Epidural myths... pethidine concerns... we've sorted the facts from the fiction to help you have a confident labour.

Chances are, you’ve already heard loads of horror stories from friends and family about long and painful labours, and watched those overacted births on TV. But this definitely isn’t the best way to prepare for your own labour. Scare stories don’t give the full picture and will probably only make you feel tense and nervous, which in itself can make labour more painful. It pays to find out the facts so you know what to expect when the time comes. Here, we unravel some of the myths and truths about the pain relief methods you’re likely to be offered.

Epidurals make it impossible to push

This used to be true with the extra-strong doses that were given years ago, but it’s not always the case with a modern epidural (a local anaesthetic passed through a fine plastic tube into your back to numb the pain). Amanda Mansfield, consultant midwife at the Royal Free Hospital in London, says some women can still feel when to push. She advises, ‘If you want to stay mobile, have the epidural when you’re in established labour and ask for one that uses a low-dose mixture. A ‘mobile’ epidural can help you retain some sensation, so you can still walk to the toilet or move around if you want and you may be able to push with guidance from a midwife. Contact the hospital before the birth and see what they offer, as different hospitals have different facilities.

Pethidine gets into the baby’s bloodstream

Pethidine (a synthetic version of morphine that may be given in an injection or intravenously) doesn’t actually take away the pain - it just makes it more bearable by dulling sensations. But as the drug gets into your bloodstream, it also enters your baby’s, with varying effects. Midwife Amanda explains, ‘Pethidine can make both you and the baby drowsy, which may interfere with breastfeeding. In some babies it can also cause short-term breathing problems straight after birth. It may not be serious for the baby but it can be frightening for the parents.’ Fortunately, this can be easily treated with an antidote.

You won’t get anaesthetic if you need an episiotomy

You can breathe a sigh of relief about this one as, happily, it’s just an old wives’ tale. In fact, if you’ve had an epidural earlier in labour, then you’ll already be numb if you need an episiotomy (a cut between the vagina and the anus to help your baby come out), so you shouldn’t feel a thing. If you haven’t had an epidural, a local anaesthetic would be used, so you’ll feel the needle, but not the procedure itself. Midwife Amanda says, ‘There should always be adequate pain relief - either your epidural would be topped up or we’d use a local anaesthetic. I have known some women to report pain, but that’s usually because the jab hasn’t quite kicked in. It does work very quickly, though - about 15 to 30 seconds. An episiotomy is all about having to deliver the baby rapidly, so the midwife has to get the balance right between pain relief and the need to deliver the baby as quickly as possible.’

An epidural makes labour longer - in some cases

There’s evidence to suggest that having an epidural can add up to an hour to the length of labour. ‘If you have an epidural early on in your labour, it can affect the contractions and slow things down,’ explains midwife Amanda. ‘It could also increase your chances of having intervention later in the labour. You need to have a drip and you’d be monitored for the first half hour after your epidural is topped up, and a lot of women are continually monitored so they are permanently on the bed. This means they are less mobile and that slows down contractions. If contractions slow down or stop altogether, then a drug called Syntocinon - an artificial form of the labour hormone oxytocin - may be necessary, and that increases the chance of intervention.’ But whether the extra labour time is actually a problem is another question. If, for example, you’re having a very painful labour, you may decide that getting some effective pain relief is worth a slightly longer labour.

Using gas and air makes you feel sick

You may have talked to mums who say the smell of gas and air - a mixture of nitrous oxide and oxygen - makes them queasy, but in fact the gas is odourless. The culprit? ‘In the past we used rubber masks but some women found the smell made them queasy,’ explains midwife Amanda. ‘These days it’s often given via a plastic mouthpiece that you suck on and we’ve found that these are more acceptable. ’However, if you do suddenly start to feel ill, it could actually be due to the way you’re breathing. ‘If women breathe heavily and at the wrong time, they sometimes feel sick,’ says Amanda. ‘Ask your midwife about the best time to use gas and air. When you feel a hardening of your tummy we’d get you to breathe in slowly, then take deep breaths before the peak of the contraction.’ It’s also worth noting that many women feel sick - or are sick - as they progress in labour, and this may not be connected to the gas and air at all. It may feel like the last straw, but it can be an indication that you’re finally reaching full dilation.

You’re not in control with hypnosis

Contrary to popular belief, using the deep relaxation tool of self-hypnosis to help you cope with labour pain is nothing like being hypnotised on TV or in a stage show. Some women think someone else will do something to them if they are hypnotised and that they won’t be in control or aware of what’s going on. But this couldn’t be further from the truth. Midwife Amanda says, ‘I’ve found that women who look at alternative methods of pain relief such as hypnotherapy are actually more in control, as these techniques enable them to relax and focus. They can breathe through the contraction and see the pain as a positive thing and part of moving the labour forward. Sometimes they’ll focus on the pain itself - for example, one woman I know visualised a beach and every time she had a contraction she visualised a wave.’ By practising self-hypnosis in advance of the labour, either by going along to classes or using books or CDs at home, your body will learn how to relax when it comes to labour. The HypnoBirthing Method provides birthing classes, which teach easily learned self-hypnosis techniques. Visit www.hypnobirthing.co.uk to find a class near you.

If you use a birthing pool, you have to give birth in it

Many women like the idea of being in water during labour, especially if they tend to take a warm bath to ease back pain or tummy aches. But some mums-to-be are anxious about actually giving birth in the pool. ‘The woman can get out of the pool if she wants to,’ says midwife Amanda. ‘She may decide she wants to walk around, use aromatherapy or hypnotherapy. If she stays in the pool, water works well with gas and air and massage - her partner can even get in the pool as well. ‘Don’t worry about the baby coming to any harm. Newborns have something called a ‘diving reflex’, which stops them from inhaling water - they only breathe in when they encounter air for the first time. As the baby is born, the midwife would bring him to the surface. Also, you’ll only be able to stay in the pool if your labour is progressing normally - if there are any problems we’d get you out straight away.’

TENS machines interfere with other equipment

Some mums-to-be worry that the electrical pulses from a TENS machine (a small box with wires that attach to your back that blocks pain signals from reaching your brain) could affect the foetal monitor strapped on their tummy. But there’s no need to be concerned as the baby is monitored by ultrasound, whereas the TENS machine delivers an electrical pulse; the two are very different systems and there’s no interference between them. Midwife Amanda confirms, ‘A TENS machine won’t affect other equipment. You can use it with any form of pain relief except water; in fact, women who come in with one will often keep it on throughout their labour. We advise mums-to-be to have some practice sessions before the birth to learn how to use it effectively.’ You can’t, however, use a TENS machine if you have a cardiac pacemaker.

This article first appeared in August 2008. Copyright c 2007 The National Magazine Company Limited. Published in association with Prima Baby magazine. Prima baby is a registered trademark of The National Magazine Company Limited.