Medicated Pain Relief Options during Labour & Childbirth

By Dr Juanita Galea

It is with great pleasure that I accept to contribute to The Cloth Nappy Company with a blog. Having been given, pretty much, a carte blanche on what to write about, made me think extensively, and I realise now the reason is that so much of what The Cloth Nappy Company is about is so close to my heart - motherhood, the environment, challenging what has been accepted as the norm, and so on.

Let me start by introducing myself. I am a 37 year old anaesthetist, wife and mother of 3 mischievous boys, born within 5 years of each other. Adam is 6, Noah just turned 5 and Jacob is 1 and a half. Yes, you guessed right, they keep me pretty busy but that's a no-brainer, isn't it?!

I have decided to contribute by combining my experiences as an anaesthetist with a lot of experience in obstetric care and that as a mother. When you're expecting, few things take up as much space in your mind as the process itself of actually giving birth, and what the majority of mothers-to-be worry about most is whether they can handle the pain of childbirth.

Now, just to make myself clear, I am in no way about to tell you that, as anaesthetists, we have some magical powers that make all the pain disappear. That is what I always say after introducing myself once I've been called to assist a mother in labour. However, the good news is that we have a pretty good track record in managing to reduce the pain of childbirth to discomfort. After assessing each particular case, we proceed to offer any of the methods available to us in order to make your experience a more positive one. Safety, of both the mother and the unborn baby, is our top priority, so you will never be offered something that we believe is too risky for either of you. We are trained to assess risk and we will not offer you any method of pain relief during labour that might put you or your baby in danger. That said, like anything else, pregnancy itself included, there is always the risk of complications & side effects, as tiny as that risk may be, but these are carefully balanced against the benefits you will gain from any said intervention.

Entonox (nitrous oxide)

You will hear much about pain relief during labour. One method, is the famous gas & air, also referred to as laughing gas. Chemically, the gas is nitrous oxide, which is mixed with oxygen, in a 50/50 ratio, to result in entonox, which is then given by inhalation during labour. Many do very well with it but in a few others, it does not provide adequate pain relief or it gives too much side effects, such as nausea and vomiting, to be useful. Hence, other options may need to be explored.

Analgesic drugs

Another drug often administered by your midwife herself is the administration of pain relief drugs such as paracetamol or opiates (most commonly pethidine or morphine). Whilst this takes the edge off the pain, it might be more effective in the beginning rather than towards the end of the process of labour. If given towards the end, one has to keep in mind that it might cause transient effects on the newborn, until it's effect wears off.

Regional block (epidural block)

The epidural block, or as it is more commonly referred to, 'the epidural', is a procedure where the anaesthetist injects a local anaesthetic in to the space around the spinal nerves in your lower back. An epidural line is inserted and lasts until needed. This anaesthetic usually blocks the pain from the contractions and during the birth very effectively. It often does not block the sensation of pushing so well. If the adequate dose is given, you can usually move and can push your baby out when you need to. As any other intervention or medication, there are a few possible side effects and complications, most commonly a low blood pressure, nausea and vomiting, and the possibility of a subsequent strong headache.

There are more methods of providing medicated pain relief during childbirth but I have skimmed through the commonest ones used for normal deliveries in Malta. There is much more to say, and that is without having gone into birth by Cesarean section. 

Childbirth is a process that leads us to meet those little beings we love with all our hearts before we actually hold them. I have myself had different experiences for each of my three boys. I can say neither was like the other but one piece of advice is to face childbirth with positivity. Being somewhat anxious is completely normal, even for a medic like me who knows exactly what to expect. However, trying to remain calm and focused, whilst trusting the professionals taking care of you and your little one is the best way to approach it. Be informed, make your choices and do not be afraid to ask questions or change your mind at any point during your pregnancy or childbirth.

You will be forever changed after you give birth. Make it a positive experience! It is the beginning of an adventure that never ends!

Dr Juanita Galea MD, DESA, graduated from the University of Malta in 2005. She has worked in the Department of Anaesthesia and Intensive Care at Mater Dei Hospital since 2008. She has also worked at William Harvey Hospital in Ashford, Kent, UK during 2012-2013, where she furthered her interest in obstetric anaesthesia, the hospital being a high risk obstetric centre. She has obtained her European Diploma in Anaesthesia and Intensive Care, the European speciality exam. She attended various courses & seminars, both in Malta and abroad.

Juanita is married to Dr Malcolm Paul Galea, a family doctor with a busy private practice, and together they are the parents of Adam, 6, Noah, 5, and Jacob, 1.