Drugs for labour and birth Your three best bets
Margot Bertelsmann gives the lowdown on your pain relief options
LABOUR DAY IS
dawning and you’re considering your pain relief options. Will you be squeezing your birth partner’s hand and breathing through your labour as you go drug-free and au naturel, or are you leaning more towards “knock me out at the first twinge of pain and wake me when the hairdresser arrives”? You can choose different levels of intervention. They all have their benefits and drawbacks. Let’s look at the main three methods of pain relief.
GAS AND AIR (ENTONOX)
WHAT IS IT? A mixture of nitrous oxide and oxygen gas, which has an anaesthetic and muscle-relaxing effect. It’s also known as laughing gas. HOW IS IT ADMINISTERED? You breathe the mixture in through a mouthpiece, which you hold over your mouth, for about 20 seconds as a contraction begins. An advantage is that you therefore control the dosage as you administer it yourself. Many maternity hospitals deliver entonox via wall-mounted piping. HOW WILL IT AFFECT ME? It’s only a mild painkiller and won’t take away all sensation. It’s not yet completely clear how it works to lessen pain. Other effects are feeling light-headed and giggly – a “happy drunk” sort of feeling. The gas is cold to breathe in and can cause a dry mouth. Some women report getting drowsy after using it. HOW WILL IT AFFECT MY BABY? Entonox is not thought to cross over to the baby’s body, so it’s safe for your baby. WHAT IS IT? Pethidine is a synthetically manufactured opioid, which means it’s derived from the poppy plant and related to morphine. It’s of course potentially addictive, but it’s unlikely that you will use it again soon after labour, so this isn’t a huge concern. It’s used for moderate to strong pain. HOW IS IT ADMINISTERED? You’ll receive a pethidine injection into your thigh. It takes effect in about 20 minutes and stays in your system for about four hours.
HOW WILL IT AFFECT ME? Pethidine blocks the pain receptors in your brain. It does have some side-effects, such as nausea and vomiting, it also has a sedating effect and can cause constipation, sweating, dizziness and retention of urine. Some women become confused and it has an effect on their perception of what’s going on around them. Reviews of pethidine are mixed: some women find it too sedating, others say it doesn’t block enough pain. Obstetrician and gynaecologist Dr Nirvashni Dwarka says pethidine is often administered together with aterax (hydroxyzine dihydrochloride). “It has a sedating, and mild anti-anxiety and anti-emetic (vomiting) effect, so that prevents some of the side-effects of pethidine but also amplifies its effect.” HOW WILL IT AFFECT MY BABY? Pethidine does cross the placenta and is detectable in breastmilk, so it can affect your baby. Some babies have breathing difficulties, because pethidine can repress the baby’s respiratory centre. For this reason, doctors try not to administer pethidine when the birth is close, to minimise the amount of the drug left in the baby’s system after birth. Babies born to mothers who received pethidine are also more likely to develop jaundice. It can cause a baby to be “sluggish” and struggle with the sucking reflex and breastfeeding right at the beginning. There is a pethidine antidote (naloxone) which can be given to babies, and it takes effect quickly, though, Dr Dwarka says.
WHAT IS IT? Only the most popular method of pain relief for women in labour, that’s what. It’s routinely available in private healthcare, but not always in governmental facilities, and it can remove 100 percent of the pain of labour because it’s a regional anaesthetic. This means it blocks sensation in one part of your body completely. Finetuning of epidurals has meant women can get partial epidurals, where pain is reduced but sensation is not blocked, or epidurals that wear off right before the pushing part of labour (so that you can push more effectively), or even a flexible, “walking” epidural, which can be topped up, but which allows you to move around during labour.
HOW IS IT ADMINISTERED?
A combination of anaesthetic and narcotic agents is delivered by injection into the epidural space – the fatty area in the spine between the dura mater, a membrane, and the vertebral wall. A catheter is left in place and “a midwife can top up or decrease the dose as required,” says Dr Dwarka. HOW WILL IT AFFECT ME? You can remain conscious – even during a C-section – but pain-free. An epidural can be a lifesaver in a long and difficult labour, and allows you to rest and gather your strength for the next stage. It can also ensure you are not too traumatised by a difficult delivery and gives you a more positive birth experience. Side-effects can include a sudden drop in blood pressure, a severe headache, shivering, and numbness. “Epidurals can prolong the second stage of labour (the bearing down stage) because sometimes you can no longer feel the contractions,” Dr Dwarka says. “In this case the midwife or obstetrician will have to tell you when to push and there is an increased risk for an instrumental delivery with forceps or a ventouse to help deliver the baby’s head.” She says headaches or backache for a day or two after delivery can occur, but they can be treated. “But it is uncommon to develop chronic backache from an epidural.”
HOW WILL IT AFFECT MY BABY?
“With an epidural, there has to be continuous monitoring of the baby,” cautions Dr Dwarka. “This often means there are two belts around your tummy – one monitoring the contractions and the other the baby’s heart rate. Hence, is it not always possible to move around with an epidural as most of our maternity units do not have remote foetal monitoring units.” A baby might struggle to latch for a while after delivery, but studies are not unanimous on this, or any other effects there may be on a baby.
IS A TENS MACHINE FOR ME?
A TENS machine is a transcutaneous electrical nerve stimulator – in plain English, though, it’s a handheld device with electrodes that you stick onto your skin (usually on your back), which pulse electric impulses into your nerves to stimulate them. You control the amount of charge that’s released. As a contraction builds, you can activate the TENS machine and in theory the current then stimulates your body to produce painkilling substances. Reports on how useful it is during labour vary widely. Women say it works best after about 30 minutes of use. Of course, like other non-invasive forms of pain relief, such as hypnobirthing, labouring in warm water, or using breathing techniques, this labourassisting device is completely safe to use and has no effect on the baby at all. It doesn’t have adverse effects on the mother either: there are no physical side-effects such as nausea, and you administer and control it yourself. You can still move around during labour and you can use it with other pain relief methods if you want to, except in water. You can buy a TENS machine: for between R1 300 and R1 800 you can get an obstetric TENS machine from NeuroTrac (tensmachines.co.za/ womanshealth.htm) or MamaTENS (tenscaresa.co.za/product/mamatens/). Speak to your midwife or doctor too – they may know where to get one. But by far the simplest way to get your hands on one is to hire it. For around R400 you can hire a TENS machine for up to four weeks, so you have a chance to practise before you give birth, and you’ll still have it even if your baby is overdue. Check out Mother’s Instinct on support@motherinstinct. co.za or motherinstinct.co.za/birth_ pool__tens_rental, or Tens 4 Hire: tens4hire.co.za/rental-obs.htm.
DEPENDING ON YOUR PREFERENCES, YOU CAN CHOOSE DIFFERENT LEVELS OF INTERVENTION