Pain relief during childbirth

Giving birth hurts. No one can deny this. Almost all women experience the dilation contractions as painful; these are contractions of the uterus muscle which cause the cervix to open.
The expulsion contractions, together with the pushing, ensure the birth of your baby. Some people experience these contractions as painful. Others see it as a relief after hours of having to breathe away contractions.
No matter how you look at it, every birth is different. The duration and the degree of pain during a birth vary. In addition, every pregnant woman experiences the pain differently or deals with it differently.

NATURAL PAIN RELIEF

ENDORFINE

There are different things you can do that can help you to deal with the pain during the birth. For instance, you can do breathing and relaxation exercises to cope with the contractions. Courses during pregnancy such as pregnancy yoga or Samen Bevallen (Giving Birth Together) can help you with this. Showering, massage, changing your posture and movement can also reduce the pain. A calm and relaxed atmosphere also has a positive effect. It is important that you choose a place where you feel most comfortable: at home or in the hospital. When you are relaxed, your body produces the hormone endorphin. This is a natural form of painkilling which makes the contractions feel less painful. The counterpart of endorphin is the hormone adrenaline, and it also has an opposite effect. If for instance you are anxious or you are in a place where you do not feel comfortable, you will produce the hormone adrenaline which makes you less able to handle the pain of the contractions. Therefore, it is important to make sure you relax, in a way that is best for you. Think of dimmed lights or music if you feel comfortable with this.

Geboortetens

An easy-to-use form of pain relief during childbirth is the Geboorte(= birth)TENS. TENS stands for Transcutaneous Electrical Neuro Stimulation. It is a device that relieves pain by means of electronic stimuli. Through two electrodes from the device, the four stickers on your back give a pleasant tingling sensation. A boost button on the device can be activated during contractions, blocking the transmission of the pain stimulus and causing you to experience less pain.

ADVANTAGES OF THE geboorteTENS

  • Easy to use
  • Not harmful for you or your baby
  • You can keep walking around
  • Can be used for both home and hospital births
  • Intensity of the electronic stimuli you can determine yourself
  • Works mainly with back contractions

DISADVANTAGES OF THE geboorteTENS

  • It is not compatible with bath or shower
  • The helping effect is experienced differently by each woman

If you would like to use the GeboorteTENS, you can borrow one through PUUR. We ask a €25 deposit for this. The costs for the stickers/electrodes are €15 and you will have to pay for them yourself. Sometimes, your health insurance will reimburse you for the GeboorteTENS device and you can order one yourself. Check your insurance policy to see if it will be reimbursed.

For more information, please visit the website: www.geboorteTENS.nl

OPTIONS FOR PAIN MANAGEMENT IN THE HOSPITAL

If during labour the contractions are felt to be too painful you can opt for pain relief. There are different forms of pain control in the hospital:

  • Remifentanil
  • Epidural (lumbar puncture)
  • Pethidine
  • Nitrous oxide

The moment you want pain relief, we go to the hospital. First, we will make a heart sound (CTG) of the baby of at least 30 minutes. A good condition of the baby is a condition for any form of pain relief. After this heart recording, an internal touch will be performed to see how many centimetres of dilation you have. This will also determine which forms of pain relief will be the best choice, a choice that is made in consultation with you. The gynaecologist will then take over the care for the delivery.

REMIFENTANIL

Remifentanil is a morphine-like painkiller that is administered in a low dose via an infusion. It is more powerful than pethidine and disappears from the body more quickly. It ensures that the sharp edges of the contraction are removed. You still feel the contraction. Remifentanil is only administered after 6 centimetres of dilation because the effect of remifentanil decreases after a few hours.

ADMINISTRATION

Through an infusion in your hand or forearm, remifentanil is pumped directly into your blood vessels. This is why it has a quick effect that occurs after about one minute. You are given a button which you can press to administer the painkiller. You decide when and how often you press the button. The pump is set in such a way that you cannot overdose yourself.

BENEFITS

  • It can be administered in any hospital, at any time.
  • It works fast, after just one minute
  • The pump is connected in the room, you do not have to go to the operating room for this.

DISADVANTAGES

  • It can only be given in a hospital. This means that a gynaecologist will supervise your delivery.
  • Side effects may include drowsiness, nausea, or itching.
  • The painkilling effect diminishes after a few hours. This is because your body quickly gets used to this substance.
  • It can make you breathe less easily. You will therefore be given a sensor on your finger to measure the oxygen level in your blood. A doctor will stay in the room for the first half hour to keep an eye on everything. After this time, your body will have adapted to the morphine to a certain extent, and everything will be monitored from a distance.
  • It can affect your breathing and the amount of oxygen in your blood. Since your baby will be getting oxygen through you, this may also affect your baby. That is why it is important to register the condition of your baby with a heart monitor (CTG).

LUMBAR PUNCTURE (EPIDURAL)

The epidural, or in medical terms the epidural, is the most effective form of pain relief. However, it also has the most disadvantages and possible complications. An epidural can be used from early on in labour.

ADMINISTRATION

A cardiogram will be taken for at least half an hour to assess your condition and that of your baby. An infusion will also be inserted to give you extra fluids. An anaesthesiologist will numb the skin in your back. A thin tube is then inserted through a needle. After correct insertion and checking, the needle is removed. This tube remains in place and is taped firmly in place. The medicine that provides the pain relief is injected through this tube. Then a pump will be connected to it. This will ensure that a numbing medicine is administered constantly and for as long as necessary.

You will start to notice the effects after about fifteen minutes to half an hour after the injection of the anaesthetic. It is not that you feel no pain at all anymore, but you will certainly notice that the severity of the pain decreases considerably. When you are fully dilated the pump is turned off. This way you will be able to feel the contractions better and you will be able to push with them to have your baby born.

The insertion takes about an hour. In the Spaarne Gasthuis hospital, you are in the preparation room of the operating theatre complex during the epidural. Your partner may not be present and will wait in the delivery rooms. A nurse will be with you.

BENEFITS

  • Most effective form of pain relief
  • It can be administered in any hospital, at any time. Because the anaesthesiologist must administer the epidural, you may have to wait a little while when it is a busy period.

DISADVANTAGES

  • It can only be given in a hospital. This means that a gynaecologist will have to supervise your delivery.
  • During the insertion you must sit still, even when a contraction comes.
  • After placement, you should not walk around, as the strength in the leg muscles is reduced.
  • You will feel less urge to urinate. The bladder will be emptied with a tube (catheter)
  • Many pregnant women need medication to stimulate contractions, as they are not frequent or strong enough to achieve sufficient dilation after getting an epidural.
  • The pushing may take longer, increasing your chances of an artificial delivery; a vacuum extraction or caesarean section.

POSSIBLE COMPLICATIONS

  • One side effect is that you may develop a fever. If that is the case, we do not know whether this is due to the epidural or to an infection, and we will discuss with you whether you should take antibiotics during the birth. Some of these antibiotics will also reach your baby. Your baby will also be examined by the paediatrician after birth.
  • You may have severe headaches in the first few days after giving birth.
  • Your blood pressure may drop. Before the epidural is performed, you will receive extra fluids through an infusion in your arm. Your blood pressure will be checked regularly.
  • In rare cases, bleeding into the epidural space or meningitis may occur. In the worst case, this can cause temporary permanent damage, such as loss of sensation, muscle weakness or even permanent paralysis.

PETHIDINE INJECTION

Pethidine is a morphine-like medicine with an analgesic effect. The worst pain is reduced and often you can relax more between contractions. Some women doze off or even fall asleep.

ADMINISTRATION

It is only given during the dilation phase. However, it is no longer given at the end of this phase, just before the expulsion. This is because of the possible side effects for the baby and because you may be too deeply asleep to push actively. Sometimes pethidine is combined with a sleeping aid, such as phenergan or normison.

This is administered via an injection into your buttock or thigh. It works within fifteen minutes to half an hour. The drug is effective for two to four hours.

BENEFITS

  • Pethidine can be administered in any hospital, at any time (provided that the hospital is busy).
  • About 50% of the women are satisfied with the analgesic effect
  • It affects your consciousness, so you can become sleepy or even fall asleep. This can be pleasant if you are tired from the contractions. It ensures that you can rest for a while.
  • It can sometimes relieve you if you must wait for an epidural.

DISADVANTAGES

  • It can only be administered in a hospital. This means that a gynaecologist will supervise your delivery.
  • Approximately 50% of women do not experience it as analgesic.
  • Especially in the active phase of dilation, pregnant women do not experience the effect as pain reduction. One of the reasons for this is that the contractions become more and more intense in the active phase. The pain does not diminish but might have increased without pethidine.
  • You may feel nauseous, drowsy and sleepy. You may then be less aware of the birth.
  • You can't walk around, because it's easier to fall when you're sleepy.
  • It travels through the placenta to your baby, which can also make him drowsy and cause him to move less. That's why it's important to register the condition of your baby with a heart monitor (CTG).
  • Your baby may have more difficulty breathing immediately after birth. This is especially the case if the pethidine has been administered shortly before the birth. If this is the case, your baby will be taken to hospital immediately after birth to be given extra oxygen to help the breathing going (better). It may be necessary for a paediatrician to come to the hospital.

Nitrous oxide

Nitrous oxide is a mixture of 50% oxygen and 50% nitrous oxide. It is a colourless gas with a slightly sweet taste and smell. By diluting the nitrous oxide, the effect is less intense, and it is a friendly substance to use during childbirth. When you breathe in the gas, your consciousness lowers. You remain fully conscious, but get a little high, which suppresses the pain.

ADMINISTRATION

During a contraction you administer the nitrous oxide to yourself via a mouth mask. You put a cap over your nose and mouth, and then breathe in the gas. After the contraction you remove the cap, and the administration of the medicine stops automatically.

BENEFITS

  • It works fast, after just one minute.
  • It helps you relax and makes you more tolerant of pain.
  • There is no need for a cardiogram.
  • It can also be used in the bath.
  • You experience the delivery consciously.
  • It'll be out of your system in no time.
  • It has no side effects on the baby.

DISADVANTAGES

  • It can only be administered in a hospital. This means that a gynaecologist will supervise your delivery.
  • Alrijne hospital (Leiderdorp) and Spaarne Gasthuis (Haarlem) do not have this option. Only in the Amstelland hospital (Amstelveen) is this option available in every delivery room.
  • You may get nauseous, dizzy or sleepy.
  • You can't walk around with the nitrous oxide equipment.
  • It has a moderate analgesic effect.
  • It is only useful in the active phase of labour. You must have good contractions and there must be a good progress of dilation.
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