thought I'd just briefly write up a few subjective notes which may or may not be useful to people thinking about options. Since I've done the whole gammut, like.
You may well laugh. I mean, sure, take them. Don't expect to notice anything.
Paracetamol and codeine:
The NHS now routinely says this is ok during labour. It's better than a poke in the eye with a sharp stick and takes the very edges of the pain to blurred line status. Over the counter in the UK, this is sold as Co-codamol.
DO NOT BUY. why on earth would you want to buy one? A totally pointless purchase, when there are rental options available at about a third of the price. In the UK, the most obvious place to rent is Boots the Chemist. I strongly recommend a Tens machine. Here are the reasons:
a) The pain relief on Boots rental machines works in stages, and is controlled by you. This helps to give you a sense that you are the one who is controlling the situation, not someone in a white coat.
b) Your partner will have to help you put it on. This helps with a feeling of togetherness - it's a small thing I know but on something like this, the feeling that you are a team is invaluable.
c) It's a teensy bit complicated to get your head around for the first few tries - this gives you something to concentrate on other than the contractions (always a good thing)
d) This is actually a really important one - on the last setting (when you're close to transition or in it) the setting button becomes a demand feed one during the contraction ie: you set a general level of pain relief then when you feel a contraction coming on, you PRESS THE FUCKER DOWN WITH ALL YOUR FUCKING MIGHT. the thing is, when you're in transition, you can't push. Everything in your body knows this, so you need a distraction which will allow you to twist and gnarl one or two of your body parts in to teeny tight balls of tension in order to enable the rest of your body to do the much needed relaxation. It's weird. You'll know what I mean when you get there. So you have several options eg: grasping your partner's hand until their bones are crushed in to dust is a favourite; twisting one foot and toes in to putty as your push the end of the bed with all your might... and concentrating hard on trying to break the Tens machine by pressing the button until your thumb starts bleeding.
Disadvantages of using the Tens Machine:
1) It's a bit of a faff and while you're getting used to it, you forget which button to press, you turn it off by accident - all kinds of nonsense. believe me, turning it off by accident mid-contraction? Not the best idea in the world.
2) If you want a water birth, you have to take it off.
3) If you're havng an Epidural - you have to take it off.
Both of the above scenarios result in a sudden, and shocking awareness of how much these bloody contractions are really hurting. That's quite nasty. However, it's not nasty enough to put you off using it, I'd suggest.
Gas and air:
Right. Myth that it's really whacky and gets you really high and like isn't it funny, your borth partner can have a suck and get high... yeah yeah. If you've ever had any "interesting" drugs in your life, then I wouldn't take the G&A myths seriously in any way. Basically it makes you a bit whoozy.
It makes you a bit whoozy. To be honest with you, I'm not sure what it actually does, if anything to relieve actual pain. What it does do though, is give you that sligt "Whoah..." which takes you away from it slightly. It doesn't do you or your baby any harm, it does not extend or prolongue contraction periods, it does not seep through to the child and make them dopey on release. It also provides another one of those "things to focus your tension on" pieces of apparatus when you're in full blown labour. Check out the teeth marks on your filter when you've finished. I had to change rooms quickly this time around, and took the filter with me so we could belt between them and smack it in to the piped in feed as fast as possible. the contraction started just before that happened and it was a great comfort just having the piece of plastic between my gritted teeth. Just think of it as being a more hygienic version of the leather strap they used to use on patients (to chew on and scream in to) before anesthetics.
It makes you a bit whoozy. Now. If your contractions happen to go on for say, 42 hours, and you spend say, 6 hours after finally goign to hospital, waiting to dilate enough to have an epidural, with only gas and air and a Tens machine for company then believe me, you get pretty fucking whoozy. Whoozy enough to, say, understand that you're having a contraction, but to be so out of it that you forget to use any pain relief until half way through. Ow. Ow ow ow. Is it worth it even for those little glitches? Oh Yes.
Pethedine in my case, in my first labour, was used as a "zonker" to whack me out for three hours and stop the pain whilst I dilated a bit more, before going in to a birth pool. Fuck me, what a mistake. The whole thing was a catalogue of mistakes frankly but then I didn't really know that at the time. My strong, STRONG advice and I can't state this enough is - if you are not dilating; if you do not have fancy ideas about birthing pools and all the rest of it then you really need time without pain. Time without pain does not have to be a strong drug which possibly ends up with your baby having trouble with breastfeeding (evidence suggests it, despite claims that it exits the baby's system in plenty of time). The fact that you can't have this administered in the States should tell you something.
The most you can say for it is that it is a zonker. You're simply aware of contractions but you sit there like a zombie. It takes away any sense that you are in control, it makes you feel vulnerable and confused. It is frankly bloody awful.
This may come across as cheerleading for an Epi but that's not quite the case. Let me go through the negatives first. There is a very, very slight possibility of lasting back nerve damage!!! Argh! Even the thought of that is quite terrifying. This time round I wasn't that 1 in 100,000, thank goodness. However a week later I still have two numb patches on my bum. This is most peculiar! Secondly, once you've had one, again - you've ramped up the pain relief to such an extent that it would basically be impossible to come back down from it - the pain of the heavy contractions at the end would knock you out. So you've entered an intervention spiral that you can't then escape from. Thirdly, and this is well worth taking into consideration, your back is fucked for at least 5 days. Bruising, pain and when the effects completely wear off, this time around I had sharp, nasty pains inside my backbone - nice. Not. they didn't last long but still. the point is that the few days directly after the birth play hell on your body, and the less it is bruised and battered, the better you will cope. An Epi makes that a bit more difficult.
There are a couple of different types of epidural. One I had in my first birthing experience was a "One shot". That was a quick Epi which was aimed at stopping me shaking uncontrollably (ugh, really, it's a long story), then I had a further two. One was the now traditional level which again, I experienced this time - a perfect numbing of the area from the bottom of the lungs to top of the legs. I say "numb", but how the relief works is that you can feel pressure, but not pain - so for example, someone could stick a needle in you - you'd feel it go in, but not to "ow". The drug wears off gradually, meaning you need a top up any time after an hour - with me it lasted approx an hour and a half.
The third type of Epi is more related to the possibility of an emergency ceasar - then they just go for gold and numb everything from your tits down, including your legs. I also had that one for the first birth and MAN THAT SUCKS. The major reason being that when they put your child to your breast, you can't feel a thing. It's bloody horrible. Let's face it though, if you're in a position where you end up with that level of Epi, you're on your way to theatre (or extremely likely to be), so it's not something you would actively choose to do, in any case.
So. What are the positives... to retread my advice - in my case, for example: if you're having problems dilating then
things will probably end up being intervention city anyway (simply
because 48 hours without decent pain relief means no sleep and no real
energy from eating - an impossible situation when trying to push the
baby out at the end). if you're at the stage of being in hospital
because you can't handle the pain - go for an epidural. You can relax,
sleep, it doesn't affect the baby... you can even read the papers if
you want. If you're in the UK, and someone suggests pethedine, my very subjective opinion is to be as firm as you can be. Tell them you do not want pethedine. It is not a soma holiday. It leaves you dopey and disoriented, and it wears off, leaving you still in extreme pain, hours later, plus there are still doubts about the effect it has on your kid, in terms of learning to breastfeed, for example.
There are downsides. Oh yes. A grand don't come for free. Your back will already be knackered after the birth - you can't possibly lose that much weight that quickly and survive it intact, unless perhaps you're an Olympic athlete. Then imagine that for several hours you've had a bunch of plumbing in your back. There are bruises. There is bruising, right in the middle of the area that you will be bending, lifting and staggering around from in the first crucial days after the birth. I'm saying this not to put you off, but to be straight with you. It's a real bitch. and Epidural should not be treated as an easy way to have a pain free birth. It has consequences.
Secondly, once you've had an Epi, you're stuck on a bed. Do you choose to lie down, or sit up? Either way, that's about the extent to which you're going to have freedom of movement - and in terms of pushing the baby out, that is an extremely important consideration. It makes things more difficult. If you sit up, the birth canal may not necessarily be easy for baby to come down. If you lie down, that can have the effect of pulling the baby up and away from the cervix. It makes things harder to actually achieve.
Another extremely important negative is that regardless of the fact that you can feel pressure, what you cannot do easily is get a real handle on how well you're pushing. during half of my pushing this time around, I remembered strongly the feeling I'd had the first time- am I a fraud here? Am I actually pushing anything at all? I feel like I'm just holding my breath and pushing my cheeks out... luckily for me this time, the epi started to wear off part way through my pushing - not to the extent that I could feel a lot of extreme pain, but enough that bang - all of a sudden I had a strong sense of where the baby was. I knew what my pushing was doing. that's a very difficult balancing act to achieve and to be honest, I'd say it was a lucky break rather than something that could be arranged.
Last negative for an Epidural is that it seems to give the medical staff carte blanche to handle you like a piece of liver on a chopping board. I had surface scratches, a huge swollen area for no apparent reason and I swear to God, the guy who was going to give a ventouse if I hadn't hurried up was carrying on like I was a bag of shopping.
I've tried to be fair and balanced here. I think that were I capable, given the amount of pain I've experienced in my epic labours, I'd try to give natural as good a go as any - and I would recommend that to other people. As I said earlier - if you start going down the intervention route, then there is almost no choice but for that to escalate. Go in to your delivery with as much knowledge about your options as possible because one piece of wrong advice can really screw up the whole experience and leave you shellshocked if, like me, you have unsurmountable problems and need to have intervention of some sort.
Hopefully this may be useful to someone or other! Please do leave comments.