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RT @invisiblymeblog: @fmauk Absolutely, and this can have a huge knock-on effect to our social lives, relationships, confidence & mental he…

The Fibromyalgic Pregnancy and Beyond - Pain Relief

Pain Relief

Okay now this is a tricky section to write.  The thing is, we are all so different and therefore so are our reactions to the pain of labour and how we perceive and cope with it.  Some need minimal or no pain relief at all and some want everything going.  Both options are absolutely fine, midwives will be guided by your needs and tell you what all your options are at the time as these will vary according to what stage of labour you are in and what medications you are currently using.  In my experience, women with FM seem to tolerate pain for longer than women without FM.  This is probably due to having built up a certain amount of tolerance to pain through living with FM. 

Breathing

Okay, okay, I know we all have to breathe! I am talking about structured, controlled breathing in this instance.  Let me explain…  As your contraction begins to build you can: Inhale slowly and deeply through your nose. Concentrate on how your breath feels as it passes over your throat area. Then gently plug your ears with the respective index fingers and close your eyes. Exhale slowly producing a long and continuous humming sound, repeat as often as required. This serves to distract you from the pain but also has the added benefit of getting a good flow of oxygen to your hard working muscles.  Also I have seen women try the following various techniques: Visualisation (you are ambling along a sandy beach, in a meadow etc.), affirmation (your body is strong, is working well for you, knows what it is doing etc.), conscious relaxation of tense muscles, non-focussed awareness (notice what you see, hear, feel, smell and then forget about it, move onto the next sensation), vocalising (moaning, making single sounds like ‘oh, oh’, groaning), singing or prayer.

 Mobility

Moving around during labour is often a great help to women.  For those of us with FM, changing position and the ability to wander around to some extent during labour is almost vital if you want to avoid the pain associated with stiff muscles from staying in one position too long. Moving around; even if only to change your position from sitting, to standing to kneeling on all fours, can help to ease your baby deeper into your pelvic outlet, the start of your birth canal. Walking up and down stairs or stepping on and off a step in a sideways movement is thought to also help shift your baby deeper into your pelvic outlet. Some women find that kneeling on all fours or sitting on a birthing stool can help them push more effectively.  A bean bag or large ball such as one used for abdominal exercising can be very comfortable to sit on while in labour and will encourage you to sit in a good position too.

 TENS

This is a hand held, battery powered device that sends electrical impulses through your lower back through 4 electrodes. You control the intensity of the stimulus and are able to boost it during a contraction.  The theory behind this is that it blocks some of the pain signals from passing through the ‘pain gate’ thus restricting the amount of pain your brain has to process. In my opinion you will either love or hate this method, if it works for you it will work well and vice versa.  The majority of women I cared for with FM found this very helpful in helping them to feel in control of their labour pain. Unlike most of the other pain relief methods, this cannot be used in conjunction with hydrotherapy and you will need to rent one before going into labour as most hospital do not have a large enough supply. 

 Hydrotherapy

Anyone with FM will have been advised to try warm/hot water for pain relief, so you will have the distinct advantage of knowing whether this works for you already.  The labour/birthing pools used in maternity care are much deeper than a normal household bath, about the depth of a Jacuzzi tub. I would advise women with FM to consider this as one of their methods of pain relief.  It is completely reversible, if you do not like it you can get out and try something else, you can use alternative pain relief methods in conjunction with this such as gas and air, breathing and massage.  The added buoyancy of the water makes it much easier for you to change positions as well.

 Hypnosis

Hypnosis is just a fancy term for being really relaxed, and for really focussing in on just one thing, while everything else fades into the background.  Hypnosis for birth is proving increasingly popular, and research shows that it really makes a difference to birth outcome and maternal satisfaction.  Hypnosis is all about the mind’s ability to affect the body’s reactions and self-hypnosis is a state of deep relaxation, where the mum remains fully alert and fully in control throughout. To find out more about HypnoBirthing classes near you, go to www.hypnobirthing.co.uk. For more information and birth stories, go to the US website at www.hypnobirthing.com

 Massage

Massage is a good technique to use during labour.  It can be especially beneficial for women with FM who are unable to change positions easily, say for example if they have opted to have an epidural.  In these cases massage may help prevent muscles stiffening up and the discomfort associated with this. It is advisable for you and your partner to experiment with massage during your pregnancy to find what pressure you can tolerate and which parts of your body you prefer to have massaged.  Some women with FM find even gentle massage too uncomfortable and labour is not the right time to discover this. If like me, you are one of those people who find massage too uncomfortable, don’t despair.

  Here are some similar techniques which may work in much the same way as massage for you: Hot compresses such as a flannel or hot water bottle placed on your back or wherever else you hurt or ice packs used in the same way, a warm blanket over your entire body or a lengthy warm shower, take the shower head off the wall and direct the spray to precisely the area you need it most. One other technique you may wish to consider is acupressure however I am not able to advise you on this and suggest that you seek out the advice of a qualified practitioner during your pregnancy www.gotosee.co.uk/therapies/Acupressure.htm  for list of practitioners under timings/costs/sessions.

 As I mentioned above, the amount of pain people can tolerate varies widely.  In my experience, women with FM seem to tolerate pain for longer than women without FM.  This is probably due to having built up a certain amount of tolerance to pain through living with FM. Next I am going to discuss the methods of pain relief that use drugs to help with the pain of labour and birth.

 Entonox (Gas and Air)

This used to be known as ‘laughing gas’.  It is a combination of oxygen and nitrous oxide and you inhale it through a mouth piece or face mask.  It doesn’t really relieve the pain you feel but it does change how you perceive the pain.  It also gives you something to focus on as you need to breathe it in a certain way and begin to use it at a certain point during your contraction.  Your midwife will show you how to use it if you chose to use this method. It can make you feel quite giddy (and a few women feel queasy) but the effects wear off quickly when you stop inhaling it. It is completely reversible and you can use it in conjunction with hydrotherapy, TENS or Pethidine and in several different positions. It does not seem to affect women with FM any differently than others.

 Pethidine

This drug has similar properties as morphine but is safer to use during labour. It is given by injection in your thigh or bottom.  It often affects the vomit centres in your brain and so is usually given with an anti-sickness drug. It should take effect within about 20 minutes after being injected and while it won’t take your pain away, it does help you feel differently about it and the effects will last a couple of hours. On the minus side, it is not available for home births and it does not work for everyone. 

Some women really do not like the effects or say it feels like it put the pain ‘on top of them’ but once it is in your body it cannot be taken out again so it is best to ask for a smaller dose when trying it for the first time.  It can affect your baby if given too close to the time of birth, making your baby slow to take its first breaths so your midwife will want to perform an internal examination to see how dilated you are before administering the pethidine to you.  Be reassured that this can be reversed in your baby by giving it an injection after birth if necessary.

 Epidural

This is an injection of local anaesthetic into your lower back.  It is the only thing that can ‘take away’ your pain in labour.  All the other types discussed are pain ‘relievers’. The anaesthetist punctures a hole in your back with a needle, threads a thin plastic tube in and the needle is removed leaving a long plastic tube in for the duration of your labour.  This is taped securely to your back. It will take about 10-20 minutes to work after administered.  This can only be done by a qualified anaesthetist and so this is not available at home births. Epidurals can have some side effects immediately or soon after starting such as low blood pressure, nausea, dizziness or itching skin.

 An epidural will make you feel very numb in your legs and you will not be able to be as mobile as you may wish.  It is important to ask for help to regularly change position in order to prevent you stiffening up otherwise you may be almost immobile the next day from a FM reaction to lying in one position too long. A few hospitals offer mobile epidurals where you are able to move around with greater ease and in some cases even walk around.  You may find it difficult to pass urine, if this is the case then a midwife can insert a catheter to release the urine from your bladder. Very occasionally epidurals will have windows where the pain still breaks through so that you will feel a contraction in a small area. Epidurals can increase your chances of needing assistance to birth your baby, usually in the form of a ventouse or forceps delivery as you are not able to push as effectively.

 Epidurals can very occasionally cause bad or severe headaches the following 24-48 hours after birth which may be an important deciding factor for those of you who suffer with FM related headaches. Some people complain of back pain for varying lengths of time after having had an epidural. 

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