What pain relief can you have at a home birth?

If you are considering a home birth, you may be wondering what pain relief options are available to you. It’s important to note that every labour is different, and your personal experience of pain may be different to someone else’s. Unfortunately, we don’t have a way to predict what your birth will feel like to you. This is why it’s important to gather both information and a toolkit of options that you can use, should you need to. You don’t have to use any of these tools, and conversely you can use all of them. The main thing to know, is that you have options! Knowing how and when to use your tools best, helps you to feel more in control and confident, and I often recommend layering some methods together as it can be much more effective than using one on its own. Some options are only available in certain locations, and this may be a factor in helping you to decide where to have your baby; at home or in hospital.

Can you have an epidural with a home birth?

An epidural is a type of anaesthetic where a thin tube is passed into the epidural space in your spine and medication is administered. This numbs the nerves that carry the pain impulses from the pelvic region to the brain. An anaesthetist is the only person who can give an epidural, so it is not available at home and is only available on an obstetric unit/labour ward/delivery suite. It takes around 20 minutes to insert the tubing into your back and administer the 1^st dose of medication. It takes another 15-20 minutes for this to have an effect, after this you may need regular top up doses. To most women the epidural provides complete pain relief, however it doesn’t always work evenly at first and on occasion, the epidural may need replacing. It’s important to be aware there are some side effects with an epidural including:

• Hypotension, this is when your blood pressure drops low. If this happens, it can make you feel, lightheaded, nauseous or dizzy. A sudden drop in blood pressure can also have an impact on baby’s heart rate. This is why continuous monitoring of baby’s heart rate is recommended when you have an epidural, this kind of monitoring can’t be performed at home. Your blood pressure is also monitored very frequently for a short period of time after a dose of the epidural medication, and you should be offered fluid through a drip in your arm or hand to help maintain a stable blood pressure.
• Prolonged pushing stage of labour. If you have a heavy or dense epidural block you may not feel the sensations of where to push or when you are having a contraction. A midwife can lay a hand on your bump to feel for when a contraction is coming and guide you when to push. A prolonged second stage increases your likelihood of interventions such as an assisted birth where a doctor uses forceps or a ventouse to help you birth your baby, these can’t be performed at home.
• You may find it difficult to pass urine as the nerve pathways from your bladder to your brain are numbed. This is especially common if the block is heavy. You may also feel unable to stand, meaning it’s difficult to get to the toilet to attempt to pass urine. A full bladder can block the decent of your baby’s head through the pelvis and if not drained regularly it can damage your bladder, you may be offered a small tube called a catheter to be put into your bladder until after the birth of your baby to keep your bladder empty.
• Around 1 in 100 women gets a persistent headache after an epidural. If this happens, it can be treated. It may require a trip back to the hospital for review by an anaesthetist.
• You may experience some soreness of your back for a few days after having an epidural. This should improve over a short time and should be manageable with your usual postnatal pain relief such as paracetamol or ibuprofen. There is no evidence that epidurals cause long-term backache.

Can you have gas and air at a home birth?

Gas and air (also called Entonox) is a combination of oxygen and nitrous oxide gas. It’s most effective when breathed slowly and deeply through a mouthpiece with tubing connected to a canister of gas which is available in the home environment. There are no harmful side effects and no impact on your contractions or your baby, so it is safe to use in labour. Often the deep breathing that the gas and air encourages you to do, helps you to feel calmer and gives you a sound to focus on, similar to a white noise. Many women like it because it’s easy to use and you control it yourself. The gas takes about 15-20 seconds to work. It can make you feel lightheaded or ‘spaced out’, and some women find that it makes them feel sick, sleepy or unable to concentrate – if this happens, you can stop using it, take some deep breaths of room air and within a minute or two it will have left your system and those side effects will stop. If you’ve been using the gas and air for a while, you may notice your mouth gets dry, using a lip balm and having a drink nearby can help with this.

What other pain relief is available at home births?

There are many pain relief methods you can use at home! When creating your birth plan, consider these options:

• Water immersion – The warm water may provide some rest and relaxation, as well as a sense of weightlessness which enables you to change position easier, helping your baby to navigate through your pelvis. An inflatable birthing pool can be sent to your home with all the equipment you might need for a water birth.
• TENS machines – (Transcutaneous Electrical Nerve Stimulation) This device emits an electrical pulse that stimulates nerve pathways in the spinal cord, pain signals also travel along these pathways and the theory is, if we can replace the pain signals with these electrical pulses, we can block the pain signals getting to your brain. In labour you control the electrical currents using a hand-held device, pressing a boost button when you are having a contraction. It is most effective when started early on in labour before the contractions become strong and regular. You shouldn’t use a TENS at the same time as water immersion or a shower as it’s electric, but you can use it prior to or instead of using water. You can purchase a TENS machine from Private Midwives.
• Breathing techniques and hypnobirthing– A mixture of visualisation, mindfulness and deep breathing may help you concentrate on your body and baby during labour, while ignoring any extra noise or things going on around you. Your Private Midwife may be hypnobirth trained so speak to them for further information on how this can be included into your antenatal care package. This is a method that can take some practice and repetition can help it to be more effective when baby’s birthday arrives.
• Movement – One of the benefits of birthing in your own home is your home comforts, you may find benefit from cuddling up on your sofa, resting in your bed and having privacy in your own bathroom. Freedom of movement helps you to tune into your body and instincts to shuffle and tilt your hips helping baby navigate the pelvis and birth canal. Dancing around your kitchen to your favourite song boosting the positive feel-good endorphins and oxytocin is such a fun way to help your labour along
• Massage or Counter Pressure – A good massage or some firm pressure on your back can feel like such a relief in labour. I also recommend practicing during your pregnancy with your birth supporter to find what feels good for you and what doesn’t. This can be layered with aromatherapy massage oils which can have a calming effect- speak to your midwife or an aromatherapist for which massage oils are safe in pregnancy and labour as there are some which are not safe.

As you can tell there are so many options to consider and knowing how to use these options can help you to feel in control, my top tip is to share your thoughts with any birth supporters you may have so they know which options you may like to try and if there are any that you don’t think is right for you. It’s a personal decision which method/s you use, and you can speak to your midwife if you are considering any of these as they can provide you with further details. There are plenty of options that can be used at a home to help and there is always the choice to transfer to the hospital from a home birth for additional pain relief, should you feel you need it. Research has shown us that women giving birth at home generally feel more relaxed, in control and able to cope with the intensity of their contractions. Interestingly, a study of about 17,000 planned home births found that only 281 people, (less than 2%) transferred to the hospital for additional pain relief during labour. This suggests that as many as 98% of people are able to cope with the sensations of labour using the techniques in their home environment.

If you would like to find out more about home births or make a booking please contact us on 0800 380 0579