A Guide For Parents-To-Be: Part 3 (Pain Management and Pain Medication)

Pain Management and Pain Medication in Labor

One of the things pregnant women fear most is whether they can handle the pain of labor. It can be scary when no one can explain to you what a contraction feels like and everyone just wants to tell you horror stories about long hard labors! I'm here to tell you, you can. It is a mental game and with someone to support you (whether that be a doula, a good nurse, or a prepared partner) you can do this!!!! But what if you don't want to handle it. What if it is worth it to you to just get pain medicine instead? That's ok too!! This is your birth and you have choices, including  whether you want to take pain medication or not. So lets talk about some of the options out there and the pros/cons for each.

First, lets talk about some non-invasive pain management techniques. These techniques are what most doulas will use to help relax mom and minimize pain.

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• Position Changes- 
• Every woman is different. Different positions will be comfortable for different mama's. But there is one universal position that DOES NOT HELP with pain management. This is lying flat on your back in bed. When a laboring mom gets stuck on her back, she often feels the contractions way worse than they actually are. 
• Many hospitals want to continuously monitor or even intermittently monitor your baby's heart rate and contractions while you lye in bed. There are other ways though!! Often you can sit in bed, lye on your left side, sit on a birth ball next to the bed, etc. Do not be afraid to mention these alternatives! They will help you minimize pain. 
• Out of bed there are many other positions you can try. You can kneel, rock, sit on a birth ball, lay over a birth ball, walk, squat, lunge, dangle, lap squat, etc. All of these position changes will help move things along and minimize pain. There aren't really any cons to position changes. It may take a few to find one you like, but it is worth it.
• Accupressure-
• Accupressure can ease anxiety, mitigate pain and help speed things along if labor is stalled. 
• It can help dad, help mom. It can help mom, help mom. Accupressure is a very simple technique that can take the edge off of those agonizing contractions. 
• 4 points that will help most during labor: GB-21, Hand Point, KID1, SP-6. 
• Check with your doctor before using these points. Some women react differently to accupressure.
• Breathing Techniques-
• This is the easiest and most basic technique. EVERY woman should know at least one breathing technique to help her relax and get through a contraction. 
• The simplest and most effective is take slow deep breaths. It's as simple as that!! Slow breath in 2, 3, 4. Slow breath out 2, 3, 4. 
• Breathing greatly help in pain management. If you are not breathing, you wont be able to handle  it. If you breathe too fast, you may hyper ventilate! Get your partner or a nurse to help you remain calm and breathe with you when you start to feel anxious! 
• Vocalization also helps. Whether singing, humming or moaning. (I took to moaning.) 
• Relaxation/Focusing Techniques- 
• Once again different things work for different mama's. So try a few! You can try visualizations, massage, music, counting, or focal points. 
• Your doula may help you relax with Roving Body Check. 
• Heat/Cold-
• I have mentioned hot and cold packs in a previous post with tips to handle labor pain. Hot packs feel amazing, especially if you have back labor. I carry around two rice packs with me in my doula bag just for this reason!! Cold packs keep you from overheating, I mean you are running a marathon here!!!
• The warmth of a shower can relieve pain too. During the birth of my daughter I spent countless hours with the shower head on my back. The heat gave me major relief.  Some hospitals/birth centers even offer labor tubs! If one is available to you, I would consider trying it out!!

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• Counter Pressure-
• A different kind of labor is back labor. It is when you feel the contractions in your back, instead of your tummy. In the case of back labor counter pressure is vital. You may like constant pressure against the pain or light massaging or heavy massaging! Be prepared (partner) to try different styles that work for the mama.

Now onto pain medication. After all, that's what most of you want to know about!!

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• Systemic Painkillers-
• Often narcotics or tranquilizer's. 
• Narcotics are used to take the edge off of the pain. You can still feel it, it just isn't so bad. They are usually given through IV or less often injected into muscle. Often, you cannot receive narcotics after 7 or 8 cm because it will effect the baby. These can make you a bit sleepy and nauseous. They take effect within minutes.
• Narcotics are often given with a tranquilizer. The tranquilizer is used to calm anxiety or nausea. 
• Pros- Narcotics often lessen the perception of pain for 2-6 hours and promote rest. 
• Cons- Don't eliminate pain. Often come with sleepiness, nausea and may temporally depress breathing for you or baby.

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• Epidural-
• An epidural numbs the lower half of your body. It is continuous pain relief that is delivered through a catheter (small flexible tube) inserted into the space just outside the membrane that surrounds the spine. It can be turned down or up if the dose needs to be adjusted. This is the most common pain medication used in labor. 
• Pros- Alleviates most pain. You are awake and alert (if you want to be hehe). Usually has little effect on baby.
• Cons- May decrease your blood pressure and lower baby's heart rate. It can cause temporary difficulty in breathing. You may need a catheter since you often cannot empty your own bladder. Fever, soreness and itchiness at the injection site are common. May make pushing more difficult and additional interventions such as pitocin, vacuum extractor, forceps or cesarean may become more likely. You must remain in bed which could stall labor. You usually must remain in bed after birth (per hospital policy). A headache in the days following delivery is possible. May cause some trouble latching on to breastfeed.

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• Spinal Block- 
• A spinal is very similar to an epidural. It has the same effect on your body however it differs in two ways. 1. It is delivered directly into the spinal fluid. 2. It is a one time injection instead of a continuous feed. This results in an immediate reaction but doesn't last quite as long. 
• Usually used late in labor when there is no time to wait for an epidural or more recently in combination with the epidural. 
• Pros- Complete pain relief in lower body for 1-2 hours. Medication is only given once and you will remain alert and awake. Usually has little effect on the baby.
• Cons- May decrease your blood pressure and lower baby's heart rate. It can cause temporary difficulty in breathing. You may need a catheter since you often cannot empty your own bladder. Soreness at injection site is common.  May make pushing more difficult and additional interventions such as pitocin, vacuum extractor, forceps or cesarean may become more likely.  You must remain in bed during labor. A headache in the days following delivery is possible.  May cause some trouble latching on to breastfeed.
• Local Anesthetic-
• A local anesthetic is often used during labor to numb the tissue in the vaginal opening if an episiotomy is needed. More often, it is used if your care provider has to repair a tear. It is injected into the vaginal tissue or perineum and takes effect very quickly.
• Pros- Temporarily numb a specific area. Negative effects are rare.
• Cons- An allergic reaction is possible. Not for labor contractions.
• Pudendal Block-  
• A pudendal block is usually given in the second stage of labor just before delivery of the baby. It relieves pain around the vagina and rectum as the baby comes down the birth canal. It is also helpful just before an episiotomy.
• Pros- Relieves pain in lower vagina and perineum for up to an hour. 
• Cons- May work on only one side of perineum. Cross placenta and can effect breast feeding relationship immediately after birth. Risk of hematoma and infection (although rare)

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Labor is a personal time and experience. Opinions, needs and wants differ greatly. If decide against or decide to use pain medication, do not let other people's opinions effect you. This is your decision! As always, I invite you to educate yourself further on these options. Decide what is right for you by making an educated decision. 

Sending Easy Birth Dust Your Way!!

Covered in part 1: Important Decisions to Consider -

                              (Vaccinations, feeding baby, circumcision, discipline, and routine procedures)

Covered in part 2: Interventions

To be covered in part 4: Making Decisions on Raising Baby
                             (Babywearing, Day Care, Montessori Method, Co-Sleeping, Introducing Solids)

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