction is gone, you remove the mask from your face. So you are able to regulate it yourself. The gas works effectively for 2 hours. Therefore, depending on the expected duration until ejection, it is possible to get it from about 7 centimeters of dilation (also depends on whether you are expecting your first or subsequent baby). The pain experience during the peak of the contraction will decrease and you can relax better during the contraction break. It is a form of pain relief that we as midwives are allowed to give. No transfer to the gynecologist is necessary. Nitrous oxide is only possible in the Sophia birthing center, because here there is a special suction system in the chambers. When you start pushing, the nitrous oxide is stopped.

Benefits of nitrous oxide:

No transfer of care: administration by your own obstetrician
Nitrous oxide works after only 1 minute
Helps relax and allows for better tolerance of contractions
No risk to you or the baby
After you stop inhaling, nitrous oxide quickly disappears from your body

Disadvantages of nitrous oxide:

You have to stay in bed
Chin mask may feel uncomfortable (it should be left on for up to 20 minutes after stopping the nitrous oxide)
Side effects: nausea, dizziness, drowsiness. This disappears almost immediately after stopping nitrous oxide