We talk to an NHS maternity specialist about what to expect and how to cope.
Author Dr Tony FordhamPain is an unfortunate yet inevitable, necessary and natural side effect of pregnancy. Women know to expect pain during labour, but less well-known are the other pains that might be experienced in early pregnancy. This can include pain associated with growth of the baby and pain during the build-up to labour.
Early pregnancy is a strange and exhilarating time for women – changes happen in all parts of the body including hair, breasts and skin. It is not thought of as a common time for pain to present as a symptom, yet many women report cramping period-like pain in the first few weeks.
This may represent an implantation event and usually settles by itself. Pain that persists or is accompanied by other symptoms such as bleeding warrants a trip to the gynaecologist for an early pregnancy ultrasound scan.
A baby grows rapidly throughout pregnancy, but in the second trimester this becomes considerably more noticeable and a mother will start to become aware of the reassuring feelings of movements and kicks.
Aided by pregnancy hormones, the body has to stretch to accommodate the fast-growing baby. The stretching of the muscles and ligaments of the pelvis and abdomen is often quite uncomfortable, particularly for first-time mums.
These pains often present as muscular or joint soreness, aching and stretching around the hips and pelvis, which is known as pelvic girdle pain, or Symphysis Pubis Dysfunction. Pain running down the sides of the tummy is most likely due to the stretching of the ligaments inside.
Mild muscular and joint pains of pregnancy can usually be remedied by simple solutions such as hot water bottles, warm baths, pregnancy message, or gentle pregnancy stretching and yoga, Namaste!
As a pregnancy progresses a woman can experience mild contraction-like pains that are irregular and sporadic, commonly known as Braxton-Hicks contractions. Pains that become more regular may represent early labour, and so this is probably the time to call the midwife!
Usually at this stage of early labour a midwife will advise to time the pains and attend when they are more regular. This is the best time to relax, eat and rest as much as possible – a warm bath can be quite relieving for these pains.
When the pains become more intense a midwife will assess the contractions and can offer pain relief if required. Pain relief is offered in a stepwise fashion in early labour, usually starting with Paracetamol or dihydrocodeine, which is a weak opiate-type medication that is safe in pregnancy and for the baby.
As for the main event, there are a whole host of options for pain relief. Not all options will suit every woman, and there is no right answer.
Hypnobirthing has become a popular method to control the pain of contractions or ‘surges’ and many women swear by it, particularly with the right mindset, concentration, and prior information and training. However, not all women will experience effective pain relief. There are numerous books, courses and groups that can be attended antenatally to learn more.
The use of a Transcutaneous Electrical Nerve Stimulation (TENS) Machine has also gained significant popularity. The machine is attached to the lower back and releases mild electrical currents across the skin that may reduce the intensity of contractions. There is no solid scientific evidence for or against its use, and reduction of pain seems to differ from woman to woman.
Entonox is a very effective and short-acting pain relief, also known as ‘gas and air’. It is inhaled during contractions and provides an element of dissociation that enables women to relax. Some women gain great benefit from Entonox, but some can end up feeling light-headed or even nauseated.
A stronger painkiller used in labour is an injection known as pethidine. It is a mild derivative of morphine and significantly helps women to rest during labour. If given too close to delivery it can reduce the effectiveness of pushing and can make the baby sleepy when it is born – if this happens another medication can be given to reverse the effects. Your midwife will never advise use of pethidine if she thinks the labour will progress quickly.
An epidural is the most effective method of pain relief in labour. An anaesthetist (a doctor who specialises in pain medicine) will assess the suitability for an epidural in labour and counsel a woman as to what the process will involve. They are usually relatively easy and safe and will remove the majority of pain in labour, although some women may still feel the presence or pressure of the contractions.
There is stigma associated with having an epidural in some groups of women, and some believe there to be adverse side effects associated with having an epidural, such as long-term back pain. Nevertheless, in some parts of the world an epidural is seen as the gold-standard for pain relief in labour – some European countries such as France have an epidural rate of around 80%.
At the end of the day your labour is your labour – a woman can accept or refuse any medical intervention or offer of pain relief, and there is no right or wrong plan. There are plenty of options available, from limited medical intervention through to complete removal of pain with an effective epidural.
Many women go into labour with preconceptions of what pain relief they would and definitely would not accept and may become disheartened if this does not go to plan. Labour may be the worst pain a woman will ever experience, and if this is the case and it becomes overwhelming there is no shame in asking for stronger pain relief options. When the baby is born, nobody will hand out a medal to the woman who was in the most pain.
In spite of this, remember that labour pains are completely natural and often when a woman feels like she cannot take any more the baby’s head will be crowning and they will find a new lease of energy that makes them feel like a superwoman.
Trust your body, you’re about to do something amazing.
Dr Tony Fordham is a Specialist Registrar in Obstetrics & Gynaecology. After graduating with a medical degree from the University of Liverpool he began Paediatric Surgical training, but realised his real passion was women's health and maternity care so switched to the Obstetrics and Gynaecology programme.
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