105. Medical Procedures And Medications In Labour

Many women find that using self help techniques such as changing positions, relaxation, showering and massage are all they need to cope with labour pain. Some women find that they need or want more help to cope with labour.
Other pain relief options including medication are available. It is important to know how they can help you as well as possible side effects for you, your baby and your recovery. Your healthcare provider can help you with decisions about pain relief options in labour. We encourage you to find out more about these options before your labour starts.

• Stands for Transcutaneous Electronic Nerve Stimulation
• Given through electrodes taped to your skin (a mild electric current tricks your nerves so that you feel less pain)

Benefits

• Can provide good pain relief in early labour
• You control the strength of the current
• Takes your mind off the pain
• Mom is able to move around
• No effect on labour or on baby

Disadvantages/Risks

• Not as effective in active labour
• Not as effective if you don’t know how to use it before labour begins
• Can’t be used in the bath or shower

Other Information

TENS works best if you begin using it in early labour so you would need to have the unit rented and in your home before you go into labour

TENS machines can be rented from a medical supply store. You usually need to put down a deposit along with the rental fees. Some will come with instructions on how to use the unit you rent or you can get advice from a physiotherapist

• “Laughing Gas” (a mixture of 50% nitrous oxide and 50% oxygen)
• Self administered during a contraction, through a mask you hold to your face
• Can be used in any stage of labour

Benefits

• Can provide good pain relief at any stage in labour without long-lasting effects in mom or baby
• You control the amount you receive
• Can be used with other methods of pain control
• Helps you focus on breathing
• Little effect on baby

Disadvantages/Risks

• May cause dizziness, numbness or tingling, or nausea
• Doesn’t eliminate pain

Other Information:
Supporting a woman who is using Entonox:

• Breathing the Entonox will make her mouth dry so be sure to offer ice chips, sips of water and lip balm between contractions
• Remind her to take slow deep breaths into the mask from the start of contractions to ensure she is getting enough medication, then to breath room air after the peak and between contractions to exhale the gas from her lungs
• Continue to use comfort techniques such as massage and touch

• Pain medication such as Morphine ®, Fentanyl ®
• Usually given by injection or intravenous

Benefits

• Can be used throughout labour
• IV (injected into a vein) works in 2 to 3 minutes; lasts 1 to 2 hours
• IM (injected into muscle) works in 20 to 30 minutes; lasts 2 to 3 hours
• Decreases the perception of pain felt in labour
• May help you to relax so that you can use self help techniques more effectively

Disadvantages/Risks

• May cause dizziness, nausea, drowsiness
• May make your baby drowsy and may affect breathing and breastfeeding (a drug can be given to temporarily reverse these effects, until the narcotic is no longer active)
• Does not eliminate all the pain

Other Information
Supporting a woman who has had a narcotic in labour:

• The medication may make her dizzy and feel uncoordinated so she will need your help to change positions in bed
• Continue to use comfort measures such as massage and touch. Wipe her face and offer her sips of water between contractions
• A woman using narcotics in labour may be very sleepy and thus unaware that a contraction has started until it is at its peak. This makes it difficult to use coping and comfort techniques effectively. You can let her know a contraction is starting if you keep one hand on her abdomen to feel for the uterus beginning to tighten. The nurse can help to show you how to do this
• After the birth, keep baby skin to skin with mom (or dad if mom is unable) as much as possible to help with breastfeeding

• Uses an anesthetic, which numbs nerves, or a combination of anesthetic and narcotic
• Medication is given through a small tube inserted into the space surrounding your spine (the tube stays in place until after your baby is born)
• The tube may be hooked to a pump which regulates the amount

Benefits

• Can be used throughout labour
• Can provide the most effective pain relief
• A low-dose block can sometimes give effective pain relief and still let you move around with help (this is not always possible and you may have to stay in bed)
• A full block completely blocks feeling from waist to knees
• Top-ups (more medication) are easily given, and often this can be controlled by the labouring woman herself.
• Pain relief can be achieved in 2 to 3 contractions
• You can be awake if a cesarean birth is needed

Disadvantages/Risks

• You may develop a fever in labour and the need for more bloodwork and monitoring for you and your baby
• May slow or stop labour if given before active labour is established. If contractions slow down, oxytocin may be needed to stimulate labour
• An epidural may lower your blood pressure. For this reason, you must have an IV started before the epidural
• A decrease in your blood pressure could slow the baby’s heart rate for a short time
• Sometimes the dose needed to give pain relief causes weakness of the legs and you may have to stay in bed
• Pain relief may be “patchy”, (which means you may still feel pain in some areas) This can usually be fixed
• You may lose bladder tone temporarily and you may need to have a catheter (a tube in your bladder) during labour to drain the urine
• You may lose the urge to push with contractions. Your nurse can direct you to push with contractions, sometimes forceps or vacum extraction is needed for the birth of your baby.
• You may experience shivering and/or itchiness
• You may have a headache after delivery
• Minor back pain (bruised feeling) at the site of the epidural is common and usually goes away within a week
• Very rarely, breathing problems, infection, nerve damage or paralysis may occur

Other Information
When epidural medications are given, you will be attached to an electronic fetal heart rate monitor. The monitor will be placed around your abdomen again for routine monitoring or if there is a concern about your baby, if you receive oxytocin to stimulate your labour or if you receive extra doses of epidural medication. Most women who want an epidural can have one. There are some medical conditions that prevent a woman from having an epidural If you are interested in having an epidural for pain control, discuss this with your healthcare provider ahead of time.

Supporting a woman who has epidural anesthesia:

• Help her to spend about 20 – 30 minutes in each of these positions to help the baby move through the pelvis: Sidelying (left), semi prone (left), hands and knees or kneel over a birth ball, semi prone (right), sidelying (right), semi sitting.
• Encourage her to change position every 20 -30 minutes, as much as she is able. This will decrease the chances that the baby will remain in an unfavorable position. Depending on the type and level of anesthesia a woman may be able to stand and walk to the bathroom with support or may only be able to turn over in bed with a lot of assistance
• Be aware of her position in bed. Does she look like she would be comfortable staying in that position for an hour? A woman with epidural anesthesia may not be aware of her body and may remain in a position that she would normally change because she was uncomfortable. If she remains in a poor position for a long period it could cause back, shoulder or hip pain in the postpartum period
• Continue with comfort measures such as offering sips of fluid, wiping her neck and face with a cool cloth or massaging her hands, shoulders, scalp or face
• Ask to delay pushing until the baby has progressed down in the pelvis and the mother feels an urge to push.
• In the postpartum period keep baby skin to skin with mom (or dad if she is unable) as much as possible to help baby with breastfeeding