Pregnancy- What are my pain management options in labor?
Labor- the process of childbirth.
Many women wonder: Will it hurt? How much will it hurt? What can I do for the pain?
Well, I hate to tell you, but it isn't called labor for nothing. Yes, labor hurts. How much depends on the stage of labor, whether your water is broken, and ultimately how high your pain tolerance is.
Your pain management options during labor include breathing/relaxation techniques, IV pain medication, and the epidural.
It is important to talk with your doctor or midwife BEFORE you go into labor about what options are open to you. This is important because you may run into certain situations. It is possible that your hospital of choice does not offer the epidural. Your provider may not give IV pain medication. Or maybe your provider doesn't allow you to have the epidural until you are dilated a certain amount.
Now let's talk about pain. When in the hospital, you will be asked what you're pain level is on a scale from 0-10. 0 = NO PAIN, 10 = THE WORST PAIN YOU CAN IMAGINE (I frequently tell my patients to imagine having their arm chopped off and that would be a 10). It is important to be realistic about what you're pain level really is. This allows us to treat your pain effectively, and evaluate that effectiveness. Also you will be setting yourself for for disappointment later. For example: if you are talking on the phone, laughing, smiling- do not rate your pain at an "8". Take some time to study the example pain scale that I have included to kind of get an idea about what each level may feel like for you and remember, pain is entirely subjective. Your "5" is not necessarily the same as someone else's.
Now, I am going to break down the differences of your options to get you through labor.
- This is exactly how it sounds, you breathe through your contractions and concentrate on relaxing through them. This can be very effective for pain management as long as your pain tolerance level is not very low.
- Having a good labor coach to assist you makes this goal much easier to obtain (I can attest to this personally!). By "good labor coach", I mean someone who sit by your bedside, holding your hand and talking and/or breathing through the contractions with you. Too many times I see the dad sitting on the couch watching television, playing video games, or even sleeping!
- If you choose this method, I highly recommend taking a birthing class with your coach. Although if you are unable to to, your nurse can teach you basic breathing techniques when you get to the hospital.
- There are many physical aides out there to help with pain management and relaxation. For example, a clean (or new) sock filled with rice, this can then be heated for 30 seconds and then applied to the lower back, neck, etc. (p.s. this works great for non-pregnant people too!).
- Massage also can help a laboring mother get through the pain of labor. Coaches need to be sensitive as to where mom needs to be massaged, and when...meaning if mom says "don't touch me", then don't touch her.
- Another Method for natural child birth that I am starting to see more of is hypno-birthing. Mom's learn self hypnosis. I have seen this work well for some, not so well for others. I think it all depends on your state of mind. This method requires total self commitment.
IV Pain Medication
- This form pain management involves putting a narcotic into your IV line. This also can be effective for pain management. Typically the drug of choice is Stadol, although your provider may order Fentanyl, Morphine, or Demerol (not used very much anymore).
- Very good for early labor, allows you to rest and be pain free until more active labor when most moms choose to get an epidural.
- You can only receive a dose at a frequency as ordered by your provider, anywhere from 1 to 4 hours apart.
- Normally not given after about 7 cm of dilation, as delivery is expected to be soon, and the medication can repress the baby's breathing after birth.
- Side effects include lightheadedness, dizziness, feeling "drunk" or "high", sleepiness, nausea, and vomiting. Due to these side effects, you will not be allowed to get out of bed until the medication has worn off some. Also some women do not like how the medication makes them feel.
- If you are a lightweight with medications, these medications can "knock you out" for several hours.
- If you have used drugs before, taking narcotic pain medications on a long term basis, IV pain medications may not work for you, as your body has built up a tolerance to narcotics.
- This is a form of anesthesia in which a catheter is inserted into the epidural space around the spinal cord, and bathes the nerve endings with pain medication giving pain relief througout labor. This is highly effective for pain relief and is currently the most preferred method of pain management.
- This requires placement by an anesthesiologist or a certified nurse anesthetist.
- You may have to wait for certain blood work to be completed prior to placement.
- You must receive a large amount of IV fluids before it can be placed- what I mean is, when it is time for the epidural, your nurse will turn your fluids to as fast as it will go, and from that point you need to have about one full bag. This is to help prevent a blood pressure drop.
- Many hospitals require your support person(s) to leave while it is being placed.
- Certain medical conditions or certain surgeries may prevent you from being able to receive an epidural, i.e. low platelets, herrington rods, previous back injuries. If you have any known conditions, talk to your provider long before labor- you may need to have an anesthesia consult.
- The goal of the epidural is to relieve 70% of your pain. Most people feel little to nothing. And as labor progresses, you may feel pressure. Pressure is good! It makes it a little easier to push.
- The epidural can prolong pushing time. First time moms may push for up to 3 hours with the epidural.
- Your nurse may insert a Foley catheter into your bladder after the epidural is in place, because you will not be able to pee.
- If you require a C-Section after the epidural is placed, then you're in luck! Your anesthesia is already in place. Anesthesia will give an extra dose, and then of course your doctor will test to make sure everything is working as it should.
- With epidural, if you feel pain, pressure, or feel like you need to have a bowel movement, you need to notify your nurse. You also need to notify her if your hands become numb, you have difficulty breathing, or are unable to swallow- these indicate a problem with the epidural.
- The epidural can take anywhere from one to four hours to wear off after it is turned off.
I hope that this helps those of you that are unsure make a decision that is right for you.
I also want to encourage everyone to be open to everything, such as if you want nothing for pain and the pain because too much to bear, then take something IV, or even the epidural. I also would like to remind those who want an epidural- sometimes babies are in a hurry to get here, so there is always a risk of not having time to get it.
If you are unable to follow the path that you desire, don't feel like you failed! The ultimate goal is to have a healthy baby and a healthy mom.