If you are in early labour and you are not being admitted to the hospital, if you so wish, we can give you some Morphine and Gravol as an injection to help you cope with the contractions and help you get some sleep when you go home. These medications are safe to use in early labour. They help take the edge off the pain so that when you go home, you are able to rest while you are waiting for your labour to become more established.
Once you are admitted to the labour ward, the options of pain control are as follows:
With the aid of your nurse, find a position that is most comfortable for you to labour in. Most women like standing and leaning forward during a contraction. We have large air-filled balls, which you can sit on or lean on to help make you feel more comfortable. A lower back massage, especially during a contraction may help you cope with labour.
There are showers available in most of the labouring rooms. Only some rooms have a bathtub. A lot of women find that warm water on their lower back helps alleviate the pain of labour. Your partner can get into the shower with you if they want. Make sure they pack their swimsuit.
This pain control option involves putting a mask over your nose and mouth during a contraction and sucking in the gas. A lot of women find the mask makes them feel claustrophobic and the gas makes them nauseous. The gas also can make you dizzy. If you like the gas and it is helping you cope with the labour pains you can continue to use the gas for as long as you want. If you do not like the gas stop using it and consider the epidural.
This is the most effective form of pain control in labour. Most of my patients who have had an epidural in labour say that they just loved it. The aim is to make you comfortable in labour so that you can get some rest and not be too exhausted when it comes time to push. It also helps make your labour a more relaxed and enjoyable experience. You can only get an epidural once you are admitted to a labour room. You will need to have an IV started before getting the epidural. The nurse usually does this. The anesthesiologists administer your epidural. This involves inserting a small tube in your lower back. You will be given some local anesthetic over the area before getting epidural so you will not feel pain when it is inserted. The thought of having a needle and a tube inserted into their lower back is very frightening but most women hardly notice the epidural going in. The epidural is inserted in between contractions.
At Women’s hospital we use what is called the “walking epidural”. This epidural should allow you to be mobile and change position in labour. It may even be possible for you to walk with the epidural in place. This may help improve the efficiency of your labour. It is common to feel some pressure in the pelvis during a contraction but if the epidural works correctly you should not feel any pain.
We can keep the epidural working no matter how long your labour lasts. If you start to feel pain during labour, we have ways of boosting the medication in order to make you comfortable again. An epidural will typically slow your labour down and so it is quite common for us to start a medication called “oxytocin” to help get you back into labour after you have the epidural. Oxytocin is safe for use in labour.
The epidural may have some side effects. It may make you itchy and it is also common for it to cause you to shake just as if you were cold. It may also make you nauseated. If you are nauseated or itchy we have medications to help with these side effects. Epidurals can cause some lower back pain after the labour and this may last for a few weeks but will eventually go away. The risk of you developing any long-term back injury or spinal cord injury is extremely rare.
Once your cervix is fully dilated and it is time to start pushing, there is no point in pushing if you are completely frozen from the epidural. You will not be able to push effectively and you will be wasting your energy. What we usually do at this point is to turn the epidural down. The aim is for you to feel pressure but no pain. This will allow you to push more effectively while still allowing you to be comfortable. Do not start to push until you feel pressure in your pelvis. This pressure should feel like you need to go to the washroom.
The epidural is safe for your baby. The medication administered does not go into your blood and therefore does not cross over to the baby or your breast milk. It will not affect your breast milk production or your ability to breast-feed.
There might be a bit of a wait getting the epidural depending on how many anesthesiologists are working and how busy the unit is. The epidurals are usually administered on a first come first serve basis, so if you feel you would like to have one, ask for it early.
Once you have an epidural in place you will probably not have any sensation to empty your bladder. We often have to put a little tube into your bladder called a catheter to help you empty your bladder. This does not hurt.
If you feel the situation is urgent and cannot wait for a phone call then come directly to BC Women’s Hospital and we will be happy to see you there.
It usually takes 30 minutes from getting the epidural until it makes you comfortable. If you are fully dilated or progressing rapidly you may not have time to get an epidural, as you will probably have the baby before you get comfortable. However in your first labour, as the progress is usually a little slower you may be able to get the epidural at any stage in labour, even if you are fully dilated.