When it hurts


Pain is a natural part of childbirth. Labour pain is caused by several factors: the smooth muscle in the womb contracts, the pelvic muscles and external genitals are stretched and the baby’s head descends deep into the pelvis.

Keep in mind that labour pain is a natural, positive pain. It is meaningful pain. Experience of pain is individual – therefore, accurate measurement of the level of pain is not possible. The primary method of pain assessment is the mother's description of the pain she feels. Management of labour includes adequate pain relief. The midwife listens to your wishes, recommends different methods and is in charge of managing pain relief in each stage of labour.

It is usually impossible to tell in advance which pain relief method works best for you and how your pain should be relieved during labour. 

  • It is good to practice and try different positions to find the ones in which you can concentrate and relax. During labour, try to find positions that feel comfortable for you. You can use a rocking chair, a sacco chair, a gym ball, etc. 
  • A warm cushion or a warm shower or bath may provide efficient pain relief during the opening stage. Warm water has been shown to relieve stress; it has a relaxing and calming effect. In water it is also easier to find a comfortable position, because water supports your weight.
  • Touching and massaging can relieve pain. Often the mother likes it when the support person massages the site where the contraction pain is strongest or just holds the mother's hand during the most intense pain. Sometimes the midwife's touch feels comforting.
  • So-called aqua blisters can be used to relieve labour pain. This means that 2–4 blisters of water are injected under the skin of your back or stomach. Aqua blisters can be used anytime and several times during the labour.

 

When labour progresses naturally without any pharmaceutical pain relief, the mother needs much support, encouragement and presence. The support person’s role is extremely important. The midwife’s encouraging support and presence also help. It is quite normal for the mother to have moments of despair and helplessness, and she may doubt her own ability to cope.

   

What if I want more
efficient pain relief...


The medications used for labour pain relief are well known and safe.
 
 
Strong painkillers

At the early stage of labour, efficient painkillers can be administered orally or by muscular injection.
 

Laughing gas

A mixture of oxygen and laughing gas is a safe pain relief method. The mother inhales the mixture through a mask during contractions. The use of laughing gas, particularly knowing when to start inhaling, takes a little practice, but this is usually an efficient pain relief method.


Epidural anesthesia

Epidural anesthesia is administered by an anesthetist. The use of this method requires that the condition of the mother and baby can be efficiently monitored. Epidural anesthesia does not prevent you from moving, but you will have to lie down for about half an hour at first. The anesthetist passes a catheter into the epidural space with the help of an epidural needle. The anesthetic is passed along the catheter. The skin and subcutaneous tissue are numbed before this. The catheter is attached to your back with adhesive tape, and the midwife can administer additional doses of the anesthetic if needed. One dose usually works for about two hours. 


Spinal anesthesia

Spinal anesthesia is administered by an anesthetist. The anesthetic is injected into the spinal space in the back. This is a single dose anesthetic which means that, unlike epidural anesthesia, additional doses cannot be administered. The onset of the effect is quick, and it lasts for one or two hours. Sometimes when administering spinal anesthesia the anesthetist inserts a thin catheter into the epidural space. This makes it possible to continue pain relief with epidural anesthesia, if needed. Spinal anesthesia is a good pain relief method particularly for mothers who have given birth before and whose labour progresses quickly. The use of spinal anesthesia requires monitoring of the baby's heart beats, and the mother must be put on a drip.  


Paracervical block

Paracervical block (PCB) is given by an obstetrician. Its effect lasts from one to two hours. Usually the paracervical block is not placed until the labour is properly underway and progressing well.


Pudendal block

Pudendal block is given by an obstetrician, or a midwife trained in administering it. This is done during vaginal examination, with the cervix nearly or fully dilated, before the pushing stage. The effect begins in a few minutes and lasts from 30 to 60 minutes.