By: Dr Denise O’Brien
HypnoBirthing is a complete childbirth education program that teaches a simple but effective method of self-hypnosis & relaxation with a proven track record of promoting natural, reduced stress births. This always creates a more positive experience for a mother and her newborn Hypnobirthing helps women to reach a state of deep relaxation during labour using positive visualizations, relaxation techniques and simple self-hypnosis. The aim is to eliminate the fear of pain, and women are encouraged to embrace the surge of contractions, each one bringing their baby closer. Some studies suggest that women who practice hypnobirthing use fewer medical drugs, have shorter labours and have fewer interventions, although research is ongoing into the effectiveness of the technique.
This traditional Chinese medicine involves inserting thin needles into the body at certain points to restore the flow of energy or ‘chi’. The aim of the treatment is that the woman is more relaxed and as a result less likely to use medical forms of pain relief.
This complementary therapy uses essential oils made from concentrated plant extracts, applied through massage, inhaled or added to a warm bath, to calm and relax. Not all oils are recommended during labour, so check which ones are safe to use with a qualified practitioner. Some midwives are qualified aroma therapists.
This works on the premise that specific points on the feet, and sometimes on the hands, correspond to different parts of the body. Stimulating these points works on the corresponding organ or body system to provide relaxation, pain relief and healing.
Gas and air (Entonox) for labour
This form of pain-relief also known as laughing gas is a mixture of oxygen and nitrous oxide gas. It won’t r remove all the pain but many women suggest it makes labour more bearable. Many women like it because it’s easy to use and they control it themselves.
How it works
You breathe in the gas and air through a mask or mouthpiece, which you hold yourself. The gas takes about 15 to 20 seconds to work, so you breathe it in just as a contraction begins. It works best if you take slow, deep breaths. In addition if you try and relax and let your body and contractions do ‘their work’. Tensing up can make your contractions less effective. So slow deep relaxed breaths are best.
There are no harmful side effects for you or the baby but it can make you feel light-headed. Some women also don’t like it because they don’t like a mask over their mouth and some women suggest it makes them feel sick, sleepy or unable to concentrate.
If Entonox doesn’t meet your needs for pain relief, you can ask for a stronger painkilling injection as well.
Pethidine injections in labour
This is a form of morphine and is given as a intramuscular injection (into the muscle of your thigh or buttock) of a drug, such as pethidine or, less commonly, diamorphine. Women suggest the injection helped them to relax, and lessen the pain.
How it works
It takes about 20 minutes to work after the injection, and the effects last between two and four hours.
There are some side effects to be aware of:
It can make some women feel woozy, sick and forgetful some women feel very sick and can vomit following pethidine.
If given too close to the time of delivery they may affect the baby’s breathing. If this happens, another drug to reverse the effect will be given by the paediatrican so do not worry.
The drugs can interfere with the baby’s first feed as well as they may be drowsy.
An epidural is a form of local anaesthetic that numbs the nerves that carry the pain impulses or messages about contractions to your brain. In other words it blocks the pathway and your brain is unaware of the contractions or pain. For most women, it gives complete pain relief and is particularly helpful if you are having a long or particularly painful labour or require an instrumental delivery. However it’s not always 100% effective in labour.
What’s involved in having an epidural?
For the safety of the baby and to maintain your blood-pressure You will need to have extra fluids given intravenously when you have an epidural. There is a n association between having an epidural and reduced blood-pressure and this will affect the blood supply to your baby. For this reason A drip will run intravenous fluids which are basically sterile water with electrolytes through a needle into a vein in your arm.
You will be asked to either you lie on your side or sit up in a curled position, for the procedure which takes about 20 minutes to complete. Firstly the anaesthetist will sterilise your back with a cold antiseptic solution. Following this you will feel a needle type prick in the small of your back as some local anaesthetic is inserted before the plastic epidural catheter is inserted. This a very thin tube and is placed into your back near the nerves that carry back pain impulses from the uterus (womb) to the brain. Drugs, usually a mixture of local anaesthetic and morphine, are administered through this tube. It takes about 10 to 15 minutes for it to work. It doesn’t always work perfectly at first and may to be need adjusted slightly.
You will no longer feel your contractions but the midwife or student midwife will monitor them and record the frequency and duration of them. In addition your baby’s heart rate will need to be continuously monitored. See picture on page 116.
There are some side effects to need be aware of:
An epidural may make your legs feel heavy, depending on the local anaesthetic used.
Your blood pressure can drop (hypotension) and this can make you feel very sick and you may vomit however, this is rare because the intravenous fluids given through the drip in your arm helps maintain a normal blood pressure.
Epidurals cannot slow down your labour pains however they can prolong the second stage of labour. This is because you can no longer feel your contractions, and you may find it harder to birth your baby without the sensation that a woman would feel without an epidural. This means that you are more likely to need a forceps or a ventouse to help deliver the baby’s head (instrumental delivery). When you have an epidural, your midwife or doctor will wait longer for the baby’s head to come down (before you start pushing).
You may find it difficult to pass urine as a result of the epidural. If so, a small tube called a catheter may be put into your bladder to help you.
About one in 100 women gets a headache after an epidural. If this happens, it can be treated.
Your back might be a bit sore for a day or two but epidurals don’t cause long-term backache.
This stands for transcutaneous electrical nerve stimulation. Electrodes are taped onto your back and connected by wires to a small battery-powered stimulator. Holding this, you give yourself small, safe amounts of current through the electrodes. You can move around while you use TENS.
TENS is believed to work by stimulating the body to produce more of its own natural painkillers, called endorphins. It also reduces the number of pain signals that are sent to the brain by the spinal cord
TENS are probably most effective during the early stages when many women experience low back pain.
There are no known side effects for either you or the baby.
Dr Denise O’Brien is the Head of Subject Midwifery in UCD