Every labor and delivery is different, and so is the pain threshold - what is bearable for one woman may be intolerable for another. You cannot predict which way your labor is going to go but you can certainly choose to be aware of the options and its effects on labor. Further, labor pain is going to invariably occupy the minds of first-time mothers. Therefore learning about the different methods of pain relief makes sense as it will help prepare you better and hence build your confidence level.


The Facts..


• The best way to deal with a pain that won't go away (i.e. labor contractions) is to find ways of coping with it. Keep active by moving around is one such strategy.




• Many factors, which are not within your control, can affect your labor; your baby's position, the shape of your pelvis for instance.


• Studies show that medication for pain relief lowers cesarean rates by actually speeding up labor


• If you feel you are bad at managing pain, talk to your doctor about it and review the various options available


• Becoming stressed and teary about the pain may actually hamper the progress of your labor


• Drugs administered to cut down the pain have its side effects on you and your baby since it crosses the placenta


• Effects are however short-term and minimal in most cases


• If you didn't already know, fatigue heightens pain. So what you can do is relax by practicing breathing exercises to help manage your contractions and conserve the energy between contractions





Common Forms of Medicated Pain Relief

What	Effect on Mother	Effect on Baby
Pethidine or Meptazinol These are powerful, synthetic analgesics very similar to morphine in function. Narcotics are rather old fashioned and most effective when injected into the thigh or buttocks. The injection can be repeated every 2-4 hours. These drugs are usually administered when labor is in full gear. About 20 minutes is required for the effect to kick in but can last up to 3 hours.	• The drugs have a drowsy effect but won't cause any interference with the contractions or when you are trying to push in most instances. • They produce different reactions in women; some find that it relaxes and eases the tension away while others find it disorienting and the sluggishness may make pushing difficult. • Some experience nausea, a drop in BP and or depression. More drugs may be required to help manage the inconveniences.	• Effect on baby depends on the strength of dose and the timing; the nearer to the birth the greater the effect • Some babies may feel sleepy and have problems sucking and being attentive. • In rare instances baby may need oxygen for few hours to aid in her breathing.
Epidural Anesthesia A local anesthetic is given to numb your back area. After which a fine, hollow needle is inserted into the base of the spinal cord followed by a catheter. The needle is removed and the catheter is taped firmly in place. Mother must keep still while a skilled anesthetist administers the procedure - it becomes difficult during contractions. The catheter left at the injection site is topped up with anesthetic as and when there is a requirement. An IV of liquid infusion is also given to prevent BP from falling low. Sometimes low doses of local anesthetic is combined with low doses of analgesic as it works more quickly; it increases the urge to push and without affecting the ability.	• Total pain relief is achieved if administered correctly by numbing the area from the waist to the knees. • Depending on the dose and timing, epidural make it difficult to push during the second stage of labor. • The numb feeling remains for several hours • Can slow down contractions so an oxytocin IV drip may be necessary to speed things up by stimulating the uterus into action. Mother needs to be told when to push as she may not feel the contractions • The mother will need a catheter to empty her bladder • In some cases the mother may develop fever in labor • In very rare instances, a severe headache for days may follow	• Some studies indicate that babies born after an epidural are likely to be drowsy • There may be the necessity for forceps or vacuum extraction for delivery. • On rare occasions baby's heartbeat may slow down, requiring baby to be continuously observed. • If mother had fever baby may develop infection requiring observation for at least 2 days in a special care nursery
Spinal Anesthesia A slight variation to epidural in that the anesthetic is injected into the fluid around the spinal cord to provide short-term but effective pain relief. An anesthetist needs to be available and the mother must be still when medication is being given. It takes about 5 minutes to work	• Very effective pain relief for unplanned cesareans and some instrumental deliveries • Common side effect is nausea and severe headache • Can cause BP levels to drop • Effect can take up to 5 hours to wear off • Mother is mostly catheterized	• Baby stays unaffected unless there is a drop in maternal blood pressure. Oxygen supply to baby is then affected.
Entonox Also known as 'gas and air', Entonox is a mixture of oxygen and nitrous oxide which the mother will breathe in through a face mask or mouthpiece. It doesn't reduce all of the pain but makes labor more bearable. It takes only 15 seconds for the effect to kick in.	• No lasting side effects on the mother. • Relieves tension. • The gas works by numbing the pain center in your brain • No restrictions on movements • Some experience drowsiness, sickish sensation and light-headedness. Since the dose is controlled by you, it is easy to stop its use if you feel weird. • Can be used with other methods of pain relief.	• No side effects on the baby.