Regional anaesthetics

These remove sensation from part of your body by blocking the transmission of pain from nerve fibres. Caudal anaesthesia is administered by an injection into your spinal area around the sacrum, and numbs your vagina and perineum. This may be used for short-term relief if the birth involves a vacuum extraction or forceps delivery.

To administer a pudendal block, anaesthesia is injected straight into your vagina near the pelvic region, blocking the pudendal nerve. This numbs the lower part of your vagina, and may be used if you have an episiotomy.

The most widely used form of this type of anaesthesia is the epidural block. Most mothers who have a Caesarean have an epidural instead of a general anaesthetic, which allows them to stay awake throughout the birth.

Anaesthetic is syringed into the catheter, which is then sealed, although it can be topped up at any time if necessary. You need to let your attendants know in advance that you wish to have an epidural because it must be given by a skilled anaesthetist, and it usually takes 10-20 minutes to be set up. The anaesthetic will take effect within a few minutes.

Inhalation analgesic

This is a gas that you administer yourself using a face mask, and consists of Entonox (gas and oxygen). You inhale deeply as the contraction starts, and carry on until the contraction peaks or you have had enough. You then put the mask aside and breathe normally. Gas works by numbing the pain centre in the brain, and can make you feel as though you’re floating. You may be able to practise this in an antenatal class.

Narcotics

Now considered rather old-fashioned, the most commonly used is pethidine, which is derived from morphine, and is given by injection in the thigh or buttock in varying dosages during the first stage of labour. It dulls the sensation of pain by acting on the nerve cells in the brain and spine. If you choose this, it is probably wise to ask for a small dose to see how you are affected. It will take about 20 minutes to work.

How drugs affect your baby

Most drugs will cross the placenta to affect your baby once they are in your bloodstream. Those used in epidural anaesthesia cannot enter your baby’s blood.

Drowsiness

A large dose of sedatives or tranquillizers may affect his ability to suckle, and to respond to you immediately after he is born.

Breathing and sucking

If you take pethidine late in your labour it could affect your baby at birth because narcotics can depress your baby’s breathing and make sucking inefficient.

Epidural anaesthetic

After an injection of local anaesthetic in your back (to numb it), the anaesthetist will insert a fine, hollow needle into the epidural space — the region around the spinal cord — and the anaesthetic is injected through this.

The kind of pain you’ll experience during contractions can vary. It may feel like a thick band being squeezed around your abdomen as the uterus hardens and tightens for several seconds before relaxing. Some women compare it to severe menstrual cramps, others experience backache, but there may be a combination of sensations as the contraction peaks and then subsides.

Individual response

You may prefer not to use certain drugs during your labour as they can dim your awareness of what is happening; however, it is very difficult to know the level of pain you can manage without relief, particularly if this is your first baby. Some women are surprised by the overpowering intensity their contractions, others may find their pain worsen through fear and anxiety.

Analgesia, such as epidural anaesthesia can offer complete relief of pain, while gas and oxygen and narcotics help reduce pain to bearable levels. Many opt for no drugs in the early part of the first stage, then have gas and oxygen towards transition. Don`t be self-critical if you do need drugs for pain relief it isn’t a sign of cowardice. Remember, labour isn`t a test, and drugs may even be essential to deliver your baby.

If you wish to have full participation in your baby’s birth without dimming your consciousness of the physical and emotional sensations, there are alternatives to drugs for pain relief.

A clear choice

Find out as much as possible about the types of pain relief that will be available. Have a discussion with your doctor, midwife and hospital attendants, and then outline your choices in your birth plan. Be prepared for your plan to change if any complications arise.

How drugs affect you

Apart from offering pain relief, drugs can affect your experience of childbirth in other ways. Make sure you opt for the type that will help enhance, rather than detract from, the pleasure of your baby’s birth.

Drowsiness

This is a common side-effect of gas and oxygen, tranquillizers and narcotics. Some women enjoy the sensation of drifting, but sometimes this can make mothers feel they lack control A few women have become so lightheaded they were unaware of what was happening around them, and gave birth without realizing it had happened.

Dizziness

Pethidine and other narcotics can sometimes induce a feeling of confusion, or disorientation, and some mothers have even had hallucinations.

Nausea

The sensation of nausea is usually slight with gas and oxygen, but is quite common after using pethidine and other narcotics, and a few mothers may suffer attacks of vomiting.

Your state of mind can have a major effect on the intensity of pain experienced in labour. So if the use of drugs will make you less anxious and more relaxed, there is no point in depriving yourself since excessive tension can affect the uterus, increase your perception of pain, and lengthen labour.