Chartered Physiotherapist, Jane Appleyard looks into some simple strategies for pain relief during childbirth, with a closer look at obstetrics TENS.
What do we know about pain?
Pain is our protective mechanism telling us that something unpleasant or damaging is happening to our bodies. We have millions of nerve endings, some fire in quickly and cause us to react to protect ourselves, for example if we attempt to pick up something that’s really hot and could cause a burn. Other nerve endings transmit more pleasant sensations such as warmth and touch.
Where do we feel pain?
We actually feel pain in the brain. It’s our processing centre where we decide if the pain needs some action and attention or if it can just be ignored. Now this is good news because it allows us to have some control over the levels of pain we’re experiencing. We can do this using many different techniques.
The fact that our brain acts as our central processing centre is the reason why pain is such an individual experience and this especially applies to childbirth. A simple scale is often used to obtain an idea of what level of pain someone is experiencing. We’ve all had headaches and sometimes we would grade them as a 2/10 and at other times a 10/10. Our perception of pain is on a sliding scale.
What helps us to cope well with pain?
We know that having a degree of knowledge and an understanding of what’s happening to our bodies is helpful which is why antenatal education for mums and their birth partners is really useful.
We need to be given a realistic view or expectation of what lies ahead and this can be difficult if it’s a first child. However, it is also worth bearing in mind that the experience can vary considerably between subsequent deliveries.
It is important that we harness our body’s ability to produce natural painkillers and any strategy that enables us to feel more ‘in control’ is going to help reduce pain.
Emotions and the Environment
Both have a significant effect on the levels of pain we experience. If we’re excited and focused on the anticipation of a happy event then we’re less likely to feel pain than if we’re fearful or stressed. Some women feel supported and safe in a medical environment whereas others feel more comfortable and relaxed in the familiar surroundings of their home.
Choosing a birth partner or partners is really important so think carefully about who will be able to give you the encouragement you’ll need. There is an increase in the popularity of doulas here in the UK. They can provide support for the whole family whether you decide to have a home birth or deliver your baby in a hospital or birth centre. More information about doulas is available here.
Movement and Mindfulness
Having an understanding about the correct breathing techniques, making sure we change position often, watching out for build up of tension in muscles especially in the neck, shoulders and jaw area can be achieved by many different methods.
Some women find a water birth is a wonderful experience, others have practised hypnobirth techniques. There are many ways of calming the brain to enable it to deal with pain messages and it is great to have a number of techniques you can reach for that you’ve practised and feel comfortable using.
What are non-invasive methods of pain relief?
There are two simple strategies for pain relief during childbirth. They both supplement the above principles by continuing to keep you in control.
Entonox – usually referred to as ‘gas and air’, is a colourless, odourless gas. It is made up of half oxygen and half nitrous oxide and is also known as laughing gas. Women describe different experiences often that they were still aware of the pain but it was less unpleasant as they felt relaxed, cheerful and happy.
Transcutaneous Electrical Nerve Stimulation (TENS) – a bit of a mouthful for a relatively small device! Perhaps one of the simplest ways of visualising how it works is to imagine you’ve dropped something onto your foot. The first reaction to ease the pain is to rub the area. This can help because your brain is aware of the sensation of ‘rubbing’ and this can mask the underlying pain. It’s probably where the phrase ‘rub it better’ comes from.
What is obstetric TENS and does it work?
TENS is a small battery operated device that attaches to the middle and base of your back using sticky electrode pads. It allows you to;
- Stimulate nerves and in effect confuse the ones that usually transmit pain. Your brain feels the sensation of the TENS and this can help to override pain messages.
- Have some control and the ability to produce a distraction during a contraction.
Feedback from women who’ve used the device report;
- After 2-4 hours of using the device in the early stages they described less pain on the 0 – 10 scale
- Their memory of pain after the delivery was less than women who’d not used TENS.
- They would choose to use it again in a future delivery
How to use obstetric TENS
The device has a full operator’s manual as well quick start guide. Read through the guidelines about using it safely and make sure you’re confident setting it up and have had a practice using it before you go into labour.
When you do go into labour, attach the sticky electrodes and set up the device so it is in place to help with those early contractions. It is a good time to practice using TENS along with all the other non-invasive techniques you’ve tried.
The benefits of using TENS are;
- You can move around
- There are no side effects for either you or your baby
- It’s a drug free form and can be used alongside other methods of pain relief (apart from in water)
- It gives you a way of having some control over pain as well as a distraction.
How do I decide what will work for me?
TENS is one of the many simple strategies for pain relief during childbirth. Probably the best piece of advice is to use a birth plan as a guide and keep an open mind as you go through the process. Remember the people supporting you want to keep you and your baby safe.
Perhaps we shouldn’t say ‘a baby is delivered’. That makes it sound as if it’s as easy as ordering a takeaway!
A few women experience very serene, calm deliveries just breathing their baby into the world. For most however it’s more of a challenge and we have to work hard throughout the process to cope with both the physical exertion and mental control required to manage the experience.
Just remember childbirth isn’t a competition and using any form of pain relief whether it’s simple non-invasive techniques or a medical intervention really doesn’t matter.
No mum is a failure and every mum should be proud of what she’s achieved. Your body has brought a new life into the world and that deserves a gold medal.
Enjoyed reading about these simple strategies for pain relief during childbirth? You might also like to read these blog posts from Jane Appleyard:
Sex and the pelvic floor: fact or fiction part two (covering the topic of sex after having a baby)
de Smit Medical has been working alongside Chartered Physiotherapist, Jane Appleyard to create a blog for advice and thoughts on a range of topics relating to the pelvic floor. Return to our blog for more articles and videos.
Jane Appleyard has over 30 years' experience as a Chartered Physiotherapist and specialises in pelvic health. You can read Jane's bio here.