There are different methods to alleviate the Labour pains with conventional medical methods. Peridural anaesthesia (epidural) is by far the most commonly used method. For example, it has almost completely replaced the pudendal block in the delivery room.
I would like to emphasise once again in advance: If, for whatever reason, a woman chooses or needs medication to relieve labour pain, she has not "failed"! A woman giving birth cannot fail! In any case, her body is doing a great job. And the much-cited "birth experience" is not diminished by a requested drug-based pain relief. So no mother has to be disappointed with herself if she has requested a vaginal birth without any intervention - and then has her baby under an epidural, for example.
Sometimes measures to alleviate or eliminate pain during labour are not only desired, but also medically advisable. In this case, the obstetric team will suggest appropriate measures - for example, an epidural if the pregnant woman has certain pre-existing conditions such as a heart condition. However, the measure may also result from the current development of the labour. In some cases, an epidural can also prevent a caesarean section.
Consult your midwife and/or doctor in advance about the advantages and disadvantages of certain pain-relieving measures that could be suitable for you. Here is a brief overview of conventional medical methods:
Peridural anaesthesia (PDA)
Using a fine hollow needle, the anaesthetist places a soft catheter between two vertebrae in the so-called peridural space. This is a fluid-filled space between the vertebrae and the spinal canal in which the nerve roots that transmit the pain are located. Once the catheter is in place, the needle is removed and pain medication is injected through the catheter. For this procedure, the woman giving birth should sit as relaxed as possible with her back rounded. However, an epidural can also be inserted with the woman lying down. In any case, the injection site is locally anaesthetised beforehand.
The injected anaesthetic then "attaches" itself to the nerve endings and in this way inhibits the transmission of pain to the brain. The effect of the epidural sets in after around 15 to 20 minutes. The woman giving birth remains fully conscious. However, she has little or no pain for two to three hours and only feels the contractions as a kind of pressure. The painkiller can be re-injected as required.
So that the pregnant woman can "feel" the exit phase better and actively participate in it, the medical team often withdraws the epidural in the final phase. However, this does not mean that the woman is now overwhelmed by the contractions "from zero to 100". She should feel these contractions, but they should be muted.
If a caesarean section becomes necessary in the course of labour and there is still enough time, this can be performed with an appropriately dosed epidural. However, if it has to be done quickly, the pregnant woman will be given a general anaesthetic for the caesarean section.
From an anaesthetic point of view, an epidural is low-risk. It can happen that the blood pressure suddenly drops. In this case, the woman is usually given an infusion as a precaution, which can then be used to administer a drug that stabilises the circulation. Although other serious side effects are possible with this form of anaesthesia, they are extremely rare.
However, I would also like to look at epidural anaesthesia from the perspective of obstetrics. This is because it has various effects on the birth process: For example, epidural anaesthesia impairs the strength and coordination of the muscles in the legs and torso of women giving birth. This is why the women affected regularly lie down during labour and have their baby in a supine position. This makes the birth more difficult for the mum, but also for the baby, because in this position the pelvis is narrower, the path over the perineum is longer and gravity cannot help. Women find it harder to breathe in the supine position. This means that babies are more likely to suffer from a lack of oxygen.
More and more clinics are now offering a so-called walking PDA. The dosage of the pain medication should be adjusted so that the mother can move and walk around. So much for the theory. In practice, however, some women with a walking PDA still find it difficult to stay on their feet because they cannot feel them properly. A labour drip is also required with a walking PDA and a CTG lead is necessary. Both hinder mobility during labour.
As an epidural also impairs the sensation of the bladder, in many cases a bladder catheter is also placed in the woman giving birth. In addition, a contraceptive drip is often necessary if the relaxed female body only produces weaker contractions or contractions so weak that the birth stops. It is not uncommon for a suction cup to be used during an epidural to help the baby into the world.
Various studies also suggest that the birth takes significantly longer with an epidural, i.e. causes the child additional stress. Other research, however, assumes that this is not the case.
If you had an epidural at birth, your baby may well be sleepy and listless after the birth and may not be aware of its hunger. It is therefore important that you pay a lot of attention to your baby and breastfeeding so that it can recover quickly from its exhausting labour.
Pudendal block
This involves local anaesthesia of the pudendal nerve, which transmits pain impulses to the central nervous system. The aim is to block this transmission and suppress pain in the area of the perineum, vagina and pelvic floor. To do this, the doctor injects a painkiller into the left and right side of the vaginal wall. The effect sets in within minutes and lasts for about an hour. This procedure is often used if an episiotomy is required or there is a risk of a perineal tear.
However, the pudendal block has proven to be relatively unreliable. This is also one of the reasons why it has almost replaced the epidural. In most cases, the pudendal block only alleviates labour pain, but does not eliminate it.
Spinal anaesthesia
This method is used when it is already too late for an epidural or if a caesarean section is necessary. With spinal anaesthesia, the anaesthetist injects the medication directly into the spinal canal. The injection site is anaesthetised locally beforehand. The woman giving birth then initially feels a sensation of warmth in her legs and abdomen. After a few minutes, the full effect of the spinal anaesthetic sets in and lasts for one to three hours, depending on the dosage. The woman can no longer feel her legs and can only move them slightly or not at all. If her blood pressure suddenly drops, the woman is given an infusion.
In rare cases, intense headaches can occur as a side effect of spinal anaesthesia if cerebrospinal fluid (CSF) leaks from the puncture site on the spinal cord. This is technically known as a spinal headache. However, the risk is very low as extremely fine needles are now used. For anatomical reasons, there is virtually no risk of injury to the spinal cord.
Nitrous oxide
In German delivery rooms, women giving birth are increasingly being offered laughing gas (nitrous oxide) again to relieve labour pain. Using a breathing mask, the woman can independently inhale a mixture of nitrous oxide and oxygen, which takes effect very quickly. The woman largely controls the duration and dosage herself.
Despite the use of nitrous oxide, the contractions can still be felt, but the pain is reduced. Whether the relief of labour pain is considered sufficient depends on the individual pain perception of the woman giving birth. Many women cope quite well with laughing gas, but for some the pain is still too severe. In any case, nitrous oxide makes the woman feel more relaxed and allows her to perceive everything in a more "muted" way. Side effects can include nausea and dizziness, and in rare cases hallucinations.
The effect of nitrous oxide wears off just as quickly as soon as the expectant mother takes off the mask. The pain relief then ends as quickly as it began and any side effects also disappear.
Ultimately, however, nitrous oxide not only affects the woman's central nervous system, but her entire body. The German Society for Anaesthesiology and Intensive Care Medicine (DGAI) and the German Society for Gynaecology and Obstetrics (DGGG) therefore point out that harm to mother and child as well as to the obstetrics team cannot be completely ruled out. Reliable study results are still lacking.
This method of pain relief is not suitable for women who suffer from heart disease or folic acid or vitamin B12 deficiency. For example, the body needs vitamin B12 to break down the nitrous oxide.
Nitrous oxide passes through the placenta to the baby and can cause the baby to be sleepy and drowsy after birth. If you have needed nitrous oxide as an aid to relieve labour pain at birth, it is important that you patiently help your baby to breastfeed and wake him up to drink if he sleeps off his hunger. This will help your baby to recover quickly from the exhausting labour.
Spasmolytics
There are various medications in the form of suppositories or infusions that relieve labour pain. It will not completely eliminate labour pain, but it will be milder. Spasmolytics have an antispasmodic effect and relax the uterine muscles, especially the cervix. In this way, they can also support the progression of the opening phase, which is why they are often administered during this phase of labour. The baby is therefore not exposed to any side effects.
Opioids
This type of painkiller is injected into the gluteal muscle or administered in the form of infusions. As opioids belong to the morphine family, the woman experiences relatively quick and strong pain relief. Opioids also have a relaxing effect and thus promote the opening of the cervix.
As a side effect, however, they make the woman giving birth drowsy. They can also lead to nausea and vomiting. In rare cases, opioids also suppress the urge to breathe. In this case, the woman would be given an antidote that strengthens her breathing, but in turn weakens the pain-relieving effect of the opioid.
Side effects for the child: Opioids also reach the baby via the mother's bloodstream and make it sleepy. If the baby is born before the pain medication has been broken down, it can also affect the newborn's breathing. If necessary, the baby will then be injected with an antidote. If you have needed opioids as an aid for your birth, it is important that you keep a close eye on your baby after the birth and help it to get enough breast milk. This will help your baby to recover quickly from the stresses and strains of labour.
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