Antenatal Class - The four forms of pain relief

Okay, so here we are in the hospital (not really, this is a follow up to this post here - sorry, just too much been going on to keep these posts concurrent)...the midwives have (hopefully) allocated a room, but we could still be 15+ hours from the baby actually being delivered...during this period Mum is going to be taking long walks around the golf course (trying not to be hit by golf balls), taking more baths, listening to calming music (which Flyingpops is choosing now - Clannad especially seems to be going down well) and most importantly - taking some drugs (contractions are painful)...

There are 4 (main) types of pain relief used in delivery -

1 - A TENS unit (TENS = Transcutaneous Electrical Nerve Stimulation)
2 - Entonox (Nitrous Oxide and O2 - otherwise known as laughing gas, used to make drag racing cars go really, really fast - roughly equivalent to 15mg of Morphine)
3 - Pethidine injection (opioid painkiller, according to the midwife they would use Heroin, but the war in Afghanistan has made it too expensive, so Pethidine it is)...
4 - Epidural anesthesia (is capable of killing all sensation below the tummy - may offer a pain-free birth)

There are, of course, the odd occasions where a full general anaesthetic has to be used, but it isn't considered "usual"...

So let's look at each in turn (in a bit more detail)...

TENS Machines
Commonly used for pain relief for muscularskeletal injuries, these machines work by disrupting the normal operation of the nerves...apparently there isn't any sort of research to support the fact that it actually can reduce pain during child birth (although we are getting used to hearing this disclaimer, simply because it's understandably difficult to get large groups of pregnant women to volunteer for medical studies that might risk the health of their unborn children), but it's non-invasive and gives Mum some buttons to fiddle with (the distractive powers of which should not be underestimated)...

Entonox
Quite a lot of women need go no further than "gas and air", the effects come and go extremely quickly, so mum needs to be inhaling deeply (and that word is operative as, according to our NHS Physio, most women only do so generally in a rather shallow fashion) as soon as each contraction starts and only stop again when the contraction is complete...again, gas and air is completely non-invasive and is out of the system as quickly as it went in...

Pethidine
Delivered by intravenous injection, as well as it's considerable pain killing properties (not quite as good as Morphine, but almost) it also (very rapidly) induces a cocaine-like stimulant rush and an opioid euphoric state (similar to Heroin) which lasts for about 2-2.5 hours - (horrifyingly) some women get so high they actually start to sing...(note to self to remember to pack the ear-plugs)...oh and it must be mentioned here that for a small percentage of women, Pethidine doesn't work at all...

Epidural
A huge needle (I have held one and they are quite scary) is inserted into the spine, through which a little catheter is fed, this is then used to pour anaesthetic drugs directly into the epidural space - although this can only happen if the midwife can get hold of an anaesthetist (in our NHS class they only said they would *try* and arrange it, if Mum wanted it, there is no guarantee that an anaesthetist will become available)...this procedure *should* numb everything from the bump down, meaning the birth would be pain free (unfortunately we saw a TV show on the weekend where a proud new Mum announced that despite the epidural she was still in a lot of pain, but I'm guessing this is the exception rather than the rule), major downsides are (1) it's impossible to tell when contractions are happening, so Mum can't naturally sense when to push (increased risk of doctor having to manipulate the baby/yank it out with a sink plunger), and (2) Mum isn't going to be moving around at *all*, with all sensation gone from the legs it would be inadvisable... ;)