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Doctor’s Advice On Pain Relief Options When Giving Birth

Dr TC Tan | Published on February 6, 2023

Giving birth is a magical process but the pain of the process is what most women worry about. Knowing your pain relief options will enable you to be better prepared for labour.

Entonox Gas

Also known as “laughing gas”, a mixture of oxygen and nitrous oxide is administered through a mask as soon as contractions start, for best effect. When inhaled during delivery, the gas alters the state of mind to make pain more manageable but does not actually eliminate pain. While only about 50% of mums-to-be find it effective, it still remains widely used because it allows them to be fully in control of when to take the gas and it doesn’t have any side effects on the baby. Short-term side effects on the mother include light-headedness, drowsiness and nausea.

Pethidine Injection

Administered via injection into the thigh or buttocks, pethidine takes effect after 15 minutes and provides a varying degree of pain relief depending on the individual. Its side effects on the mother are similar to that of laughing gas but the biggest drawback is its drowsy effect on the newborn, which can cause the baby breathing problems. To avoid this, an injection of pethidine is limited to at least 6 hours before delivery and when the cervix is dilated to a width of less than 4 centimetres. An antidote will be administered to the baby to counter the side effects.

Epidural

An anaesthetist will insert a hollow needle in the mother’s lower back through which a fine plastic tube will enter the epidural space to deliver the anaesthetic. It numbs the nerves that send pain signals from the birth canal to the brain, and is considered to be the most effective pain relief during labour. Once the tube is in place, the epidural can be topped up to maintain pain relief until delivery. The set-up takes about 15 minutes and another 10 to 15 minutes to take effect.

Epidural analgesia (EA) is the only pain relief that allows the mother to stay awake throughout labour. For mothers in severe pain, a variation called Combined Spinal-Epidural Analgesia (CSEA) delivers the first dose of anaesthetics deeper into the backbone canal (the intrathecal space) to allow for more rapid pain relief. In Patient-controlled Epidural Analgesia (PCEA), the mother can top-up the epidural herself by pushing a button. This allows her to have better control of her labour pain, as opposed to EA or CSEA where the anaesthesiologist administers the drug.

An epidural is very safe — with limited side effects on mother and baby during labour and after delivery. It can potentially lengthen the second stage of labour but the extended duration is not significant, and contrary to popular belief, does not result in a caesarean. While numbness in the legs is a common complaint, it should subside in a few hours. However, it is important to note that it can cause nausea during labour. Other common complaints include back pain and headaches after the epidural, but they are temporary and will subside in a few days. There are no permanent side effects.

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