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Dealing with pain

During the pregnancy we prepare you and your partner as good as possible for the delivery. It is very important to be as relaxed as you can during the birth. There are a number of tools to deal with the pain of the delivery:

  • Taking a hot shower or a hot bath can help you relax and deal with the contractions better.
  • Try different positions. If the contractions increase in strength and become more painful it’s often hard to relax. In that case, it is important to find a way that makes you feel at ease and a position in which you can deal best with the contractions.
  • Breathing is very important. When you follow the rhythm of your breathing and you try to concentrate on this, you will be less focused on the pain. It will help you relax.
  • If you know you find it hard to relax, we recommend that you do a pregnancy Yoga course. Here you will mainly focus on breathing.
  • If you are interested in alternative form of pain relief that you can use at home, then ‘Birth-TENS’ may be an option. TENS stands for Transcutaneous Electric Neuro Stimulation. The small device releases minor electric pulses that influence the contractions in such a way that the intensity of the pain decreases. This will have no adverse effects on you or your baby. For more information go to geboortetens.nl. A number of health insurers will cover the rental of the birth-TENS.

If the pain gets too intense and these tools are not enough then you always have the option to get pain relief in hospital. With this type of pain relief we will hand over the care during your delivery to the midwife of the hospital.

There are two types of medicated pain relief:

Epidural

Also called a “ruggenprik” in Dutch. An epidural is an injection in the lower back containing a combination of pain-relieving drugs. This pain relief will numb the lower body and the pain will disappear (almost completely) within 15 minutes. An epidural requires you to go to the operating theatre where an anaesthesiologist inserts a small tube (catheter) in your lower back under local anaesthetic. This way pain relief drugs can be given throughout the delivery.

Pros:

  • Most women (95%) don’t feel any pain anymore during the contractions.
  • As far as known epidurals do not have any adverse effects on the baby or breastfeeding.
  • An epidural does not make you feel sleepy or drowsy and so you can fully experience the birth.
  • In the Maxima Medisch Centrum it is possible to get an epidural at any time of the day.

Cons:

  • Sometimes the epidural only works on one side of the body. In approximately 5% of the cases the pain hardly reduces. This could be because of where the needle was inserted and the dosage of the drugs. In such a situation the epidural may be administered for a second time.
  • The delivery, especially the pushing, will take longer. This increases the chance of a birth with a vacuum extractor (vacuum-assisted vaginal delivery).
  • The contractions need to be supported by drugs more regularly.
  • You may not leave the bed, as you have less sensation in your legs. This will slowly come back after the administration of drugs has been stopped.
  • A drip will be placed, to prevent your blood pressure from dropping too low.
  • You will probably get a Foley, because the anaesthetic will prevent you from feeling when you need to go to the bathroom. After the delivery the Foley will be removed together with the catheter in your back.
  • Your body temperature may rise because of the epidural. This will make it hard to determine if a rise in temerature is due to the epidural or if you have a fever as a result of an infection. In some cases you will get antibiotics just in case. There is a chance that your baby will be admitted to paediatrics and treated with antibiotics following an examination by the paediatrician.

Remifentanil

Remifentanil is a morphine-like substance (opiate) that is administered through a drip, which is connected to a PCA-pump (Patient Controlled Analgesia). By pressing a button you can determine the dose of Remifentanil yourself. The pump is programmed to avoid an overdose. Using Remifentanil for pain relief is only recommended if there are reasons not to give an epidural.

Pros:

  • Remifentanil takes the edge of the pain (but not as affective as an epidural)

Cons:

  • Remifentanil may impact your breathing and the oxygen level in your blood.
  • There is a slight chance of the mother having a respiratory arrest when using Remifentanil. This is why you and your baby will need to be continuously and carefully monitored when using this drug.