Drug Free:

Breathing Techniques and Relaxation

This can be used by everyone, whether or not other methods are used. Breathing techniques help to keep you relaxed which helps relieve tension. The more tense you are the more things hurt, as you may remember from having injections/blood tests etc. Breathing techniques and relaxation are normally taught at antenatal classes, but the general idea is to breathe slowly and steadily, focusing on the out breath. It often helps if your birth partner does the slow breathing too, as this will help remind you what to do (just saying "breathe" won't help much, as I experienced!). Relaxing music in the background can also help, along with visualisation of peaceful scenes.

More info on breathing can be found in this babycentre article and in this babyworld article

Water

In my personal opinion water is a very useful aid for ME/CFS sufferers during labour. I wanted to use a birthing pool during my labour but was fobbed off by the hospital staff (apparently this happens fairly often). Labouring in water reduces pain, aids relaxation and, especially useful for ME/CFS sufferers, it supports some of your body weight, making it easier to find and maintain comfortable positions.

You shouldn't get into a birthing pool until you are at least 5cm dilated else labour can slow down, but can stay there to birth if you chose. You can use gas and air while in the pool, but not pethidine, epidural or TENS.

For more information about labouring and birthing in water see: homebirth.org.uk babyworld, active birth centre,

TENS ( Transcutaneous Electrical Nerve Stimulation)

A TENS machine uses electrical pulses via pads on your back which create endorphins (feel-good hormones), these block the pain messages from your womb. You can control the level that it is set to. You can also use other pain relieving drugs such as pethidine or gas and air while using TENS.

For more info see Pregnancyuk.net babycentre.co.uk

Drugs:

Drugs tend in general to provide more effective pain relief, but you may find your body reacts unusually to them, and some can affect the baby.

Entonox (gas and air)

This is a mild pain killer that's a gas mixture of 50% oxygen and 50% nitrous oxide, it is pumped into hospital labour wards, or held in canisters for home births. You can use it when you need it in labour, breathing it in deeply and evenly during contractions via a mouthpiece or mask. It doesn't remain in the body for long, the advantage of this is that if you find it gives you side affects (common ones being nausea and lightheadedness) you can stop using it and the side affect will quickly diminish. However it does mean that you have to keep using it to get the pain relief, I found it only helped with the pain when I was inhaling it, and that it only takes the edge of the pain rather than completely removing it.

It does cross the placenta, but is not thought to have any affect on the baby.

Pethidine

Pethidine is injected into the muscle of the buttock or thigh. It is a similar drug to morphine and takes about 20 minutes to start working and lasts about 2 to 3 hours. People describe it as helping them distance themselves from the pain, or sending them to sleep. Some women find it doesn't offer them any pain relief, and others hate the drug, saying they lost any sense of control. It offers better pain relief in early labour than later labour.

It can cause nausea so you are likely to be given an anti-sickness drug too. It crosses the placenta and is present in breastmilk, can cause breathing problems if the baby is born between 1 and 3 hours after the injection is given and can cause the baby to be sleepy and affect its sucking reflex for a few days after birth. Meptid is a less available alternative to Pethidine that has less likely hood of causing problems in the baby.

You can get different size doses, 50mg, 100mg or 150mg, if you do decide to try pethidine I would recommend trying the lowest dose if you know you are sensitive to drugs, you can always have another dose if you need it. But I would not recommend the use of this to ME/CFS sufferers.

For more info see: Birthsource.com UK Midwifery archives

Epidurals

Epidural's are local anaesthetic which is administered by an anaesthetist into the area around the spinal cord, it blocks all pain below the site of the injection. It takes about 20 minutes for the procedure to take place and the effects last about 2 hours (but can be topped up via a drip). Normally it is given at about 5-6 centimetres of dilation, though there are no set rules on this. 90% of women get total pain relief from it, which would enable you to get complete rest, even a sleep, to save energy up for the second stage.

People often find epidurals cause nausia and shivering, you may also need to have a drip to control your blood pressure and are likely to need a catheter. You will have a monitor strapped to your bump and your baby's heart rate will be constantly monitored. Epidural's tend to make the labour longer, and there is a slightly higher chance that you will have an oxytocin injection (to speed up contractions) or need forceps, ventouse or cesarean section. Some people also find that they have longer term problems like headaches or backache after having an epidural.

The standard epidural makes your legs and feet completely numb and may prevent you feeling your contractions. This is likely to mean you have to stay in bed (lying or sitting) and that a midwife may have to tell you when to push if it has not worn off for the second stage.

Mobile epidural's are administered in the same way as standard ones, although the injection often contains an opiate like pethidine as well as the local anaesthetic (the pethidine doesn't enter the blood stream so shouldn't cause the same problems as a standard pethidine injection may). With a mobile epidural you are more likely to be able to move about, though this may be limited movement and the risk of an assisted delivery is lower.

One member of this group reports that her anaesthetist had trouble inserting the epidural, which the anaesthetist believed was due to weakening of the muscles in the back due to ME.

For more information on epidural's see: Bupa, ivilliage.co.uk, Reported Side Effects of Epidural Anesthesia