Once the quiet phase of labour emerges into the active phase, the contractions become stronger and more painful and most women want an analgesic which will reduce the painful sensations. An injection is given into a muscle, usually in the thigh or the upper arm. Within 20 minutes of the injection, the pain is reduced considerably and the woman relaxes and fells drowsy between contractions. The effect of the injection lasts for about 2-5 hours, so that several injections may be needed in the course of labour.
Gas/oxygen machine ; Towards the end of the first stage of labour and in the second phase, the woman may need further help to reduce the discomfort. A commonly used gas machine is called the Entonox machine. This machine mixes the gases and has a hose with a face mask attached so that the woman can breathe the mixture.
The nitrous oxide gas acts on brain cells to reduce the perception of pain, provided it is given in sufficient concentration. A concentration of 50% is usually suitable but must be mixed with 50% oxygen. The best relief of pain is when the woman uses the mask properly by putting it tightly over her face and she starts breathing deeply from the machine as soon as she feels that the contraction is starting. It is preferable that she holds the mask to her face and continue breathing until the pain becomes less, then remove the mask from her face until the next contraction comes on.
Many women, particularly those delivering a second or subsequent baby find that the pain relief from pethidine and the inhalation of analgesic is all that they need, but some women require more. The only person that can determine the amount of pain felt is the woman herself, so the woman in labour has a right to ask for additional sedation and receive it.
Pain is likely to be more severe in a woman delivering her first baby as the head of the baby presses down and stretches the vaginal entrance. A local anaesthetic injected into the tissues will relieve this pain so that the bursting feeling is eliminated. The doctor may give the injection into the stretched tissues between the vaginal entrance and the anus. This is called a perineal nerve block. An alternative and better method is for the doctor to give an injection to numb the nerves which supply the vulva as they pass through the pelvis. To do this, the doctor puts a finger in the woman's vagina and gently pushes to one side until he reaches a triangular shaped bone which is a part of the pelvis. This is called a pudendal nerve block. Quite quickly, all painful sensations in the vulva and lower vagina are eliminated so that the baby's birth is relatively painless although the contractions of the uterus are still felt.
EPIDURAL ANAESTHESIA ;Increasing numbers of women are now choosing to have an epidural analgesic so that the childbirth may be relatively or completely painless. It is usually given when the woman is in the active phase of labour because if it is given too early it may stop labour from progressing. A woman who has been given an epidural anaesthetic needs to be observed meticulously because the drug may cause vomiting and sometimes a fall in blood pressure. Because the woman has no sensation of pain, she may find it difficult to aid her baby's birth by using her abdominal muscles and pushing when she has a uterine contraction. This means that the second stage of labour may last longer than in women choosing other methods and forceps delivery of the baby is more frequent. The problem is that for a woman to use this method of childbirth, she has to be attended by a skilled doctor. This method relieves most of the pain of childbirth and gives the woman the joy of seeing her baby been born, hearing its first cry and cuddling it as soon as it is born.
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