H

Little progress: Continuous fetal monitoring may prevent women moving around much in labour. Photo: Michele Mossop

If medicine can perform miracles like organ transplants, how come having a baby in the 21st century can still hurt so much? I wondered about this through the long hours spent beside my daughter as she endured a labour that was even harder than my own experience 30 years before.

Her drug options for pain relief were much the same as mine, none of them foolproof.

There was gas, the mix of nitrous oxide and oxygen that helps some, but not all, women; an epidural - a shot of local anaesthetic into the lower back - and pethidine, an injectable narcotic.

But while an epidural can be a powerful pain blocker, it's sometimes ineffective. It can also slow labour down by interfering with oxytocin, the hormone that helps the uterus contract to push the baby out. It also increases the chances of a forceps delivery and severe tears in the perineum, says Dr Hannah Dahlen, Professor of Midwifery at the University of Western Sydney's School of Nursing and Midwifery. Pethidine can help too, but it doesn't work for everyone and its lingering effects after birth can make babies so drowsy it can be hard to get breastfeeding going, she says.

But rather than wait for better drugs to arrive in the labour ward, Dahlen thinks the health system should make better use of non-drug ways to relieve pain, like reducing fear, using heat packs, warm water and massage.

Fear, says Dahlen, can disrupt the hormones that are important for giving birth. It increases production of adrenalin which not only inhibits calming hormones called endorphins that help relieve pain, but also reduces oxytocin, slowing labour.

An antidote to this is what's called continuity of care - when women have the same midwife or the same group of midwives caring for them throughout pregnancy and birth, explains Dahlen.

''This continued contact with the same midwife or midwives allows women to build up a relationship of trust so they feel more relaxed during labour. There's good evidence that with continuity of care women are less likely to need pain relief in labour,'' she says.

Research has also found that immersion in warm water in labour reduces pain and that standing, sitting, kneeling or walking around in early labour, instead of lying down, can reduce the need for an epidural.

Yet, despite the evidence, not all women get to use these approaches, says Dahlen.

''Although NSW Health recommends that women in labour have access to immersion in water, in some private hospitals women are talked out of using water,'' she says.

''As for moving around, too many women have continuous fetal monitoring which restricts their movements.

''Some fetal monitoring is always good but this can be intermittent. Continuous fetal monitoring should only be for women with complications. It's often the thing that stops active labour happening and means women never get off the bed.''

How can women have a better chance of accessing continuity of care, water and a more active labour? By finding a hospital offering these choices, booking in early - these programs have long waiting lists - and letting your midwife know you want to be active in labour, advises Dahlen.

Improving muscle strength helps too, adds physiotherapist Jane Simons.

Simons, who runs private exercise classes at the Royal Hospital for Women in Sydney, says that ''improving strength in all muscle groups makes it easier for women to change and maintain different positions during labour if they're able to stay active''.

Strong legs make it easier to squat or stay upright, or use pelvic rocking - the technique of moving the pelvis from side to side, around and around or back and forth to help soothe contractions - while upper body strength can also make it easier to position yourself on hands and knees.

This can help with pain and, anecdotally, can sometimes help get the baby's head into position for delivery, says Simons.

''Labour is unpredictable but getting your body as strong as possible before birth is like getting credit in the bank,'' she says.