Questions to ask

Drugs and anaesthetics Before accepting any drugs their possible effects should be considered carefully. Drugs and their effects How drugs can effect you and your baby. Anaesthetic injections Anaesthetic drugs can be given by injection to relieve pain during labour. Addiction The link between drugs for pain in labour and later drug addiction in the child.

If you are offered drugs for easing pain in labour, there are a number of questions you need to ask yourself and your caregivers.

First, you may want to consider why you are being offered the drugs in the first place.

• Is it because the midwife or nurse has no other ideas to assist you manage the labour?

• Are drugs being used to "keep you quiet" as your natural moaning and groaning is making the staff feel uncomfortable?

• Is it because they are short staffed and cannot offer you the one-to-one care that makes it easier for you to handle labour contractions?

• Does the midwife think that she knows better than you do about how you are handling the labour?

Many midwives and nurses believe that they are the experts when it comes to ways of managing the pain of labour. Their beliefs stem from personal experience as well as having supervised thousands of women, most of whom will have been drugged during birth. Good midwives - those who understand the role that pain plays in keeping birth normal - are often in short supply in hospitals, and many of the best have left the system because they are exhausted from battling ignorant and often unsupportive colleagues.

When a midwife suggest she can get you "a little something for the pain" or says "tell me when you want to have the drugs" it can undermine your confidence in a big way. It suggests that you will not be able to handle the contractions without medication and affects your resolve to do the best for yourself and your baby. It is rare for midwives to mention the affects the drugs will have on your baby as they are concentrating on you and your comfort.

The time you will most likely yell for the drugs is around transition, that short space of time between first and second stage of labour when everything feels out of control (this is quite normal!). Women are often able to find that little bit of extra stamina when they know that the worst is almost over and it is impossible to make an informed, rational decision about drugs when your body is working overtime to get the baby ready for birth. This is not the time to even consider medication, and midwives who offer it at this point in the belief that they are helping you are just showing their lack of skill in helping you through this rocky patch.

Whenever you are offered drugs for pain or other medication, these are the vital questions you should ask of your caregiver:

B   Benefits - what are they.
R   Risks - to me and my baby.
A   Alternatives - what can we try instead?
N   Nothing - what if we decline the offer and do nothing?

Having obtained the answers to these questions, give yourself time to consider your options. Don’t be rushed into making any decisions. Ask the caregiver to come back in 10 minutes while you discuss the suggestions with your support team.

Remember that once you accept drugs they are in your system and you cannot "take them back".

If you decline to accept the drugs when they are first offered, you can still take them later, if you need them. The less exposure your baby has to the medication the better, and there are always other ways of easing your own discomfort that won't jeopardise your baby.