Pain varies from person to person, and even varies in the same person at different times. Each person will have different problems, wishes and ability to cope with the childbirth experience. There are many methods of providing relief of pain in labour.
Not all methods are suitable for everyone. We want to emphasize that if you do not want any kind of medication, then none will be given to you. However, you may want to keep an open mind and seek the advice of your health care provider and/or anaesthetist before making up your mind.
An anaesthetist is "on call" 24 hours a day, 7 days a week in our Birthing Centre.
This person is a specialist who gives anaesthetics. In addition to giving anaesthesia for cesarean sections, the anaesthetist advises on and provides various methods of pain relief for labour and delivery.
Many methods of pain relief have been used for the pain of labour Some women may require more than one method or none at all. These methods generally fall into two categories and are available at North York General Hospital.
All labouring women have different needs for pain relief and no single method is the ideal solution or necessarily correct for everyone. We encourage you to go through labour with an open mind and discuss any concerns that arise from this information with your health care provider.
Methods not using medication
- Breathing and relaxation exercises
- TENS (transcutaneous electric nerve stimulation)
- Whirlpool baths/showers
Breathing and relaxation techniques help you cope with the pain of labour and may be used along with other comfort measures. You can get more information about these techniques from prenatal classes, individual reading and your nurse in the Birthing Centre.
A massage by your support person assisted by your nurse/midwife.
Whirlpool baths and showers can help you cope with your labour contractions. Prior to coming to the hospital, taking a shower may help relax you. In the Birthing Centre, whirlpool baths are available in most birthing suites for your comfort. The baths may be used even if your amniotic sac ("water") has broken, but can not be used if you have an epidural. Your nurse will discuss this option with you when you are admitted to the birthing suite.
Methods using medication
- Nitrous oxide (Entonox)
- Injections of narcotic drugs or sedatives
- Epidural nerve block
- Other local anaesthetic nerve blocks
Nitrous oxide (laughing gas)
Nitrous oxide is an anaesthetic gas given with oxygen through a rubber mask. By taking a deep breath, the gas goes into your lungs and blood stream. You may feel a little light-headed, but it will help to take the edge off your labour pains. Nitrous oxide is available in our well ventilated birthing suits.
Narcotics (strong pain killers)
If labour becomes too uncomfortable, you and your heath care provider may decide on an injection of a narcotic drug. Such drugs do not give complete pain relief and can cause drowsiness in mothers. Gravol is also given at the same time to prevent nausea and vomiting. If this drug is given shortly before delivery, the baby may be drowsy and will need medication to reverse the drowsiness. Therefore, narcotics are generally not given if we think the baby will be born within the next four hours.
An epidural is a very effective and safe pain relief methodprovided by an anaesthetist. You will be able to remain alert and enjoy your childbirth experience with little discomfort. An epidural would be done with your consent and at the request of your health care provider.
An epidural is a method of pain relief using a local anaesthetic (the same type of medication used by the dentist to freeze a tooth). The nerves to the uterus and birth canal are frozen by an injection into the lower back. Epidural analgesia does not make you or your baby sleepy and can be used without slowing labour — in fact, labour may become more effective once the pain is relieved.
An intravenous (IV) in your arm or hand is required for patients needing an epidural or spinal procedure. The intravenous line allows for a bolus of fluid to be given before the procedure.
Steps for an epidural/spinal
- Careful positioning is required and remaining very still is important while the epidural is being inserted. Spinals and epidurals have different onset times and your anaesthetist will select the correct method depending on the circumstances.
- Your support person may be able to stay or could be asked to leave the room depending on the anaesthestist's preference.
- You will be positioned on your side or sitting as requested by the anaesthetist
- Your back will be washed with an antiseptic
- You will receive freezing in the skin of your back. This feels like a bee sting.
- A special needle is introduced carefully between the bones of the spine, into the epidural space.
- A thin flexible plastic tube (the epidural catheter) is then passed through the needle. This epidural catheter is left in place and the needle is removed.
- Local anaesthetic ("freezing") is injected through the tubing to relieve the pain.
- The tubing will be taped to your back — nothing sharp remains in your back.
- It takes about 5–25 minutes for the epidural to work and ease the pain.
- The epidural tubing will be connected to a pump, which will continually give local anaesthetic mixed with a narcotic drug to ensure pain relief until after the baby is born.
- You will still be able to move your legs although they may feel weak and slightly numb. You can be aware of your contractions but they should not be painful.
- After your delivery, the epidural catheter will be removed by the nurse or midwife.
- Later on in the Mother and Baby Unit, the intravenous line will be removed.
Patient-controlled epidural analgesia (PCEA)
PCEA is the newest method of maintaining epidural analesgia for pain relief in labour. The anaesthetist programs the anaesthetic dose into the pump. If you begin feeling discomfort, you are able to adjust the level of pain relief by pressing a handlheld button attached to the PCEA pump (a computerized machine).
With this technique, you have full control over when you wish to give yourself the anaesthetic. Once you have given yourself a dose of this anaesthetic drug, you will need to wait for a certain period of time (usually about 10 minutes) to allow for the anaesthetic to work. If you require more medication, you can then press the button again. There will be a limit to the amount of medication that you can give yourself and the PCEA pump will lock out for a period of time. PCEA has demonstrated increased user satisfaction and provides excellent pain relief, while using less local anaesthetic.
Side effects and complications with epidural or spinals
There are risks with any medication or procedure; epidurals and spinals are no exception. Although serious complications are very rare, the common ones are:
- A drop in blood pressure: this risk can be minimized by starting an intravenous (IV) line and giving you fluid before the epidural. Your blood pressure is carefully monitored before and after an epidural, so that low blood pressure will be quickly treated. A drop in blood pressure may cause nausea, vomiting and dizziness.
- Shivering: this is not a serious side effect, but commonly occurs during labour, with or without the epidural.
- Numbness: the local anaesthetic used for pain relief can cause temporary numbness and weakness in your legs. For safety reasons, we request that you not try to get out of bed.
- Trouble emptying your bladder: this problem may require the insertion of a small tube (catheter) into your bladder to drain the urine.
- Backache: recent studies have found no difference in the incidence of childbirth-related backache whether an epidural was inserted or not. Some patients experience backache that can last a few days or weeks.
- Headache: this risk of a headache is approximately 1 in 200. If the spinal membrane (the dura) is accidentally punctured by the epidural needle, you may have a severe headache within 24 hours. The anaesthetist will be informed and there is an effective method of treatment available.
- Itchiness: this is a side-effect of the narcotic drug given during an epidural or spinal. Although rarely severe, there is effective treatment available to make the itchiness less bothersome.
- Inadequate pain relief: sometimes there is inadequate pain relief in spite of an epidural. If this occurs, the epidural catheter may have to be adjusted or removed and a new catheter is inserted. Very rarely, some of the medication may be accidentally inserted into the spinal space or a vein. This may cause temporary effects such as: ringing in your ears, blurred vision, tingling around your mouth or seizures.
More serious complications such as meningitis, paralysis or death have been reported, but are extremely rare. Persistent weakness or numbness in one leg can occur in 1 in 2,500 women. This is usually caused by pressure from the baby on the nerves that pass through the pelvis and less commonly from the epidural perssing on a nerve in the back This numbness and weakness can last several weeks and then will gradually subside.
Anaesthetic for a cesarean section
Cesarean sections are ideally done under epidural or spinal analgesia unless there are medical reasons against them. This means that you are frozen from the level of the nipple line down. The local anaesthetic used for a cesarean is stronger than that used to treat the pain of labour. This will allow you to experience the birth of your baby with your partner, who may choose to be present during the cesarean section. In an emergency situation, a general anaesthetic ("going to sleep") can be given more quickly by injecting a variety of drugs into the intravenous line. Your partner will then be asked to wait outside the operating room until you are transferred to the recovery room.
Epimorph: Pain control after a cesarean section
If you have a cesarean section under an epidural or spinal anaesthesia, your anasthetist will give you a small dose of morphine (epimorph) through the epidural catheter or spinal needle. This will offer very effective pain relief for 12-24 hours following delivery of the baby. There are no harmful effects on your baby from this medication. Oral pain medication is available when needed.
Support person present during anaesthetic procedure
Your partner or any other support person is welcome to be with your during your labour and birth or cesarean section done under epidural or spinal. Occasionally, the support person may be requested to leave the room.
Can all women have an epidural?
Medical problems such as bleeding disorders, skin infections at the site for the epidural insertion, as well as spinal or nervous system diseases, may prevent the safe use of epidural in patients. If there are other reasons that an epidural is being questioned, these patients are often sent to the hospital during their pregnancy to have an anaesthetic consult by one of the anaesthetists.
If an epidural cannot be the method of pain relief used, there are other local anaesthetic methods available. As an alternative, your doctor may administer an injection of local anaesthetic into the birth canal at the time of the delivery.
The recent popularity of tattoos over the lower back has caused concern about whether or not it is still possible to receive an epidural during labour. Theoretically, pigment containing tissue could be pushed into the epidural space or cerebrospinal fluid through the needle. The effects of this pigment in these compartments is not known. There are currently no reports of complications related to epidurals placed through tattoos. You will have a chance to discuss this with your anaesthetist.
Please do not rely on the information on this website as an alternative to medical advice from your doctor or other professional health care provider. If you have any specific questions about any medical matter, consult your health care provider. If you think you may be suffering from any medical condition, seek immediate medical attention. You should never delay seeking medical advice, disregard medical advice, or discontinue medical treatment because of information on this website