Pain relief during childbirth: what options are available in the Netherlands?

You can receive support and pain relief during labour, with or without medication. What suits you best depends on your preferences, your health, how the labour progresses and what is available at your place of birth. You do not have to make a definitive choice in advance. Discuss your preferences during pregnancy and let them know what you need during labour, even if it turns out to be different from what you had planned.

What can you do without medication?

Rest, support and a comfortable position can help you cope with contractions. Think of breathing calmly, moving around, massage or a warm shower. Your partner can stay close by, breathe with you and help you communicate your wishes to the midwife. What feels comfortable may change during labour. You don’t have to stick with a technique that isn’t working for you.

A warm bath can help you relax. Check in advance whether a birthing pool is available where you plan to give birth and when you can use it. A bath is not suitable for every medical situation. Your healthcare provider will discuss with you what is possible.

With TENS, patches on your back deliver small electrical impulses. You control the intensity yourself. You can often hire a device. TENS is not suitable for everyone: for example, if you have a pacemaker, a heart rhythm disorder or epilepsy, consult your healthcare provider first. Do not use TENS in the bath or under the shower.

Injections with sterile water are another option, particularly for back labour. A midwife will give you four small injections in your lower back. The injections may be slightly painful; afterwards, the back pain may subside. Not every midwife offers this treatment. Ask about it in advance.

These options are not mandatory steps you must complete before you can ask for medication.

What types of medication-based pain relief are available?

Epidural: the most effective pain relief

An epidural usually provides more effective relief from labour pain than other treatments. An anaesthetist inserts a thin tube into your lower back. The painkiller is delivered via this tube into the space surrounding the nerves; this is different from a drip in your arm.

You’ll receive this treatment in hospital, where you and your baby will be monitored. You usually won’t be able to walk around and may need help to empty your bladder. Possible side effects include a drop in blood pressure, itching or a fever. Sometimes the anaesthetic does not work effectively enough and the anaesthetist will need to adjust it. Your healthcare provider will also discuss less common risks and reasons why an epidural might not be suitable for you.

Remifentanil: a pump that you operate yourself

Remifentanil is a strong, morphine-like painkiller that is administered via a drip. You use a button to administer a limited dose to yourself. The drug works quickly but for a short time. It generally provides less pain relief than an epidural and may make you drowsy.

Remifentanil can slow down your breathing or cause it to stop temporarily. That is why you are given it in hospital, where your breathing and oxygen levels, amongst other things, are monitored. Your baby is also monitored. You cannot walk around or have a bath. After a few hours, the pain-relieving effect may diminish. Discuss when the administration should be stopped, for example when you start pushing.

Nitrous oxide: via a mask

With nitrous oxide, you breathe in a mixture of nitrous oxide and oxygen through a mask. It can help you to relax and make the pain feel less intense, but it does not take the pain away completely. It works quickly and the effect wears off rapidly once you stop breathing it in.

It can make you feel dizzy, nauseous or drowsy. Nitrous oxide is only available at some places of birth, such as a birth centre or hospital with the appropriate facilities. Ask your midwife if this is an option in your area.

Pethidine: an injection

Pethidine is a morphine-like painkiller that is administered as an injection. You cannot adjust the dose yourself afterwards. It can make you drowsy and, for many women, is less effective at relieving labour pain. If the drug is still active at the time of birth, your baby may experience temporary breathing difficulties.

Pethidine is therefore not usually recommended as the first choice for pain relief during labour. It is sometimes used before labour begins to provide relief from exhausting pre-labour contractions. Your healthcare provider will assess whether this is suitable for your situation.

Is pain relief available if you want to give birth at home?

At home, you can, for example, use heat, changes in position, support and TENS if that suits you. Some midwives also offer sterile water injections. For an epidural or remifentanil, you will need to go to hospital, where care will be handed over to the hospital team. This is also possible if you initially planned to give birth at home.

In some birth centres, you can be given nitrous oxide. This does not mean that you can also have an epidural or remifentanil there. Ask in advance what options are available and how a possible transfer would work.

When should you ask for pain relief, and can you change your mind?

Tell your midwife or doctor during your pregnancy which options you’d like to discuss. During labour, you can still ask for pain relief, even if you’d previously planned to give birth without medication. Make your request in good time: assessing your needs and arranging treatment takes time.

There is no standard centimetre threshold that you can use to determine for yourself whether you can still have an epidural. The team will consider, amongst other things, the progress of your labour and your medical condition. If the treatment you’ve requested isn’t possible, ask what alternatives are available and why they’re being suggested.

What should you include in your birth plan regarding this?

Use your birth plan to start a conversation. Write down what you’d like to try, what you’re unsure about, and how you’d like the team to help you make a new decision. You could include these questions:

• What options are available at my place of birth, including at night?
• What are the arrangements regarding movement, having a bath and support from my own midwife?
• What benefits, side effects and risks are relevant to me and my baby?
• How do we arrange a handover if I go into labour at home but still want medication?
• Can you explain things in a language I understand well, and arrange an interpreter if necessary?

Are you giving birth in the Netherlands and do you speak little Dutch? Make arrangements for clear explanations and consent before labour begins. Simply knowing the English name of a medication is not enough to properly discuss the pros and cons.

Further preparation with your partner

You now know the main options. What would you like to try, and how can your partner help you during labour? In the online antenatal course, midwife Geke explains natural pain relief and pain relief with medication in two lessons in module 5.

Prepare together, at a time that suits you both. Watch the first 8 videos for free (videos in Dutch).

Already taking the full course? Watch Natural pain relief and Pain relief with medication in module 5.