Painrelief

The pain of childbirth is something that women generally dread. 'How does it feel, a contraction?' is a frequently asked question. It's a difficult question to answer, since we don't experience the pain of labor the same and most women forget the pain as soon as they see their baby for the first time. Humans don't have memory of pain. We do remember how we felt in a painful situation.

Good support, possitivity and progress help us cope with pain.

Contractions that result in dilatation are painful, but since they are not continuous, you are able to cope with breath and things like warmth, warm water. Now everyone experiences pain differently and in general the contractions up to 5-6 centimeters are doable, after that they become tough. These contractions in the active phase of delivery are not continuous. You will get breaks! With breathing techniques, warm water (A long shower or a warm bath helps with the pain), massage and relaxation in between contractions also help to make it through the active phase.

Women are built to give birth, you sometimes hear. That may be true, but we take your request for pain relief very seriously. Sometimes you already know after a previous birth that you would like pain relief, discuss that with us! And if dilation doesn't progress, pain relief is a blessing. The pain relief then ensures that you can last longer. Giving birth is not a competition, if it works well without pain relief, but if the pain is unbearable for you, there are a number of options. It is good to know that with any form of pain relief (with the exception of laughing gas), an ECG of the baby must first be made and that pain relief can only be given in the hospital.


Remifentanil

Remifentanil is a strong painkiller, a type of morphine. You get it from the gynecologist in the hospital after the baby's ECG (CTG) was good. It is administered with an infusion with a pump attached to it. With this pump, which only you are allowed to operate, you give yourself a safe dose that works within a minute and lasts for 3-5 minutes. So every contraction you give yourself a dose and you can't give yourself too much. 

Remifentanil can:

lower your blood pressure 

dampen your breathing. Your blood pressure and oxygen level in your blood are therefore continuously measured. A nurse will also stay in your room for the first hour. 

Common side effects include dizziness and nausea. 

The medicine also goes to the baby. Your body breaks down remifentanil within 10 minutes and then it's out of your body. Because the baby should not be lethargic at birth, the infusion of remifentanil is stopped when pushing. 



Remifentanil is especially suitable if you don't need more than 2 to 4 hours of pain treatment. After that, it won't work as well. The advantage of remifentanil is that it can be given quickly because the anaesthetist is not needed. The disadvantage is that you can't walk around, are drowsy, the contractions subside and very rarely that your breathing stops for a moment




Relivopan/Nitrous oxide

Nitrous oxide (Relivopan®) is a mixture of nitrogen oxide(N2O) and oxygen (O2). You give yourself laughing gas during a contraction through a mouth and nose mask. You put a cap over your nose and mouth, put on a chin mask and breathe in the gas. After the contraction, you remove the cap and then the administration stops automatically. The midwife will keep an eye on whether you are using the nitrous oxide properly. 

Benefits of nitrous oxide 

  • Nitrous oxide works quickly, after just one minute. 
  • Laughing gas helps by relaxing you and makes you better able to tolerate the pain, sometimes you can sleep for a while between contractions. 
  • With laughing gas, the baby's condition does not need extra monitoring.
  • You experience your birth consciously. Giving birth in a birthing pool with laughing gas is possible, if there are no medical restrictions.
  • After you stop inhaling nitrous oxide, it quickly disappears from your body.
  • Nitrous oxide has no side effects for the baby. 



Nitrous oxide can make you feel nauseous, dizzy or sleepy. These side effects go away quickly when you stop the administration. You cannot walk while using nitrous oxide, because of the equipment. During pressing, administration is discontinued Laughing gas has a moderate analgesic effect. Nitrous oxide can only be used in the active phase of labor. Disadvantages Nitrous oxide should only be used in an environment with adequate administration and extraction options. Amstelland Hospital is one of the hospitals where nitrous oxide is possible. Laughing gas is also available in the birthing center.


Epidural

Especially in earlier stages of the delivery, or , when there is little progress in dilatation, a epidural offers good pain relief. After the skin of your lower back has been numbed, the anesthesiologist will give you a numbing medicine is by inserting a catheter (a small, flexible tube) in the lower back. When the needle is removed, the catheter stays in place. As a result, you no longer feel pain.

The epidural takes away sensation from the belly burron to the top of the legs. You stay awake, feel pressure but without the pain. You are not mobile during the delivery.You also don't feel that you have to urinate, so you often get an indwelling catheter. The epidural works after about 15-30 minutes.

Benefits

The advantage of an epidural is that it is the most effective pain relief during childbirth, it does not make you drowsy and you can get i at almost any time in labor. (generally not given in the last stage of labor when you are (almost) fully dilated.

Side effects and complications

  • Low blood pressure
  • Failed or one-sided pain relief. (it is then that the anesthesiologist will try to correct the possitioning of the epidural, but this is not always possible)
  • Nerve damage (very rare less that 1%)
  • Nearly 1 in 4 women develop a fever when they have an epidural. This is probably due to the medication, but you and your baby will have to stay longer in the hospital for observation because you are not sure that the baby does not have an infection. Sometimes antibiotics have to be started on mother and child. Headaches after the epidural are also common.