Pain relief in labour

​What are my options?

Read more about the different types of pain relief you can use at home or at the hospital.

  • Water
  • Massage
  • Morphine
  • Sterile Water Injections
  • Acupuncture
  • TENS - Transcutanous Electrical Nerve Stimulation
  • Epidural
  • Pudendal Block

Water

Effects
  • Can ease pain and help you relax
  • Contractions may seem shorter
  • Helps you relax between contractions
Who
Anyone with a normal, uncomplicated pregnancy and birth, which does not require continuous monitoring of the baby. Most of our delivery rooms have bath tubs and a few have showers as well.

How
You can be eased both in a shower and in a bath tub. A shower will usually be for a short period of time, where as you can stay in the bath tub for several hours.

For the comfort of both you and your baby, the water needs to be at temperature between 36-37 degrees Celcius.

This method of pain relief can be combined with other methods, such as acupuncture and sterile water injections.
 
Side effects
None.
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Massage

Effects
  • Can ease pain and help you relax
  • Can establish a good connection between you and the person massaging
Who
Anyone
 
How
Your husband, partner, friend or the midwife can massage you. There is no wrong way to massage. Some women prefer a light touch, while others prefer firm massage of their lower back. Try different ways and see what works for you. Although you may not know for sure what you want during birth, practicing massage in pregnancy is a good way for you and your partner to get to know your body.
 
Side effects
None.
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Morphine

Effects
  • Provides light to moderate pain relief
  • Makes you feel sleepy 
  • Can help you relax
Who
If your baby’s heart rate is normal, you can have morphine. We evaluate the baby's heart beat before morphine is given by using a CTG monitor - CardioTocoGraphy.

We do not offer morphine if we estimate you will give birth within the next 4 hours. This is to prevent side effects to the baby. This means it is usually only given in early labour.
 
How
Morphine is administered by the midwife as an injection into your thigh or bottom. It is effective after approximately 30 minutes. Morphine may not remove the pain completely, but approximately 50% of the women given it, find it effective in easing their pain. As morphine often makes you feel sleepy, it can help you rest or even sleep. The effect last for 3-4 hours.
 
Side effects
You may experience itching, nausea or a sensation that you need to vomit.

If, against expected, you give birth within a couple of hours of being given morphine, your baby may be sleepy and unresponsive at birth. If your baby experiences difficulties breathing, we have medicine which can neutralize the effect of the morphine. This is given to the baby as an injection and works very quickly. If your baby is sleepy at birth it may cause initial problems in establishing breastfeeding.
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Sterile water injections


Effects 
  • Can ease pain and help you relax
  • Effective if you have localised lower back pain or pain above you pubic bone
Who
Anyone and at any time during delivery.
 
How
Sterile water injections, in Danish “sterilvandspapler” are given by your midwife as a series of 4 injections, one quickly after the other. They consist of small amounts of sterile water injected under the skin. When the injections have been given you may move around freely. They work immediately and the effect lasts for approximately 1 hour. Approximately 50% of women given sterile water injections find them effective in easing back pain.  They can be repeated as necessary. 
 
Side effects
None, but it is painful when they are given. Each injection will feel like getting stung by a bee. The pain goes away after approximately 1 minute.
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Acupuncture

Effects 

  • Can ease pain and help you relax
  • Can make you feel sleepy and calm
  • Can have a positive effect on your cervix
Who
Anyone. Acupuncture can be given several times during birth.
  
How
Acupuncture is administered by your midwife. It is given with thin needles, and you will feel a small prick as the needles pierces the skin. You may also feel a tingling or warm sensation. 

You may stand up or sit or lie down, when the needles are placed.

The midwife will ask you about the sensation and location of your pain and feel your body in order to identify the correct areas to place the needles. It may be on your back, legs, feet, hands, head or in front of the body.

The number of needles varies from 2-12. Ideally the needles should remain situated for approximately 20 minutes, but they can be removed if they are uncomfortable. Acupuncture is usually effective after a few minutes.
 
Side effects
Almost none. Some women get a little dizzy and need to lie down for a while. It is not dangerous and only lasts for a short while. 20-30% of women get a small bruise where the needle pierced the skin. It does not affect the baby.
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TENS - Transcutanous Electrical Nerve Stimulation


Effects​
  • Can ease pain and help you relax
  • Especially effective on back pain
Who
Anyone.

However, it cannot be used if you are in a bath tub or taking a shower. TENS can intefere with certain monitoring of the baby. If so it cannot be used.
 
How
A hand-held controller connected by two sets of fine leads to 4 sticky pads placed on your  upper and lower back. Two of the pads are placed at the level of your bra strap, the other two are placed just above your bottom. The pads are covered in a firm gel which helps the pads stick to your skin and transfers the electrical impulses better. Through the wires connected to the pads little pulses of electrical energy are transferred. These pulses may give you a tingling or buzzing sensation depending on the setting which you control through the hand-held device. Your midwife will instruct you in how to use this.
The hand-held controller part of TENS is easy to hold in your hand while you are in labour. It has buttons that you can use to control the frequency and strength of the pulses. There is also a boost button for you to press with your thumb, when you want maximum output from the machine. This can help you to get through each contraction.
 
How does it work
We don’t know exactly how TENS works to help you cope in labour It may be that the electrical pulses prevent pain signals from reaching your brain. Or the pulses may stimulate your body to release natural, feel-good substances (endorphins).

TENS probably works due to a combination of factors. It may help you to feel in control of your labour and be less anxious. It also offers a distraction from your contractions.

Side effects
None. It is safe to use for both you and your baby.


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Epidural

Effects

  • Can ease pain and help you relax
  • The most effective method of pain relief in labour
 Who
Anyone.
 
How
An epidural is administered by a doctor – an anaesthetist. If you decide you want an epidural when you are in labour, then your midwife will call the doctor. An epidural cannot be booked in advance, but the doctor will get to you as soon as possible, usually within 1 hour.

Before the epidural is administered, the midwife will monitor your baby’s heart rate continuously with the CTG monitor, measure your blood pressure and put a salt water drip in your hand. The drip in your hand is because one of the common side effects with the epidural is lowered blood pressure. It may be necessary to administer medicine through the drip if your blood pressure drops below a certain point.
 
It takes approximately 10-15 minutes to administer the epidural. You can either sit or lie on your side as it is given. You need to arch your back “push your back out”. The doctor and midwife will help you and tell you what they are doing throughout the procedure.  
 
The doctor will start by washing your back to keep it as sterile as possible during the procedure. He will inject a local anaesthetic under the skin at the location where the needle will be inserted. When the local anaesthetic is working, the doctor will insert the needle into your back. Through the needle, the doctor inserts a very thin plastic tube, also called a catheter, into the location of the nerves causing your pain. When the catherter is placed, the needle is removed. The only thing remaining in your back is the very thin plastic catheter which is secured to the outside of your back with tape to prevent it from moving or falling out. Through the catheter you will be administered pain relieving medicine continuously via a small pump. The medicine given is a mixture of a local anaesthetic and a morphine-like drug.
 
Your contractions and the baby’s heart rate will be monitored continuously with the CTG monitor after you have had an epidural. 
 
How does it feel
Having a drip put in your hand feels like having a blood test. When the doctor puts the local anaesthetic in your back before administering the epidural, you may feel a tightening, stinging sensation which goes away quickly. Having the catheter put in should not be painful, but it may be uncomfortable.
 
How quickly does it work
After the catheter has been placed and the medicine has been given, you will usually feel an effect after 10-15 minutes. Maximum effect is usually reached after 25-30 minutes. When the epidural is effective, the doctor leaves. The midwife continues to care for you.
 
How effective is it?
At best, you do not feel the contractions at all, very little or have a tightening sensation. The epidural is most effective on the pains in the uterus and less on the pains caused by the baby’s head stretching the pelvic floor and the vagina in the late stage of labour. You will usually start to feel the contractions again at this stage. An epidural does not increase your risk of caesarean section
 
Side effects
  • Lowered blood pressure: May cause nausea or dizziness and can affect the baby’s heart beat temporarily. It can be treated with medicine.
  • Problems passing urine: The epidural numbs your bladder which can make it difficult to feel when you need to pass urine. The midwife will remind you to go to the toilet regularly and if you are unable to pass urine yourself, she will insert a catheter and empty the bladder for you. The catheter is removed when your bladder is empty.
  • Itching: Due to the morphine-like medication given, you may feel itching. It goes away after the epidural is removed.
  • Fever: An epidural can cause fewer. It happens to approximately 24% of women, who have an epidural. You may be given penicillin.
  • Longer birth: An epidural may cause you to dilate slower and it may take longer for you to push out the baby which increases the risk of needing a ventouse to help you deliver your baby.
  • Headache: An epidural may cause you to get a headache during the first couple of days after giving birth. It happens to 1-2% of women. The headache occurs because the doctor accidentally has pierced the membranes surrounding the spine during the procedure. You will feel the headache as you stand up and it will go away when you lie down. The headache needs to be treated by an anaesthetist otherwise it does not go away until after several weeks. The treatment consists of the doctor injecting a small amount of your blood into the area by the membrane surrounding your spine.
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Pudendal block

Effects

  • Eases pain at the very end of labour, when you are just about to push your baby’s head out
Who
Anyone.

If your baby needs to be delivered with a ventouse you will usually be offered a pudendal block
 
How
A pudendal block is usually given shortly before the baby is due to be born, when you have been pushing for a while. You may also be offered the pudendal block after you have given birth as painrelief during suturing. It is usually given by your midwife. You will be lying down with you legs bent similar to when you are having a gynaecological examination. The midwife will inject a local anaesthetic in both sides of your vagina close to the pudendal nerve. It takes approximately 1 minute to administer the injections. It numbs the nerves in your vagina so you feel less pain as the baby is pushed out.
 
How does it feel
Some women do not feel the injections because they are focusing on their contractions, others feel a stinging and tightening sensation as the anaesthetic is injected. This goes away quickly.
 
How quickly does it work
It is usually effective after approximately 5 minutes.
 
How effective is it
70-90% of women, who are given the pudendal block find it effective. The effects last for approximately 1 hour.
 
Side effects

  • Lack of sensation to push: Somestimes the pudendal block is so effective that it can reduce or even remove your sensation to push. In this case an intravenous syntocinon drip can be given to increase the streength of your contractions.
  • Affected nerves:  Some women may experience sensory loss in one of their legs. This is caused when the local anesthetis spreads to the nerves in the legs and it may affect the legs for up to 24 hours. It will go away again and there will be no long term side effects.
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