1. EPIDURAL Mobile or Low Dose Chance of urinary catheter Pain –free (for the majority) Mother can sleep or rest Possible complications: Skin itchiness Shaking Heavy legs, numbness Severe headache Immobility Possible feeling of loss of control No increased chance of caesarean birth Mother does not feel drugged or drowsy Can slow labour May lead to the ‘Cascade of Intervention’ Mother and baby need monitoring which can affect mobility Can reduce trauma if labour excessively painful Anaesthetist may not be available immediately Mother may not feel urge to push If allowed to wear off for second stage: urge to push returns Can promote a feeling of control Possible patchy or incomplete pain relief Baby might be sleepy at birth Ideal window: 4 cm to 8 cm 90% satisfaction rate May increase chances of assisted birth Top-ups available Anaesthetic: administered through fine tube by anaesthetist Epidural needle only used during initial procedure Top-ups wear off after approx 2 hours Possibly mobile: Mobility lost after 2 top-ups? May lower blood pressure

2. PETHIDINE (OR MEPTID) Midwife can administer Can be given within 5 minutes of request Intra-muscular injection: maximum 2 doses Needs to wear off for water birth Crosses placenta and gets into baby’s system Will wear off in 2 hours Can depress baby’s heart-rate Provides analgesic pain relief Works as a muscle relaxant Can cause respiratory distress in babies Can allow mother to rest or sleep Mother can feel drunk or ‘trippy’ Can be administered in a birth centre Mother might feel nauseous Works well for first time mothers: early on in long, slow labours Can help to avoid or postpone an epidural Mother might be sick Timing is crucial: Needs to be administered at least 4 hours before birth Can affect establishment of breastfeeding and bonding Ideal window: 0 cm to 3 cm

3. GAS and AIR or Entonox No adverse side-effects for baby Timing it can be tricky Mother is in control Works within seconds and wears off in seconds 50% oxygen 50% nitrous oxide Mother can be nauseous or sick May not provide adequate pain relief Midwife will discourage use during second stage pushing Should only be used while ‘climbing’ contraction: Not continuously Provides pain relief exactly when needed The deeper the mother breaths: the greater the effects Can be used in a birthing pool Can be used with TENS High satisfaction levels, when it works Works well during transition Can help postpone an epidural Administered by inhalation through mouth-piece Midwife can bring to home births

4. T.E.N.S. Transcutaneous Electrical Nerve Stimulation Can provide pain relief Has a cumulative effect Should be used from very early labour Needs partner to help put it on ‘Cuts into’ the message of pain from the uterus to the brain Provides a continuous electrical ‘pulse’ No limit to mother’s mobility May need a spare battery Promotes a feeling of control Mother responsible for own hire from 38-42 weeks May not provide adequate pain relief Cannot be used in or with water Hiring cost Mother should press ‘boost’ during contractions for higher level ‘pulse’ Can be used with Gas and Air Can be used before entering a birthing pool Stimulates Endorphins: the body’s own natural pain killers Can work as a distraction Can lead to a natural high Can help mother stay at home for longer Can help avoid or postpone an epidural 4 electrode pads taped to the back

5. DOULAS and continuous support Greek word Meaning: Woman in support of another woman Continuous support from a known female Cannot provide midwifery care Hired by parents so cost involved Can provide physical support e.g. massage Can provide emotional support Can provide assistance with relaxation Can support from early labour even at home Can act as an advocate for the mother’s preferences Research shows that pain relief and chances of assisted births and caesareans are all reduced Can be a support for the birth partner Can provide support in shifts with birth partner if labour is long Research shows increase in feelings of control and satisfaction with birth

6. HYPNOBIRTHING or Self Hypnosis or Natal Hypnotherapy Takes mother to a natural trance state Promotes a feeling of being in control Promotes a calmer and less stressful experience of labour and birth Mother needs to set aside time to practise Preferable to learn from qualified hypnotherapist Cost of one-to-one or course May not work for all mothers Can promote more and better quality sleep in pregnancy Can lead to a shorter labour Most mothers can learn the required skill Promotes a state of deep physical relaxation Inhibits the body’s stress responses Research shows: Less pain relief Fewer drugs to speed labour Less need for assisted birth Less need for surgery Increases chances of a normal birth Can help reduce morning sickness Preparation enhances the pre-birth experience Can help prevent PND

7. WATER for LABOUR and BIRTH Therapeutic properties of warm water can lead to relief of pain Increased bouyancy so UFO and squatting positions are easier Can slow labour if entering pool before established labour Need an experienced midwife Water temperature needs to be 37 degrees for the birth Pool may not be available Promotes feelings of relaxation and control Can speed labour if entering pool after established labour A gentler birth for the baby Parents can hire own pool A mirror will help the midwife to view the crowning baby’s head Can reduce need for other pain relieving drugs Research shows mothers feel more satisfied with birth experience The warm water softens the perineum

8. SELF-HELP or DRUG-FREE METHODS Relaxation Breathing Massage Dim lighting Continuity of care Continuity of support Familiarity of environment T.E.N.S. Water Aromatherapy Upright positions and mobility Reflexology Acupressure Homoeopathy Pelvic rocking