| Pain
relief ...
Epidural
These numb you completely so that you feel no pain, but they're
more complicated than other methods of pain relief and can
have unwanted side effects.
They need higher staffing levels and an anaesthetist on hand
all the time, so you can't have one at home or in a GP Unit.
Small hospitals may not always have enough midwives to cover
epidurals for normal labours so, unless there's a medical
reason, you may only get one at certain times or if an anaesthetist
is free.
Epidurals are more effective than pethidine for bad backache,
for severe pain that stops labour progressing or for a long,
exhausting labour. They may be suggested for high blood pressure,
a premature or induced labour (which can be more painful)
and for heart or lung disease. They can help a doctor to control
the delivery or intervene rapidly for a twin or breech (bottom
first) delivery; although problems are rare and an epidural
doesn't always avoid them.
An epidural may not be suitable if you've had bleeding from
the placenta, take drugs to prevent blood clots, have a skin
infection on your back or if you have spinal damage or a neurological
disorder such as multiple sclerosis. They can be more complicated
if your blood pressure is normally low, or if you have pre-eclampsia,
a disease of pregnancy involving high blood pressure. Some
interesting facts:
- About
25% of women have an epidural, excluding those who have
a caesarean section. This doubles if a hospital offers them
on demand.
- You're
twice as likely to have one if it's your first baby.
- You're
more likely to have one if your labour is induced (started
off artificially), or if your baby is in a posterior (back
to back) position.
Gas
& Air
This is a 50-50 mixture of nitrous oxide and oxygen that you
inhale through a mask or mouthpiece. It acts in about 30 seconds
and makes you light-headed for a minute or so before wearing
off.
It enters your bloodstream and crosses the placenta, but in
tiny amounts as it's exhaled almost immediately. It has little
effect on your baby .
Some women say it makes them feel dizzy, or it felt like too
much alcohol on an empty stomach. With overuse you may get a
dry mouth, and feel sick or out of control, but as it makes
you relax automatically you can't take too much. If you don't
like the effect you can stop using it at any time.
You can use it in a bath or birth pool, and it can help if your
labour has to be started off with a pessary or breaking your
waters involves a painful internal examination.
Getting the best out of it: Start to inhale slowly and deeply
as soon as you feel a contraction coming, so that it takes effect
as pain builds up. If you wait until you feel pain it will only
work as the contraction eases off.
Try it if you're 7- 8 centimetres dilated and need something
for the last few massive contractions. Or to stop you pushing
if you feel the urge before you're fully dilated. It's better
to stop using it when you're fully dilated as it can prevent
you from pushing effectively.
Pethidine
This drug, given by injection, has sedative and muscle relaxant
effects. It takes about 15 minutes to act, is most effective
after an hour and wears off in 2-4 hours. It may help you stay
in control because you feel relaxed and slightly spaced out;
or it may distance you from pain so that you don't mind it so
much.
It can make you so drowsy, however, that you wake up at the
peak of each contraction feeling that it's never-ending. If
you're out of control when it's given it can also give you a
bad trip. About 20% of women feel sick after having pethidine,
but drugs can counteract this. Strong contractions can make
you feel sick anyway.
Pethidine won't be given within 2-3 hours of delivery because
it crosses the placenta and the baby gets a large dose for his
weight. If he's born when the drug has built up in his system
but hasn't been eliminated, he may be slow to breathe and difficult
to feed. He'll get an antidote, but then he'll have to process
both drugs.
Getting the best out of it: A standard dose of pethidine (or
meptid, a similar drug with a less sedative effect) has more
effect if you're petite, generally respond strongly to medication
or are a vegetarian.
You may prefer to ask for a small dose to help you relax and
take the edge off the pain, having it as soon as you need it
rather than waiting until you're struggling, A small dose at
the right time will have less effect on your baby than repeated
large doses.
Make sure you're examined immediately before having pethidine.
You may dilate quicker than expected in strong labour, especially
if it's not your first baby. |
