Help for Labor Pain
If you're like most women, the pain of labor and delivery is one of the things that worry you about having a baby. This is certainly understandable, because labor is painful for most women.
It's possible to have labor with relatively little pain, but it's wise to prepare yourself by planning some strategies for coping with pain. Planning for pain is one of the best ways to ensure that you'll stay calm and be able to deal with it when the time comes.
Pain During Labor and Delivery
Pain during labor is caused by contractions of the muscles of the uterus and by pressure on the cervix. This pain can be felt as strong cramping in the abdomen, groin, and back, as well as an achy feeling. Some women experience pain in their sides or thighs as well.
Other causes of pain during labor include pressure on the bladder and bowels by the baby's head and the stretching of the birth canal and vagina.
Pain during labor is different for every woman. Although labor is often thought of as one of the more painful events in human experience, it ranges widely from woman to woman and even from pregnancy to pregnancy. Women experience labor pain differently — for some, it resembles menstrual cramps; for others, severe pressure; and for others, extremely strong waves that feel like diarrheal cramps.
It's often not the pain of each contraction on its own that women find the hardest, but the fact that the contractions keep coming — and that as labor progresses, there is less and less time between contractions to relax.
Preparing for Pain
To help with pain during labor, here are some things you can start doing before or during your pregnancy:
Regular and reasonable exercise (that your doctor says is OK) can help strengthen your muscles and prepare your body for the stress of labor. Exercise also can increase your endurance, which will come in handy if you have a long labor. The important thing to remember with any exercise is not to overdo it — and this is especially true if you're pregnant. Talk to your doctor about what he or she considers to be a safe exercise plan for you.
If you and your partner attend childbirth classes, you'll learn different techniques for handling pain, from visualization to stretches designed to strengthen the muscles that support your uterus. The two most common childbirth philosophies in the United States are the Lamaze technique and the Bradley method.
The Lamaze technique is the most widely used method in the United States. The Lamaze philosophy teaches that birth is a normal, natural, and healthy process and that women should be empowered to approach it with confidence. Lamaze classes educate women about the ways they can decrease their perception of pain, such as through relaxation techniques, breathing exercises, distraction, or massage by a supportive coach. Lamaze takes a neutral position toward pain medication, encouraging women to make an informed decision about whether it's right for them.
The Bradley method (also called Husband-Coached Birth) emphasizes a natural approach to birth and the active participation of the baby's father as birth coach. A major goal of this method is the avoidance of medicines unless absolutely necessary. The Bradley method also focuses on good nutrition and exercise during pregnancy and relaxation and deep-breathing techniques as a method of coping with labor. Although the Bradley method advocates a medication-free birth experience, the classes do do discuss unexpected complications or situations, like emergency cesarean sections.
Some ways to handle pain during labor include:
- massage or counterpressure
- changing position
- taking a bath or shower
- listening to music
- distracting yourself by counting or performing an activity that keeps your mind otherwise occupied
A variety of pain medications can be used during labor and delivery, depending on the situation. Talk to your health care provider about the risks and benefits of each.
Analgesics. Pain medicines can be given many ways. If they are given intravenously (through an IV) or through a shot into a muscle, they can affect the whole body. These medicines can cause side effects in the mother, including drowsiness and nausea. They also can have effects on the baby.
Regional anesthesia. This is what most women think of when they consider pain medication during labor. By blocking the feeling from specific regions of the body, these methods can be used for pain relief in both vaginal and cesarean section deliveries.
Epidurals, a form of local anesthesia, relieve most of the pain from the entire body below the belly button, including the vaginal walls, during labor and delivery. An epidural involves medicine given by an anesthesiologist through a thin, tube-like catheter that's inserted in the woman's lower back. The amount of medication can be increased or decreased according to a woman's needs. Very little medication reaches the baby, so usually there are no effects on the baby from this method of pain relief.
Epidurals do have some drawbacks — they can cause a woman's blood pressure to drop and can make it difficult to urinate. They can also cause itching, nausea, and headaches in the mother. The risks to the baby are minimal, but include problems caused by low blood pressure in the mother.
Tranquilizers. These drugs don't relieve pain, but they may help to calm and relax women who are very anxious. Sometimes they are used along with analgesics. These drugs can have effects on both the mother and baby, and are not often used. They also can make it difficult for women to remember the details of the birth. You should discuss the risks of taking tranquilizers first with your doctor.
Some women choose to give birth using no medication at all, relying instead on relaxation techniques and controlled breathing for pain. If you'd like to experience childbirth without pain medication, make your wishes known to your health care provider.
Things to Consider
Here are some things to think about when considering pain control during labor:
- Medicines can relieve much of your pain, but probably won't relieve all of it.
- Labor may hurt more than you anticipated. Some women who have previously said they want no pain medicine whatsoever end up changing their minds once they're actually in labor.
- Certain medications can affect your baby, causing the baby to be drowsy or have changes in the heart rate.
Talking to Your Health Care Provider
You'll want to review your pain control options with the person who'll be delivering your baby. Find out what pain control methods are available, how effective they're likely to be, and when it's best not to use certain medications.
If you want to use pain-control methods other than medication, make sure your health care provider and the hospital staff know. You might want to also consider writing a birth plan that makes your preferences clear.
Remember, too, that many women make decisions about pain relief during labor that they abandon — often for very good reason — at the last minute. Your ability to endure the pain of childbirth has nothing to do with your worth as a mother. By preparing and educating yourself, you can be ready to decide what pain management works best for you.
Choosing an epidural
Gone are the days when women had no choice but to endure labor and delivery without medication to ease the pain. Now, techniques like epidurals can make an otherwise painful experience more calm, controlled, and even comfortable.
Of course, many women hope to get through childbirth without having to ask for medications. But once labor starts, it's common — and completely understandable — for a woman to change her mind and request some sort of relief to make things easier or, at least, more bearable. No matter how prepared you are, physically and mentally, giving birth is hard.
Whether you've known from day one that you'd be asking for an epidural or have your heart set on a medicine-free birth, here's the lowdown on epidurals and how they can take some of the pain out of labor and delivery.
What's an Epidural?
An epidural (sometimes called an epidural block) is what most women think of when they consider pain medication during labor. Epidurals are a form of regional anesthesia that provide continuous pain relief to the entire body below the belly button (including the vaginal walls) throughout labor and delivery. With an epidural, a woman is comfortable and still fully awake.
How Is It Done?
An epidural involves medication given by an anesthesiologist through a thin, tube-like catheter that's inserted in the woman's lower back and then into the area just outside the membrane covering the spinal cord (called the epidural space). You'll need to sit or lie on your side with your back rounded while the doctor inserts the epidural.
The amount of medication can be regulated according to your needs. As your labor progresses and you start to deliver, the anesthesiologist can administer medication as needed through the catheter in your back without having to reinsert any needles.
What Will It Feel Like?
The thought of a big needle going into your back can be downright unnerving. But contrary to what many women may think, getting an epidural doesn't hurt that much at all. The skin is numbed first, so you'll probably feel just a stick or pinch and some pressure. Of course, you may be aware of the catheter in your back, which can be annoying for some women, but it isn't painful or uncomfortable.
Once the epidural is in place, you may still feel the pressure of contractions, although you shouldn't feel the pain. Actually, being aware of your contractions, if even a little, helps once you start to push.
As the doctor adjusts the dosage, your legs may feel a little weak, warm, tingly, numb, or heavy. Unlike some other labor and delivery medications, epidurals don't affect your mind. You'll still feel alert and aware of what's going on.
How Long Will It Take?
It only takes a couple of minutes to insert an epidural. You should start to feel the effects in about 10 to 20 minutes. The epidural catheter will stay in place throughout your labor and delivery.
What Are the Risks?
Epidurals do have some drawbacks. They may:
- make it harder for a woman to push the baby out (although the anesthesiologist can adjust the amount of medication being given if this happens)
- cause the mother's blood pressure to drop
- cause a headache
- cause temporary difficulty with urination, requiring a urinary catheter
- very rarely cause bleeding
Although some studies suggest that epidurals may increase the chances of cesarean deliveries (C-sections) or vaginal deliveries that require forceps or vacuum extractions, others show no correlation. It's not clear if the surgery or assisted delivery were needed because of the epidural or if the epidural and the surgery or assisted delivery were both needed because of some underlying problem.
How Will It Affect My Baby?
Some epidural medication does reach the baby, but it's much less than what the little one would get if the mother is given pain medications through an IV or if she is given general anesthesia. The risks of an epidural to the baby are minimal, but include possible distress (such as a slow heartbeat) caused by the mother's lowered blood pressure.
What Will I Feel Like After Delivery?
If you have an epidural, you may shiver a little after the baby is born (which is common with or without an epidural). You might feel some numbness in your legs and tingling as the medication starts to wear off, which may take a little while. That means you may not be able to walk around for at least a few hours after the birth. Even after that, ask someone to help you until your legs feel back to normal. If you had a C-section, the doctor may continue the epidural for a while after the delivery to control any pain.
You may also have some soreness in your back for a few days from where the epidural was inserted. Very rarely, women who get epidurals may have very bad headaches after the birth.
What Other Medications Can Help?
Epidurals aren't the only way medication can help you deal with the pain and stress of labor and delivery.
Also injected into the lower back through a catheter, a spinal block provides faster pain relief with smaller doses of medication. However, a spinal block only lasts for up to 2 hours, so it may be given during the actual delivery rather than during labor.
Some women may get a combined spinal-epidural (or CSE) block, which is, at its name implies, a combination of a spinal block and epidural that can offer faster pain relief that can then be continued throughout labor. This is often called a "walking epidural" because it allows some women to walk around once it's inserted since it has less of an effect on muscle strength. Walking can be possible with other techniques as well, depending on the medications used.
Another option for pain relief is a nerve block, which is given as an injection and deadens the sensation in specific, smaller areas of the body (such as the vagina and perineum — the area between the vagina and anus).
Analgesics are pain medications that can be administered through an IV or as a shot given as needed. Tranquilizers can be given through an IV to relax anxious women. Tranquilizers do not relieve pain, however, and can have significant side effects. If medications are given through an IV, the baby's going to get those medications, too.
Talk to your doctor about the various medications available and how they could affect you and your baby. If you're interested in getting an epidural, let your doctor know as soon as you decide, and check to see how early and how late in your labor it will be possible for you to get one.
Although many women want to give birth without any pain medications, it isn't a sign of weakness if you decide to ask for something to ease your pain or anxiety. Childbirth is often one of the hardest, most painful things the human body can go through. Getting a little relief makes you no less of a mother or woman. You know your body better than anyone — only you can be the judge of how much pain you can or can't take.
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