Dealing with pain

Giving birth hurts, we all know that. The pain is caused by dilation contractions and extrusion contractions. However, the intensity of the pain and the duration of labor is different for each woman.

Research has shown that a home birth is just as safe as a hospital birth. This is because the midwife performs continuous risk selection and has the same resources at home as in the hospital. Both at home, in the birth home and in the hospital, we supervise childbirth. It is important to choose the location where you feel most comfortable.

What can you do yourself?

Preparation by practicing breathing and relaxation techniques ensures that you can handle contractions well. By breathing away the contractions with concentration, the body produces endorphins: this is an endogenous substance with an analgesic effect. Furthermore, a warm shower, bath or massage can help relieve the pain. It is also possible to rent/buy a TENS.
Our experience is: if labor progresses sufficiently, a woman is almost always able to tolerate the pain. Nevertheless, it is very common for women to find the pain unbearable. Exhaustion, anxiety or tension can play a role in this. That is why we would like to tell you a little more about the possibilities of pain management.

You have three forms of pain management in the hospital:

– Lumbar puncture (epidural) – Remifentanil (opiate) – Nitrous oxide

Spinal Tap

Epidural anesthesia is given by the anesthesiologist. In preparation, you will receive an infusion with extra fluids and the baby’s condition will be monitored using a heart film (CTG). The anesthesiologist introduces an anesthetic into the space between the vertebrae through a catheter (tube). This is where the nerves that carry pain impulses from the uterus and pelvic floor run. Injecting the fluid disables these nerves, making the pain much less perceived. Since the nerves that go to the muscles of the legs also run here, muscle strength may also decrease here. Feeling in the legs and lower abdomen will also decrease. After insertion of the catheter, anesthesia takes effect after about 15 minutes. Blood pressure, pulse and urine output are checked regularly. We also monitor whether the pain relief is sufficient. The dose is dosed accordingly with a pump. You will receive an IV, a bladder catheter and a blood pressure monitor around your arm for this pain relief method.

Course of childbirth

After epidural anesthesia, you may feel less pain or no pain at all during the dilation phase or during pushing. You are aware of the contractions, but you no longer feel pain. The anesthesia reduces when there is (almost) full dilation, so that you can feel the urge to push again and you can push optimally. Sometimes it takes a while before the spontaneous urge to push starts. Because of this, the expulsion phase may take a little longer. As with any birth, an artificial delivery may be necessary. In the event of a Caesarean section, the anesthesiologist will choose the appropriate pain relief.

Side effects

Pain management is not without risks. Blood pressure may drop, bladder function may decrease, and sometimes you may get itching or shivering. You may also develop a fever; to determine whether the fever is caused by the pain relief or an infection, your baby must then be admitted to the pediatric ward.

Is an epidural always possible?

No. Epidural pain relief is not given in disorders of blood clotting, in infections, in some neurological disorders and in abnormalities or previous surgery of the spine.

Remifentanil

PCA is an infusion pump containing a morphine preparation(Remifentanil). With a simple push of a button, you can decide when to take a dose of this short-acting painkiller. The pain relief lasts one minute per dose, making it excellent for handling contractions. The pump is connected to a computer, which is set to a maximum dose. Therefore, you can never give yourself too much.

Course of childbirth

With Remifentanil, you will not be completely pain-free, but the pain will become bearable. Just before the birth of your child, the pump is stopped. With this method, you will receive an IV, oxygen levels in your blood will be measured with a sensor in a “pinch” on your finger, and your unborn baby will be monitored with a heart monitor (CTG).

Side effects

Remifentanil is a short-acting painkiller and has the same side effects as Pethidine. Also with Remifentanil, a small dose goes to your child. Because the drug disappears from the blood again quickly, after stopping administration, no side effects for you and your child are to be expected and your child will be born clear and awake.

Note

Since the condition of both mother and child must be monitored regularly during the administration of pain control, these forms of pain control can only be used in the hospital.

Nitrous oxide

Nitrous oxide is a fast-acting mixture of nitrogen and oxygen. It causes you to become somewhat sleepy and therefore feel the peaks of contraction less. You are not pain free. Nitrous oxide is inhaled through a mouthpiece, and you also wear a chin mask for nitrous oxide drainage.
Nitrous oxide has no harmful effects on the baby. You remain under the supervision of your own midwife.

Course of childbirth

Nitrous oxide is usually used during the final stage of dilation. During the use of nitrous oxide you remain fully conscious. We regularly check your blood pressure and your oxygen (saturation) level, which is done by means of a “pinch” on your finger. During the last phase, the pressure phase, the nitrous oxide is stopped. The chin mask remains on for a while so that the gas in the exhaled air is extracted. You are also given oxygen to accelerate the effect of nitrous oxide. This takes about 10-20 minutes.

Side effects

Nitrous oxide may have some side effects such as; nausea, drowsiness, vomiting and dreaminess. It has the fewest side effects for mother and baby compared to other pain management drugs. For more information, read the leaflet: How to deal with pain from the KNOV