It works in the same way as a local anesthetic works when the dentist numbs your mouth before extracting a tooth. The anesthetic deadens the nerves which are carrying pain signals from your womb and cervix.

You could have an epidural at any point in labor, even in the second stage when you are pushing your baby out, although a spinal anesthetic would probably be offered in that phase. Most women choose to have an epidural when the cervix is about 5 to 6 centimeters dilated and the contractions are getting pretty strong. If you are 8 or 9 centimeters dilated, your doctor might say that it’s too late for an epidural and advise you to manage without because your baby should be born soon.

Pro’s

• More than 90% of all women get complete pain relief
• Your mind remains totally clear
• Can help to control high blood pressure
• Can put you back in control of your labor, and restore your confidence
• Epidurals are more sophisticated than they used to be and you might find that your legs and feet are not completely numb

Con’s

• May make you feel shivery
• You may be numb down only one side of your body
• You have to stay in bed
• You need to have a drip in your arm. This is because epidurals make some women’s blood pressure drop which seriously affects the flow of oxygen to the baby. The drip is a safety precaution so that the volume of your blood can be quickly boosted to bring your blood pressure back to normal again.
• You will probably have a catheter into your bladder. An epidural means you can’t tell when you need to empty your bladder, so this has to be done automatically for you.
• You might feel very out of control. You have three tubes going into your body and you have to be told when to push if the anesthetic hasn’t worn off by the second stage of labor. Your doctor manages your labor for you.
• Epidurals can increase the length of labor, especially the pushing stage. Your baby’s heartbeat will be monitored continuously, using a transducer strapped to your abdomen.
• If the epidural needle goes beyond the epidural space, there will be a leakage of cerebro-spinal fluid after the tube is taken out. Even a very small leak will give you a terrible headache. This is usually treated by taking a small amount of blood from your arm, perhaps the day after your baby is born, and injecting it into your back to seal the hole made by the epidural needle.
• Some women have problems passing urine after having an epidural.
• It’s not available for a home birth.

Tips

• Keep very still while the anesthetist is setting up the epidural. You will be on your side or sitting on the edge of the bed, leaning forward. Concentrate on your breathing. Breathe in deeply through your nose and sigh out slowly through your mouth. Hold your partners hand and keep eye contact with him.
• Discuss the possibility of letting the epidural wear off for the second stage of labor when you are going to deliver your baby. Being able to feel the contractions will help you push more effectively.

You can have “gas and air” whenever you want in labor. Simply put the mouthpiece between your lips or teeth and breathe deeply and evenly. Continue to breathe deeply until you start to feel a little light-headed. Your hand will then drop away from your face and you will stop breathing in the Entonox. Within a few seconds, you will feel perfectly normal again.

Pro’s

• Easy to use
• Under your control
• Doesn’t stay in your body
• Takes the sharp edge off contractions
• Contains oxygen that is good for your baby
• Can be used for a home birth

Con’s

• Only a mild pain killer
• May make you feel sick
• Dries your mouth out

Tips

• Start breathing the Entonox the second you feel a contraction beginning. It takes over 20 seconds for the gas to give you some pain relief, and 45-50 seconds before it’s most effective. If you wait until the contraction really hurts, and then start breathing the Entonox, it will be taking effect in between contractions.
• If you take “gas and air” through a rubber facemask, and the rubber makes you feel sick, ask for a mouthpiece. It’s easy to change the mask for a mouthpiece.
• Have sips of water in between contractions to keep your mouth moist.
• When you’re pushing your baby out in the second stage of labor, women usually find it easier to concentrate without using the “gas and air”.
• Don’t feel bad if Entonox isn’t enough to help you cope with contractions. Using “gas and air” doesn’t prevent you from having any other drugs for pain relief.

Massages
Tell your partner or other birth companion where you’d like to be massaged. You might like your shoulders massaged in between contractions to help you relax. Tell him to massage you slowly. He should use firm pressure in order to stimulate your body to release endorphins, the ‘feel-good’ hormones which make massage such a positive experience. Having someone rub your back also provides warmth. And, it does not only keep your back warm, it’s also relaxing and stimulates your body to release natural pain-killing substances.

Positions
Avoid getting on the bed once your contractions are regular and painful, unless you are really tired. Your labor will be slower if you lie down. Remain upright, but choose whatever position feels most comfortable. Stand up and lean on the bed or your partner. Kneel down and lean on the seat of a chair. Get down on your hands and feet to help ease backache. Sit in a chair, then get up and walk around. Move your hips as much as you can, it gets your baby moving.

Love
Research has shown that when a woman has someone she loves with her during labor to comfort her, she gives birth more quickly and easily than if she doesn’t have that continuous loving support. So choose your birth companion carefully. Someone who won’t panic; who believes you can do it, and who is confident to talk to health professionals on your behalf. This may be your partner, your sister, your mom, your best friend or someone else. Or, you might like to choose two birth companions. It’s up to you.

Breathing

Focusing on your breathing is a great way of getting through each contraction. Here are some things to practice and keep in mind: take a deep breath at the beginning of the contraction and, as you breathe out, relax. Then breathe in through your nose and breathe out through your mouth, keeping your mouth and cheeks very soft. Don’t worry too much about how deeply you’re breathing, just keep a good rhythm. Concentrate as hard as you can on your breathing as the contraction builds up, and as it fades away. Take your time to relax when the contraction is over.

The best thing you can do to prepare yourself to cope with pain in early labor, is to conserve your energy by resting. Make yourself as comfortable as possible on the bed or on a chair. Take pillows and put them all around yourself. Have a hot, sweet drink and play some music or put the TV on, and, rest. Later on, you’ll find it much easier to cope with painful contractions if you’re not exhausted because you were rushing around in early labor.

Tips

• Ask for information: the more you know, the more relaxed you’ll feel
• Drink sips of water in between contractions
• Eat carbohydrate-rich foods when you feel hungry
• Use a small electric fan to stay cool
• Talk to your partner and hold his hand
• Listen to music to help you relax
• Move around to make yourself as comfortable as possible
• Walk around to ease aches and pains and bring on contractions
• Go to the toilet; a full bladder will slow your labor
• Trust your body: you do know how to give birth!