Labour & Pain Relief

The first signs of labour

Labour means work. The purpose of uterine contractions is to thin and dilate the uterine cervix so that the baby may be expelled. Consequently contractions are working to expel the baby. Labour begins when the mucus plug is expelled and uterine contractions become regular and increasingly more painful. Sometimes leakage or spontaneous rupture of the bag of waters may help bring on labour.

EXPULSION OF THE MUCUS PLUG

The expulsion of the mucus plug is an inconstant finding in the mechanism of labour. Formed by mucosal secretions inside the uterine cervix, sometimes tinged with blood, this plug forms a barrier to infection. It may be expelled 24 to 48 hours prior to childbirth, or even several days before. It may go unnoticed if it occurs at the same time as rupture of the bag of waters or cervical dilation.

UTERINE CONTRACTIONS

Just as any muscle, the uterus can contract. Such contractions are not under voluntary control, and all you can do is experience them. They sometimes develop during the 5th month and are painless, or may not start until the onset of labour. When uterine contractions become regular and painful, they herald the start of labour, regardless of the duration of the gestation. Uterine contractions cause the wall of the uterus to become hard. This is easily felt by a hand placed on the abdominal wall during a contraction. As the cervix is being dilated and its opening stretched during a contraction, discomfort grows increasingly strong.

Sometimes limited to the lumbar region, discomfort generally begins in the lower back, divides in half, encircling the abdomen to come together again around the pelvis. Each contraction is separated from the succeeding one by periods of relief. It may occur, especially with a first child, that contractions become immediately regular, recurring every five minutes. Their rate which at first is progressive, every fifteen, ten, and then every five minutes accelerates. They then become increasingly more painful with shorter and shorter periods of pain relief

EFFECTS OF UTERINE CONTRACTIONS

As a result of the work done by contractions, the cervix softens, decreases in length and shortens, eventually being incorporated into the body of the uterus while at the same time remaining closed. The rate of such contractions, i.e. recurring less than every ten minutes, alerts you to go to the maternity ward.

The baby gradually descends the birth canal depending on cervical dilation and can only leave the uterus after the cervix is completely dilated. As discomfort becomes more intense, you should inhale as soon as a uterine contraction occurs, and exhale slowly until the pain subsides. Between contractions you should retain all your strength, and should remain calm to surmount this massive test of physical endurance.

RUPTURE OF THE BAG OF WATERS

The outflow of about a glassful of warm aqueous fluid corresponds to rupture of the bag of waters, while a leakage gives the impression of urinary incontinence. In both cases, this flow, with or without uterine contractions, and sometimes tinged with meconium, should alert you to go to the emergency admissions of the maternity hospital to avoid infection of the amniotic cavity.

Pain relief during labour

We all experience and express pain differently. While there's no denying that labour is painful, there's no way to measure the pain. Needless to say, after delivery, when you see your child, the pain is forgotten about. Some women insist on a drug free labour, and some demand whatever is on offer. Most take the middle ground, prefering to do it naturally, but reserve the right to change their minds if the going gets really tough.

PHYSICAL THERAPY

Physical therapy helps many women cope with pain. You can try:

• Massage

• Heat walking

• Showering

• Bathing

• Rocking in a chair

• Squatting on a birthing ball 

PAIN RELIEF MEDICATION

The two most common forms of pain relief are nitrous oxide inhalant, which is given as a gas, and pethidine, which is given intravenously or with an injection into the buttocks, when labour is advanced, but well before delivery. Sometimes tranquillisers are used to calm an anxious woman so she can participate more fully in childbirth. There are also several different types of anaesthesia available, ranging from general anaesthesia (for caesarean birth) to regional nerve blocks, which numb only a small area.

EPIDURAL

Epidural anaesthesia offers longer-acting pain management without affecting the baby. In an epidural, an anaesthesiologist will numb a small area of your lower back and insert a catheter through a needle into the space surrounding the spine. Through the catheter, medication can be inserted continuously throughout labour. An epidural will numb you from the waist down, virtually taking away the pain. If you're thinking about an epidural, don't wait too long to ask for it. You'll need to receive intravenous fluids before the epidural can be started, which takes about 30 minutes.

MAKING THE DECISION

Labour is unpredictable. Until you're there, you won't know whether you'll want pain relief medication. And if one technique doesn't work, you may want to try another. So find out as much as you can by talking to your doctor or midwife about the options available at your hospital.

Good luck!