Options for pain relief

Labour is among the most painful of human experiences. The cause of labour pain is multi-factorial and includes contractions of the uterus and dilatation of the cervix during the first stage of labour, and stretching of the vagina and perineum in the second stage of labour.
Just as every baby is unique, every labour is different, and women have a wide range of differing experiences. It is also not uncommon for babies to choose to do something quite different from the plan you may have set out with for their birth! For these reasons, it is important to keep an open mind with regards to the various choices for pain relief available to you. We encourage you to attend antenatal classes and learn as much as possible about the pain relief options described here.
Pain relief for labour
Anaesthesia for Caesarean Section
Pain relief after Caesareans

Pain relief for labour

Natural methods
There are several non-medical techniques that have been used for many years to help with natural birth. These include the Alexander technique, the Bradley method, Lamaze, hypnosis, and water birth. Natural methods can play an important role either alone or in combination with medical pain relief.
Nitrous oxide
entonoxNitrous oxide (N2O) is an analgesic gas that is delivered with oxygen. You control the administration by breathing in through a mouth piece. Your midwife will explain how to get the best results with nitrous, including starting to breathe the gas in as you sense the beginning of a contraction, breathing throughout the contraction, and stopping the gas when your contraction is over. The effect of nitrous wears off several minutes after you stop inhaling the gas. Common side effects include nausea and drowsiness. About 85 per cent of women find nitrous helpful, although few women find it adequate as a sole means of pain relief. Nitrous oxide is widely used and safe during labour.
Intravenous/subcutaneous methods
Some women will find an injection of morphine (or having an equivalent medication in tablet form) helpful during their labour. These will generally begin to work within 5 to 10 minutes, and last for around 3 hours. Side effects include nausea, vomiting and drowsiness. In addition, there is a limit to the amount of morphine that can be given, as multiple doses may make your baby very drowsy when it is born.
Epidurals are the most effective form of pain relief available during labour. They work by using local anaesthetic to block the transmission of pain from the nerves that supply the lower half of your body. The procedure involves cleaning your back with antiseptic, then placing a needle between the bones in the lower part of your back.

Local anaesthetic is first used to numb the skin of your back, so the epidural needle itself will just feel like pushing. A very small soft tube (“epidural catheter”) is left in the appropriate space, and the needle is removed.
The procedure itself usually takes between 15 and 30 minutes, and once the local anaesthetic is given into the epidural catheter, you can expect each contraction to be less painful over the subsequent 20-30 minutes. In order to keep you comfortable for the rest of your labour, additional local anaesthetic is usually then self-administered using a push button (patient controlled epidural analgesia – PCEA), or it can be given by continuous infusion through the catheter. If you require a forceps or caesarean delivery, your epidural can usually be used to provide anaesthesia for these procedures.
If pain relief is requested late in labour, a combined spinal epidural (see below) will sometimes be used. Answers to some common questions regarding epidurals can be found on the ‘Frequently asked questions’ page.

Anaesthesia for Caesarean Section

Watch a patient’s journey through an elective Caesarean section at Royal North Shore Hospital. A patient information leaflet is also available.

A spinal anaesthetic is the most commonly performed technique to provide anaesthesia for caesarean section. The actual procedure is similar to an epidural, but once the medication is administered into the appropriate space, the needle is removed and no catheter is left in your back.
Spinals allow you to be awake for the birth of your baby by caesarean section, as you will be numb in the lower half of your body. Your legs will also be heavy and difficult to use for several hours. You will feel touch and pressure during the surgery, but nothing painful. The level of numbness is tested by the anaesthetist before the surgery is allowed to commence. Your anaesthetist remains with you throughout the surgery to ensure you are comfortable.
Spinal anaesthesia can be used for both elective (planned) caesarean sections as well as emergency caesarean sections. Common problems associated with spinals are similar to those associated with epidurals.
If you have had an epidural placed for pain relief during labour, it can usually be used to provide anaesthesia for a caesarean section if required.
Combined spinal epidural
A combined spinal epidural (CSE) technique involves the placement of a spinal anaesthetic, but an epidural catheter is also left in place as part of the same procedure. This is another common method of providing anaesthesia for caesareans, and can also sometimes be used if pain relief is requested late in labour.
It is uncommon for you to experience pain during caesarean section with a working spinal or epidural. If this does occur, your anaesthetist can give you pain relief medications intravenously, or you can go to sleep with a general anaesthetic at any time.
General anaesthesia
This is usually reserved for emergency caesarean sections, or for mothers in whom it is not technically possible or safe to place a spinal or epidural. More information about general anaesthesia can be found here.

Pain relief after Caesareans

A caesarean section is abdominal surgery, and once the spinal or epidural anaesthetic wears off, you will be sore. None of the strong pain medications will completely remove all pain; nevertheless it is possible for you to be quite comfortable after the operation with appropriate pain relief. The aim is for you to be safe and comfortable enough to look after your baby. There is an anaesthetist on site 24 hours a day to help optimise your pain management.
If you have a spinal or epidural anaesthetic, your anaesthetist will usually add morphine to the local anaesthetic mixture. This will provide very good pain relief for between 24 and 36 hours after the procedure. Common side effects include nausea and itch. These are nuisance side effects only, and they do resolve.
In addition to the spinal or epidural morphine, you will receive simple analgesics such as paracetamol and non-steroidal anti-inflammatories (eg Voltaren or Nurofen) regularly for several days without you needing to ask for them.
Once the spinal or epidural morphine wears off, you may need some strong pain relief tablets, in addition to the regular doses of paracetamol and non-steroidal anti-inflammatories. These are usually a morphine-like drug such as oxycodone (Endone), which you can ask for every 3-4 hours, if you need them.
Another option for pain relief after caesareans is the use of patient controlled intravenous analgesia (PCA). This involves a button connected to a device containing a morphine-like drug, connected to you via an intravenous line. When you have pain, you press the button, and the machine delivers you a dose of pain relief. It is safe for you to use when you need it, because drug delivery is limited by computer control in the device. The PCA button should only be pressed by you – it only becomes unsafe is someone else (eg friends or family) presses the button for you.
Further information r