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Pain relief during childbirth

You experience pain during contractions. Your body responds to this by making a natural pain reliever: endorphins, which help to further relieve the pain. Anxiety or tension can inhibit the production of endorphins. How you deal with the pain of contractions and what you need to do so is different for everyone. That is why we list them here for you. 

Natural pain relief

As mentioned above, fear or tension hinder the production of endorphins. That is why it is so important that you are relaxed and comfortable as possible during labour. 

In the beginning of your labor the contractions are usually manageable. So also look for distractions. As a result, you pay less attention to the contractions and your delivery will probably take less time in your opinion. Distraction can be done in various ways: watch some TV, read a book, bake a cake. When you are relaxed, both physically and mentally, you can handle the contractions better. A quiet environment, massage, yoga, and certain postures can help you with this. A massage provides distraction and prevents your muscles from cramping. Yoga helps you to relax and calm your breathing. 

Think positive. You can do this and your body knows what to do. Every contraction that is over is one less until the birth of your baby. Of course there are times during childbirth when you just don't like it. Then let your partner encourage you. 

Postures work very well. You may like to walk around. Others like to lie in bed again. The alternation between different postures also works very well. 

Also make sure you are nice and warm. This helps with relaxation. So make sure the room you are in is nice and warm. Many women find it very pleasant to use a bath or shower during childbirth.  

TENS

A birth TENS is a device that is especially suitable for pain relief during childbirth. TENS stands for Transcutaneous Electrical Neuro Stimulation. On your back you stick 4 electrodes on both sides of your spine. Then turn on the TENS. The electrodes deliver electric pulses, which reduces the stimulus transmission of the contractions. This will make you experience less pain. It is not that you are completely pain free when you use a TENS. You adjust the device yourself until it feels pleasant in the places where the stickers are. You feel a pleasant tingling between contractions. The moment you feel a contraction coming on, press the Boost/Burst button. You then have some extra stimulation during your contraction. After the contraction, you press this button again, so that the device switches back to the basic stimulation. Because you can relieve the pain yourself, you can often relax better. This in turn ensures a faster dilation than when you are tense. 

Some, not all women, have less pain from the TENS. The TENS has no negative consequences for your child. What you can experience as a disadvantage is that you have to hold it (or with a cord around your neck). Furthermore, you may not use the TENS in the shower or bath. 

During your delivery you can use the TENS under our supervision. We have such a device in our bag for you. Do you want to use this? Fine, let us know. You borrow the device from us. You can buy the electrodes per set through us. We charge €15 for this. 

Would you like more information about the TENS? Then check out the following websites:

Pain relief by medication

A number of conditions apply to any form of pain relief. We will transfer you to the gynecologist / clinical midwife and will therefore not supervise your delivery further. We will withdraw and will not see you again until you go home with your child. Before you actually receive pain relief, a heart film of at least 30 minutes is needed to see how your child is doing. You should also not be too far in opening up. The possible options and their advantages and disadvantages are also discussed with you.

Nitrous oxide

Laughing gas is a mixture of nitrogen and oxygen. It is mainly used in the last phase of dilation when the contractions are experienced as most intense. Nitrous oxide is not used during pressing. About half a minute before the contraction is at its peak, you start inhaling, until your contraction is over. Laughing gas can be used for about two to three hours during labour. 

While using nitrous oxide, you hold on to a mask yourself. You can inhale laughing gas by holding it over your nose and mouth. The chin mask you wear sucks out the exhaled air. You keep this chin mask on for another 20 minutes after stopping the laughing gas. After that, it can also go off. 

The advantage of nitrous oxide is that we do not have to transfer you to the gynaecologist for another form of pain relief with medicines during childbirth. It works very quickly and is also quickly worked out again. By using nitrous oxide, we don't have to keep an eye on your child in any other way than usual. Moreover, you experience the birth very consciously. 

Laughing gas does not work well for everyone. This makes some women nauseous, dizzy or sleepy. Because it wears off quickly, these complaints disappear quickly after stopping laughing gas. It is also good to know that nitrous oxide is not available in every hospital. For example, laughing gas is possible in the birthplace of the Diakonessenhuis in Utrecht, but not in Tergooi Blaricum. 

Epidural

The epidural is the best form of medication for pain relief during labour. As a result, if a form of pain relief with drugs is required, the hospital often prefers an epidural over other forms of pain relief by medication.  

During the insertion of the epidural, the anesthetist places a small tube in your back. As a result, you are continuously administered a combination of a number of medicines. It stays in your back for as long as needed. While placing this tube you have to round your back and you have to sit or lie still. The epidural starts to work after about 15 minutes. The epidural is both safe for you and your child. Many women feel little to no pain during contractions, but not everyone. In addition, the epidural medicines do not make you sleepy. 

However, there are also disadvantages to the epidural. You can no longer get out of bed, so you will be in bed for the rest of the delivery. Because you are sedated, you no longer have control over your bladder. So you no longer feel that it is full. You can often no longer urinate. That is why you will be given an indwelling catheter to keep your bladder empty. The contractions are often less powerful, so you receive a contraction stimulant via an IV to make it stronger again. Because the pushing often takes longer, there is a greater chance that the gynecologist will have to help with a vacuum pump (cup on your baby's head). The chance of a cesarean section is slightly higher. Your blood pressure may drop, so you will be given an IV in advance to counteract this. Sometimes medicines need to be given through this IV to get your blood pressure back to normal. We often see fever during childbirth. We do not know very well whether this is due to the epidural or an infection. So sometimes antibiotics will have to be started, so that you and your child have to stay in the hospital longer. We also sometimes see that women get itchy because of the medicines or headaches after the epidural. If you lie down there is nothing wrong, but if you sit or stand you really have a big headache. This usually goes away on its own, but sometimes you have to go back to the hospital after a few days. This headache is because a small hole has been punctured in the membranes, through which cerebrospinal fluid leaks out. In the hospital they can close this hole for you if necessary. 

Pethidine

This is a morphine-like drug. You will receive it through a prick in your thigh. It works for about 4 hours and ensures that you can relax well and therefore better cope with the contractions. Pethidine is often used in women who have not yet given birth, but who are very tired due to a long run-up to labour.

During 4 hours you will be under the care of the hospital (gynecologist / clinical midwife). If you give birth within that time, they will supervise your delivery. Then you will be transferred back to us and we will guide you further.

Pethidine does not work equally well for everyone. About 1 in 3 women are satisfied with the analgesic effect. Because pethidine works less quickly than remifentanyl, cannot be stopped after administration and can make the baby drowsy (and thus can be born drowsy), it is no longer used during labor in most hospitals.

Remifentanyl

This is also a morphine-like agent. You will be given it through an IV. Pethidine wears off over time, but remifentanyl can be administered continuously. The operation also remains fairly the same. In addition, you can give yourself an extra dose every few minutes when the contractions are very intense. This is a secure system, so you can't give yourself too much. Remifentanyl is often given a little later during labour. This is because this remedy does not work as well for you after a few hours.
Remifentanyl neemt niet alle pijn weg, maar zorgt ervoor dat je de pijn beter aankunt, dat je beter kunt ontspannen. Wanneer je mag persen wordt het infuus uitgezet, het middel is dan met een minuut of 10 grotendeels uit je bloed verdwenen.

Disadvantages of remifentanyl can be: because it is a morphine-like substance, you can become a bit drowsy. You wear a blood pressure monitor and a clip on your finger to measure the oxygen in your blood. The latter because you can sometimes breathe a little more superficially and therefore the amount of oxygen in your blood can decrease a bit. Because you can become a bit drowsy, you can no longer get out of bed. In a number of cases, the contraction activity may decrease somewhat, so that you need a contraction-inducing agent. Because it has not been used for very long during childbirth, we do not yet know the long-term effects on you and your baby. The effect on breastfeeding has also not been sufficiently studied. Moreover, it is not readily available. When we talk about pain relief with drugs, most hospitals prefer an epidural. You can only get Remifentanyl in Tergooi if there is a reason why you are not allowed an epidural. For the Diakonessenhuis in Utrecht, the nurse must be able to sit next to you to see how you are doing. This is only possible during the day and when it is not too busy in the department. If the nurse cannot sit next to you, you will unfortunately not be able to receive remifentanyl.

Want to know more? Check: De verloskundige – de Verloskundige (KNOV)

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