You've probably heard some horror stories from friends and family about long and painful labours, and watched those overacted births on TV. But this isn't the best way to prepare for your own labour. ‘Part of the problem is people often get their facts wrong,' says midwife Gail Johnson of The Royal College of Midwives.
What's more, scare stories will only make you feel tense, which in itself can make labour more painful. It pays to find out the facts so you know what to expect when the time comes. Here, we unravel some old wives' tales to help remove the fear factor about labour and pain relief.
Epidurals make it impossible to push = Fiction
This used to be true with the extra strong doses that were given years ago, but that's not the case any more. ‘Now the amount of medication used is not enough to numb you completely early on, and should also be timed to slightly wear off by the time you need to push,' says Gail Werkmeister, president of the National Childbirth Trust. So although you won't feel as much sensation or the urgency, you should feel enough to push out your baby.
‘If a woman can't feel to push at first, we let the baby's head descend a long way down the birth canal with the aid of uterine contractions,' says Dr Maggie Blott, consultant obstetrician at The Royal Victoria Infirmary, Newcastle upon Tyne. ‘By that time, she will be able to feel the pressure of the baby's head and can then push at exactly the right times in order to deliver the baby herself.'
Pethidine gets into the baby's bloodstream = Fact
Pethidine doesn't actually take away the pain - instead it makes it more bearable by dulling your feelings. But just as the drugs get into your bloodstream, they will also enter your baby's, with varying effects.
‘If you had the drug within two hours of delivery, then it can give your baby breathing problems immediately after birth, although this is easily treated with an antidote,' says Gail Werkmeister. ‘It can also make you and your baby sleepy for the first few days, which can interfere with breastfeeding.'
You won't get an anaesthetic for an episiotomy = Fiction
You can breathe a sigh of relief about this one, as happily, this is just another old wives' tale. In fact, if you've had an epidural earlier in labour, then you'll already be numb for this procedure, which involves a cut to help your baby be born, and you shouldn't feel a thing.
‘For everyone else, we would always give a local anaesthetic for an episiotomy and stitching,' says Dr Blott. ‘There is a slight stinging as the needle goes in, and then you should feel numb. It's like having teeth pulled at the dentist in that you're aware of the sensation and that something is happening, but you won't feel any pain.
‘Even in an emergency situation, the team should always be able to give anaesthetic before an episiotomy as it takes only two seconds to give the injection.’
Having an epidural could make your labour longer = Fact
There is evidence to suggest that having an epidural can add an hour to the length of a labour. ‘One reason is that an epidural may slow down the effectiveness of contractions,’ says midwife Gail Johnson. Another is that it reduces the woman’s ability to feel pushing sensations at first, so that doctors tend to allow the baby to move down the birth canal just with the uterine contractions during the early part of the pushing phase. ‘A woman who has had an epidural, and doesn’t have much sensation, could use a lot of energy pushing when it’s not effective. So if you let the body bring the baby down the birth canal, this will delay the pushing by an hour but means that when you do come to push, the baby will be born quickly,’ says Gail. But whether the extra labour time is problematic is another question all together. ‘It’s a trade-off for some women, especially those having very long and difficult labours,’ says Dr Blott. ‘For those women who may have been in labour all night but are still only 3cm dilated, it’s about balancing a slightly longer labour against going through 12 hours of intense pain. For them, an extra hour or so of labour becomes less important than getting some pain relief.’
Using gas and air makes you sick = Fiction
Some women believe the smell of this mixture of nitrous oxide and oxygen makes them queasy, but the gas is actually odourless, says Gail Johnson. The culprit? ‘In the past, women inhaled via a rubber face mask and it was the smell of the rubber that made them sick,’ she says. ‘Now it’s often given via a plastic mouthpiece, a bit like a whistle, that you suck on. This doesn’t have any smell so it shouldn’t make you feel nauseous.’ However, if you do suddenly start to feel ill, it could actually be due to the way you’re breathing. ‘You should take longer breaths when using gas and air. Shorter breaths could make you feel unwell,’ she adds.
You’re not in control with hypnotherapy = Fiction
Contrary to popular belief, using the deep relaxation tool of self-hypnosis to help you cope with labour pain is nothing like being hypnotised in a stage show. ‘We’ve seen too many TV shows where people end up acting like chickens and being told, “You will do exactly what I say”,’ says Maggie Howell, founder of Natal Hypnotherapy. ‘Women think someone else will do something to them if they are ypnotised and that they won’t be aware of what’s going on or in charge.’ She says this isn’t correct because all hypnotherapy is in fact self-hypnosis. ‘You can send yourself off into a deeply relaxed state, which has you feeling in control but as though you are in a daydream state. So if someone called out your name, you could open your eyes and respond, although you would rather not.’ And by practising self-hypnosis in advance, your body will know how to relax when it comes to labour. Maggie Howell explains, ‘You can prepare with classes or by listening to relaxation CDs, so when you go into labour, all you need to do is mentally press play.’
If you use a birthing pool, you’ll give birth in it = Fiction
Many women like the idea of being in a deep bath during labour, especially if you tend to wallow in the bath to ease back pain or tummy aches. But some mums-to-be are anxious about actually giving birth in the pool. The good news? You don’t have to stay there if you don’t want to. ‘There are far more women who go through labour in a birth pool than deliver in one,’ says Gail Johnson. ‘But if you do decide to stay tight in the pool to deliver, the midwife will bring your baby to the surface as swiftly as possible to take his first breath.’
You can still walk if you have a ‘mobile’ epidural = Fiction
A ‘mobile’ or ‘walking’ epidural may be a lower dose of the drug, but it still tends to make you feel pretty numb in order to relieve pain effectively. So don’t expect to walk around the hospital corridors to get through your contractions. ‘What the name really means is that you can move your legs and change your position on the bed with help,’ says Gail Johnson. ‘If you have a low enough dose, you could walk around. It’s more common that you’ll feel some sensation in your legs but not enough to get out of bed and walk.’ Having an epidural means you’ll need to stay in bed to be monitored – another reason you can’t walk around. ‘You’ll be wired up to a foetal monitor and also a drip to increase blood volume, as an epidural lowers your blood pressure,’ says Gail Werkmeister. ‘You’ll also need a catheter because you can’t feel to urinate.’
A TENS machine will interfere with other equipment = Fiction
Many mums-to-be worry that the pulses of electrical energy from a TENS machine could affect the foetal monitor strapped on their stomach to check the baby’s condition. But there’s no need to be concerned. ‘The baby is monitored by ultrasound, whereas the TENS machine delivers an electrical stimulus,’ says Dr Blott. ‘The two are very different systems and there’s absolutely no interference between them.’ Don’t worry about the TENS machine paraphernalia getting in the way of the doctor or midwife, you wear the TENS pads on your back, far away from the foetal monitor, which is on your tummy. ‘In fact, if you’re not using a bath, shower or birthing pool, there’s no reason why you shouldn’t keep your TENS machine on until you actually give birth to your baby,’ says Dr Blott.
Birth today – the bigger picture
Reassuring facts about pain relief and common birth scenarios
Around 48% of mums had ‘normal deliveries’ with no surgical intervention – ie, no use of instruments, induction, epidural or general anaesthetic.
One in five deliveries in England was induced, according to the latest NHS maternity statistics for 2004/2005.
About one in three women had an epidural, general or spinal anaesthetic during delivery.
Around 14% of births were by emergency Caesarean section, while 9% were planned C-sections.
Around 11% of deliveries involved the use of instruments such as forceps or ventouse.
Around 16% of mums left hospital on the day of delivery and a further 35% left the next day
For more information on pain relief, visit www.netdoctor.co.uk