Having a baby is a major, life-changing event for you and your partner. You may have expectations of the child birth experience and we at POSA are committed to making this as safe and comfortable as possible.

We provide anaesthesia for labour and delivery, as well as caesarean sections.

Types of Pain Control for Labour

What pain relief is available?

It may be difficult to know what pain relief option will best suit you during your labour. Here are some options which you may consider:

Self-help methods	Breathing techniques Massage Bathing
Complimentary Therapy	Aromatherapy Hypnosis Reflexology Accupuncture Tens Machine (Transcutaneous Electrical Nerve Stimulator)
Nitrous Oxide (Entenox)	A gas made up of 50% nitrous oxide and 50% oxygen May be used at any time during labour Will not take the pain away completely, but it may help Is breathed through a mask or mouthpiece Is simple and quick to act, and wears off in minutes It may make you feel light-headed or nauseated
Pethidine	Painkiller Administered by injection into a large muscle in your arm or leg Pain relief may be limited Effect takes about 30 minutes to work and may last a few hours Can make you feel more relaxed and less worried about the pain Side effects of Pethidine include: sleepiness, nausea and vomiting, and excessively slowing your breathing As Pethidine can cross the placenta, your baby may be slow to take their first breath or a little drowsy
Patient-Controlled Analgesia (PCA)	PCA is available in some hospitals if an epidural is not possible or you do not want one Opioids can be given directly into a vein using a pump that you control yourself by pressing a button. PCA allows you to give yourself small doses of opioids when you feel that you require it You have control over the amount of opioid you use For safety reasons, the PCA limits how quickly you can take the opioid and the total dose
Local Anesthesia	For instrumental delivery or excessive pain during a natural birth The obstetrician can inject local anesthetics directly into the vaginal area to relieve the pain associated with delivery Local anesthetics are more effective in the later stages of labour
Regional Blocks	More commonly known as epidurals or spinals This technique provides good pain relief for the entire labour and delivery Epidurals are more commonly used for labour and vaginal deliveries Having an epidural catheter allows medication to be given for pain relief for as long as necessary They can also be used to provide excellent anesthesia should a C-section become necessary Spinals are typically used for elective Caesarian sections

What is an Epidural?

An epidural is a plastic tube inserted in your lower back via a needle guide. Medicine is administered through this tube throughout your labour to ensure adequate pain relief. This will allow you to have a more relaxed and relatively pain free labour experience.

What is involved in getting an Epidural?

At any stage during labour, an epidural may be provided on your request. An anaesthestist will be called in who will be able to deliver this service. They will discuss the risks of the procedure, obtain your consent and proceed to set up for the epidural placement. An epidural may be administered in the sitting or lying position. When ready, the anaesthetist will clean your back with antiseptic solution. They will then give you a small local anaesthetic injection to numb the skin of your back. This will ensure the procedure is relatively painless. The plastic tubing will be inserted and left in your back for ongoing pain relief. Pain medicine will be delivered via this device but may take up to 20 mins to take full effect.

When pain relief is achieved you may also experience some weakness in your legs. For safety reasons, you will not be allowed to walk after receiving the epidural and you will need to have a urinary catheter. During your labour, medicine may be administered in 2 ways:

• Continuous infusion
• Intermittent infusion administered by pressing a button controlled by you

The choice between these 2 methods depends on hospital protocols. Stronger pain medicine may be administered via the epidural in the event you require a Caesarian section.

What are the risks associated with having an Epidural?

• Failure (a repeat epidural may be offered)
• Partial block (measures will be taken to correct this including offering a repeat epidural as a last resort)
• Nausea
• Low blood pressure
• Post Dural Puncture Headache (a particular type of headache which may occur after having a spinal or epidural)
• Minor nerve injury (this often resolves within days)
• Localised bleeding
• Infection
• Major nerve injury resulting in permanent nerve damage or paralysis (this is extremely rare and often due to either localised bleeding or infection)
• Drug reaction or toxicity

Complications do not occur often and rarely lead to significant problems for either the mother or the baby. Your anaesthesist will discuss these risks with you and any other questions you may have at any time. Please note that there are some situations where an epidural is strongly advised and other situations where an epidural is not appropriate

Anaesthesia for Caesarian Section

There are several methods of providing anaesthesia for a Caesarian section:

• Spinal anaesthesia (for elective and semi-urgent situations)
• Epidural top-up anaesthesia (for patients who already have a working epidural)
• General anaesthesia (for elective and emergency situations)

Caesarian sections are usually done with a spinal block (also known as a subarachnoid block). This allows both mother to be awake and partner to be present during the delivery. It also allows additional safety for the baby. The procedure and risks are similar to those for an epidural. A spinal is different from an epidural because a spinal is a single injection in your lower back without the use of a catheter, and the medicine is administered in a different place in your back. If a labouring patient has an epidural and subsequently requires a Caesarian section, the epidural can be used to provide anaesthesia. General anaesthesia may be performed in extreme emergencies, certain medical conditions or rarely due to patient preference.

Your anaesthetist will discuss your individual risks with you. We encourage you to raise your specific questions and concerns with them prior to your procedure.