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Pain Management

There are several things you can do to treat the pain during childbirth. Fortunately, the body has a protective mechanism that automatically occurs when experiencing pain. Hormones, called endorphins, are released. Endorphin is a morphine-like substance that is released by the brain and has an analgesic effect. In addition, endorphin makes you open and receptive. This is necessary for the attachment process with your baby. The pain helps you prepare for maternity. For release of endorphin it is important that you are relaxed. The following tips from our obstetricians can help you relieve the pain and relax:

- Heat
Take a hot shower, bath or use a hot water bottle

- Positivity
Every contraction you’ve had won’t come back again, so every contraction is one step closer to the birth of your child.

- Safe surroundings
Make sure you’re in an environment where you feel safe, and are surrounded by people who you trust and feel comfortable with.

- Massage
Have painful spots (often the back) massaged, or let someone push on these spots. The pushing often relieves some of the pain.

- Concentration
During a contraction, concentrate on breathing. Breathe in through your nose, out through your mouth. Between contractions, close your eyes and rest. – Pushing positions

Changing into several positions during the dilation phase or pushing phase can relieve some pain. The positions can be sitting, lying down, hanging or walking. Do what makes you feel better. You can see some positions in the following image.

Many women have the idea that they should lie on their backs while pushing. That's not the case. You can choose a position that you like at that moment. However, it is possible that based on the progress or health of the baby, we ask you to change into a different position. Our obstetricians always bring a birthing stool. If you would like to use it while giving birth, let us know.

TENS

TENS (transcutaneous electrical nerve stimulation) is a small device which provides self-controlled pain relief, it sends electrical nerve stimulation through electrodes. TENS stimulates the production of endorfines and interrupts the pain signals in the brain. TENS can help to reduce pain during labour and it has no side-effects for mother or baby. When you want to use TENS during labour you have to buy or rent it yourself. Tip: Check your health Insurance for a compensation.

Pain management with medication

If these natural ways are not enough for you to cope with the pain, you have a right to receive pain relief in The Netherlands. You will have to go to the hospital and be transferred to the care of a gynecologist. At Jeroen Bosch Hospital there are two options for pain relief, Pethidine or an epidural. It’s important that you’ve read about the pros and cons of this kind of pain relief some time during your pregnancy.

Pethidine

Pethidine is a substance that resembles morphine and is injected into your leg or buttock. It works within half an hour and will relieve the worst pain, but not all of the pain. It will last for two to four hours. Pethidine is not administered after you are completely dilated (or close to), because the side effects for the child are too severe at that point.

The benefits of Pethidine are that 50% of women are satisfied with the analgesic effect. In addition to the pain relief, it can also make you drowsy, which means you can rest when you are tired. The disadvantages of Pethidine are that it takes half an hour for it to work and that you may become nauseous, drowsy and sleepy, which may make you less aware of the birth of your child. Also, you won’t be allowed to walk anymore as you’re more prone to falling when sleepy. Pethidine can also affect your child, which can also become drowsy. As a result, the baby may have more difficulty breathing immediately after birth. This is especially the case when Pethidine is administered shortly before birth.

Epidural anesthesia

An epidural is an injection in your lower back with analgesics. As a result, the pain is often largely relieved. Under anesthesia a needle is inserted into the back, allowing a thin tube to be placed in your spinal cord through the needle. The needle is removed again, after which the tube remains. The medication is administered through the tube, through injections or continuous infusion. An epidural works within 15 minutes.

The advantage of an epidural is that 95% of women feel no pain during the contractions. Unlike Pethidine, you do not become drowsy or sleepy. As far as is known, an epidural has no adverse effects on the child or breastfeeding.

Disadvantages of epidurals are that they sometimes work only on one side of the body (5%) and that the epidural needs to be repositioned. Often, pushing with an epidural takes longer, giving you a greater chance of having to give birth with a vacuum device. Because the natural reactions of the body are suppressed, the contractions often become weaker. Often the contractions need to be rebooted with additional medication. This is often delivered through the epidural. You are also administered IV fluids to prevent your blood pressure from becoming too low. In addition, you will get a bladder catheter by default as you can’t feel the need to pee due to the anesthetic. Your body temperature can also rise due to the epidural, and it’s difficult to determine whether this is caused by the epidural or if it’s a fever caused by an infection. Sometimes you will be administered preventive antibiotics. There is a chance that your baby must be admitted to the hospital and treated with antibiotics.

For a video about pain click here.

It's very important that you make an informed choice for pain management. If you want pain relief, you can discuss this with our midwives at all times. We will discuss the possibilities. For instance, it is possible that you are too far along in labor to get an epidural or Pethidine.

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