Pain relief during childbirth

The pain during labour is something many women worry about. "What does a contraction feel like?" is a common question, but it’s one that no one can truly answer. We don’t have a memory for pain, and once the birth is over, your baby makes up for everything. Of course, you’d do it all over again for them!

Tips to better manage the pain

Labour is painful. However, everyone experiences pain differently. Generally, contractions are manageable until about 5-6 cm of dilation, after which they get more intense. Birth is partly physical, but it’s also mental. Telling yourself "I can’t do this" with each contraction won’t help. Instead, try to clear your mind and find a peaceful spot where you feel comfortable. A long shower or warm bath can help ease the pain, and you can ask your partner to massage your lower back. After each contraction, there’s a break, so close your eyes and rest when you can.

Pain relief: when is it necessary?

You often hear that women are built for giving birth. While that may be true, we take your request for pain relief very seriously. If you’ve had a previous birth and know you’ll want pain relief, discuss it with us! If your labour is progressing slowly, pain relief can be a blessing, helping you get through it.

Labour is not a competition

If you manage without pain relief, that’s wonderful, but if the pain becomes unbearable, there are options. It's important to know that for all pain relief options (except nitrous oxide), a heart monitor (CTG) will first be done on the baby, and pain relief can only be administered in the hospital.

What are your options?

    Gas and air

    Gas and air (Relivopan®) is a mixture of nitrous oxide (N2O) and oxygen (O2). You administer it yourself during a contraction using a mouth-nose mask. You place the mask over your nose and mouth, breathe in the gas, and then remove the mask after the contraction, which stops the flow automatically. The midwife will monitor you to ensure you’re using the gas correctly.

    Benefits of gas and air

    • It works quickly, within one minute.
    • It helps you relax and makes the pain more manageable. Sometimes you can even rest between contractions.
    • There’s no need for extra monitoring of the baby’s condition while using gas and air.
    • You remain conscious and aware of your birth experience.
    • You can use gas and air in a birthing pool if there are no medical restrictions.
    • The gas leaves your system quickly once you stop inhaling it.
    • There are no side effects for the baby.
    • You may feel nauseous, dizzy, or sleepy, but these effects disappear quickly after stopping the gas.
    • You can’t walk while using gas and air due to the equipment.
    • During the pushing phase, the use of gas and air is stopped.
    • It provides moderate pain relief.
    • Gas and air can only be used in the active phase of labour.

    Disadvantages of gas and air

    Gas and air can only be used in an environment with proper administration and ventilation systems. Amstelland Hospital is one of the hospitals where gas and air is available, and it’s also offered at the birthing centre.

    Epidural

    An epidural provides effective pain relief, especially when there is still little dilation. After numbing the skin on your lower back, the anaesthetist inserts a small tube (catheter) into the epidural space using a needle. Once the needle is removed, the catheter remains in place, allowing pain-relieving medication to be administered. This medication numbs you from the point of insertion down to your toes, so you won’t feel any pain. You also won’t feel the need to urinate, so a urinary catheter is often placed. The epidural typically takes 15-30 minutes to start working.

    The benefit of an epidural is that it’s the most effective pain relief during labour, and it doesn’t make you feel drowsy.

    An epidural provides effective pain relief, especially when there is still little dilation. After numbing the skin on your lower back, the anaesthetist inserts a small tube (catheter) into the epidural space using a needle. Once the needle is removed, the catheter remains in place, allowing pain-relieving medication to be administered. This medication numbs you from the point of insertion down to your toes, so you won’t feel any pain. You also won’t feel the need to urinate, so a urinary catheter is often placed. The epidural typically takes 15-30 minutes to start working.

    Remifentanil

    Remifentanil is a strong painkiller, similar to morphine. It is administered in the hospital by the gynaecologist after confirming that the baby’s heart rate (CTG) is normal. It is given through an IV connected to a pump, which only you can control. With this pump, you can safely give yourself a dose of the medication, which works within a minute and lasts for 3-5 minutes. You can administer a dose during each contraction, and there’s no risk of giving yourself too much. Remifentanil can lower your blood pressure and slow your breathing, so your blood pressure and oxygen levels are continuously monitored. A nurse will also stay in the room with you for the first hour..

    Common side effects include dizziness and nausea. The medication does pass to the baby, but your body breaks down remifentanil within 10 minutes, so it leaves your system quickly. To ensure the baby isn’t drowsy at birth, the infusion is stopped during the pushing stage.

    Remifentanil is ideal if you only need pain relief for 2 to 4 hours.

    After that time, it becomes less effective. The advantage of remifentanil is that it can be given quickly, without the need for an anaesthetist. The downside is that you won’t be able to walk around, you may feel drowsy, contractions can slow down, and in rare cases, your breathing may pause briefly.