# Pain relief during latent phase of labour



## alicaptain (Jan 6, 2012)

Hiya,

I was wondering if there were any guidelines on pain relief during the latent phase of labour. I had a rather nasty labour experience last time (May 2011) and I'm due to give birth again in May this year and am trying to do everything I can so that I have a more pleasant and less traumatic time.

Basically last time my latent phase of labour lastest 5 hours and from the moment I had my show the contractions started every 2 to 3 minutes apart lasting a minute. Due to the frequency and strength of them I went into the labour ward, who did their best to send me home as despite the stregth of the contractions (I was also violent sick with each contraction and had chronic diarreah). Due to previous medical history (childhood thyroid cancer) they had to admit me, but did this so reluctantly and totally refused any pain relief whatsoever saying that until I was 4 cm there was nothing they could do. This went on for 5 hours where I stayed at 2cm, but then dilated fully within 55 minutes and gave birth 12 minutes later, all without any pain relief as by this point they said it was too late.

I suppose my questions are:

1) Can a midwife really totally and utterly refuse to give you any pain relief before 4cm, even if it is clear that contractions are strong and regular?

2) Depending on the answer to the above, seeing as this will be my second birth in 12 months and I had this quick labour last time are they likely to be more lenient and let me have pain relief this time?

I've read the NICE guidelines and seen that it says that 1) Epidurals are not associated with slowing down the first stage of labour and 2) That epidurals can be given during the latent stage.  I am aware of the risk of epidurals slowing down the second stage, but I am willing to take this risk so that I don't need to go through the same experience again. Due to the speed to the labour and delivery I had extensive tearing and another reason for wanting an epidural is to make the likely repair work less painfull this time round. Do midwifes need to abide by these guidelines, or can local hospital policy override them?

Thanks!


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## Kaz1979 (Apr 11, 2011)

Ali, will give you short response now as on phone and more detailed response later when at home. 

An epidural is not recommended before 3-4cm as prior to this labour can stop it would be a decision taken by anaesetist as to whether to give you an epidural or not. 

Your labour is likely to be quicker and hopefully your latent phase quicker also. Will give you a more in depth response later on. Hope that's ok. 

Kaz x


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## Kaz1979 (Apr 11, 2011)

Ali, 

Right am home now and can can give you proper reply. 

In answer to your first question - I would hope that a midwife would never "refuse" pain relief however as I said earlier at say 2cm it would not be good practive for us to give you an epidural particularly in a second labour as once you have had a baby before your external cervix can be slightly open at the end of your pregnancy (our midwifery term is a multips os) with your internal cervix opening shut. Some midwives may give you pethidine at this stage if you are struggling with the pain as this will help you to relax, in my opinion this may be a more of an option than an epidural. 

Have you considered "natural" methods for the latent phase such as hypnobirthing, a TENS machine etc? 

It is highly likely that as your body has done this before and not that long ago that hopefully your labour particularly the latent phase will be quicker. 

I can tell this is of concern to you so I will ask Emily Catlin to give her opinion as well. 

I would also suggest that you have a hospital appointment to review your notes of your last labour with your consultant he/she can then "authorise" pain relief in early labour possibly earlier than we would normally give it. If you dont have another apointment at the hospital ask your midwife when you see her next to refer you back to the hospital and explain why. 

Hope that helps. 
Kaz xxx


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## alicaptain (Jan 6, 2012)

Hi Kaz,

Many thanks for your replies.

I have contacted the hospital to get a copies of my notes from last time. The only consultant I see is the thyroid specialist, who I see every 6 weeks. I assume he wouldn't be the person to go through the notes with; who should it be? I do have an appointment with my midwife (who is fantastic) in a couple of weeks so I can speak to her about this and ask for her assistance. She agrees that my labour was totally mismanaged last time, and is doing everything she can to help me this time but unfortunately she is really busy and I don't get to see her very often.

It's difficult because I really don't want to be an annoying, argumentative woman during labour but I just want to be aware of "my rights" as I've always just had total 100% trust in doctors, midwifes etc without questioning it. I was told in black and white last time that unfortunately midwifes are not allowed to give any kind of pain relief before 4cms. I could understand it if they'd said "we don't recommend it as you might have hours to go" or tried to discourage me, but they just flatly said unfortunately there was nothing that they could do, that all women have to go through this etc etc. I outright asked them "so all women have contractions every 2 minutes for 5 hours, whilst being sick and trying to run to the toilet inbetween with no pain relief" and she said yes, that is what happens and that most women don't even come to hospital at that stage but go through that at home. I've always seen myself as a strong person (having gone through numerous operations and treatment for my cancer, I'm not exactly unfamiliar with hospitals and pain) but I have never been made to feel so utterly useless and weak in my life. 

I didn't have an ounce of fear in my body last time I went into labour, and was so excited about it and actually looking forward to it. I am just absolutely terrified this time round and not trying to be argumentative or be obstructive; I just want to know what the truth is as unfortunately I was lied to by the very people who were supposed to be helping me.

I am going on a hypnobirthing course as I do feel that would really help. I'm not necessarily asking to be given an epidural the minute I go into hospital - I just want to know that if I experience the same unrelenting pain again that there is something that can be done about it.

Sorry if it sounds like I'm midwife bashing by the way - I don't mean to. As soon as they realised that I wasn't actually making up the contractions and the baby started to appear, they couldn't have been more professional or fantastic and the care I received during and after the birth was top notch.

Many thanks

Ali xxx


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## emilycaitlin (Mar 7, 2006)

Hi,

I agree with all that Kaz has said. I suppose epidurals could slow down the first stage a bit as you are not mobile, amd able to help move the head down to help the cervix to dilate quicker. As kaz said though, you will always be slightly dilated after having one baby, and the latent phase can stop and start, so you do have to be innestablished labour for one, pethidine or entonox if you really aren't coping should be available though, hypno birthing is brilliant, I've seen drs think women have got epidurals as they are so relaxed with it!

Emilycaitlin xx


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## Kaz1979 (Apr 11, 2011)

Ali I hear what your saying and it didn't come across as midwife bashing. Ask your midwife to refer you to a consultant obstetrician. I would expect as you said you have had treatment for cancer that you would've been booked under a consultant obstetrician not a midwife. But you may have only see them once or someone from the team. 

The hypno birthing will really really help and you will hopefully find this will get you through the latent phase and maybe all your labour. I have looked after many ladies using it including one lady who had a very long latent phase. 

If you are back at the same hospital as your last baby the consultant can look at your notes during that appointment. 

Kaz xxx


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