Transcript – Coping with moderate to severe pain during labour

This information is about pain relief options for moderate to severe pain. Within the ‘Pain relief options for mild to moderate pain’ section, the idea of starting on the analgesia ladder (or starting off with milder forms of pain relief and progressing if needed), was introduced along with some of the available pain relief options to help you manage pain or discomfort. However, if the pain gets more intense or you are unable to cope with the pain despite using the milder options, the following alternatives may be of interest to you. It is important to know that certain of these pain relief options are only available in certain locations for labour and birth.

Diamorphine is generally used when labour is established and the pain is more intense. It is an opiate drug which relaxes the body and reduces pain. It is given through an injection in your thigh, entering your blood and disrupting the pain pathways in order to reduce the pain. It can have side effects including drowsiness, nausea, euphoria (which is an intense state of happiness or excitement).  It can affect your breathing sometimes, by slowing it down or making your breathing shallower and can also affect baby if they are born soon after diamorphine is given, making the baby drowsy at birth. The midwife will be noting your breathing patterns and checking baby when it is born and will take things like pain relief method into account. 

Remifentanil is very similar to Diamorphine, but rather than being an injection, it is given continuously through a drip and cannula which is a small plastic tube which has been placed into a vein usually in your hand. It is a ‘patient controlled medication’, meaning it enters the body quickly and wears off quickly, so you have a button you press so that the pain relief occurs with your contractions. It has the same side effects as diamorphine (drowsy, nausea, euphoria) and can affect breathing as your breathing becomes slower and shallower in the short term, but this can be corrected if there is a concern and you may have oxygen administered at that point.

An epidural refers to a mixture of an opiate drug and local anaesthetic being given through a small plastic tube which has been inserted into the ‘epidural space’ next to your lower spine. Epidural will affect the nerves that run out from your spinal column and the aim is to make you completely numb around your abdomen and legs, so if you want to be mobile during labour, this might not be the option for you.

When working correctly, epidural is an effective form of pain relief, but it can lead to longer labours, increased risk of a forceps or ventouse (suction cup) delivery and is associated with some more serious but rare risks which your doctor and midwife will discuss with you if this an option that you are interested in. You will need to be in a Consultant obstetric Labour ward in order to have an epidural. They are not available at home or in Midwife-led birth centres.