Pain Relief
Many women, particularly first-time mothers, find that the excitement about their baby’s birth is overshadowed by worry about pain during labor. Labor invariably involves pain, but you can build up your confidence by preparing for the intensity of contractions, by understanding your own limits of pain tolerance, and by learning about different methods of pain relief. If you can, think of the pain in a positive way-each contraction brings the birth of your baby closer.
COPING WITH PAIN
The kind of pain you’ll experience during contractions varies from woman to woman. Very often, it feels like a thick band being squeezed around your abdomen as the uterine muscles harden and tighten for a few seconds before relaxing. Some women describe it as being like severe menstrual cramps, others feel a backache, but there may be a combination of sensations as the contraction reaches its peak, culminating in a wave of discomfort, which then subsides.
Individual response You may prefer not to use drugs during labor because they can dim your awareness of what’s happening and deprive you of the sensation of giving birth. It’s difficult, though, to know your own pain threshold, particularly if this is your first baby. Some women are surprised by the overpowering intensity of their contractions; for others, the pain may be made worse by fear and anxiety.
Pain relief in childbirth can be complete, as in epidural anesthesia, or or it can reduce pain to bearable levels as with gas and air and narcotics. Many women choose to have no drugs in the early part of the first stage. Don’t blame yourself if you want some pain relief with drugs-it isn’t a sign of cowardice. Your labor isn’t a test, and the use of drugs may even be essential for you to deliver your baby.
If you haven’t made up your mind about the use of painkillers, you may want to go without drugs for as long as possible. If so, a useful tip is to wait 15 minutes after you feel you want pain relief before actually having it. During that time, your labor may progress well, and it gives you and your birth partner time to discuss whether or not you can get by with encouragement, or whether you really do feel the pain is increasing to the point where you need some relief.
If you want to participate fully in your baby’s birth without dimming your consciousness of the feelings involved, there are alternatives to drugs for pain relief. Also, your body can provide; its own brand of painkiller and relaxant, endorphins. The morenatural your labor, the more quickly your own endorphins will be produced and your pain threshold increased.
A clear choice Find out as much as you can about the types of pain relief available. Talk to your doctor, midwife, and hospital staff, and outline your choices in your birth plan. Have an alternative version ready in case any complications arise.
Many doctors and midwives want to make labor and delivery as pain-free as possible with the help of drugs, but you have the final say in whether or not to use pam rehef, so do make your preferences clear. Don’t hesitate to question the use of drugs, or ask your healthcare provider’s advice.
PAIN-RELIEVING DRUGS
Some types of pain relief will only be available in large or teaching hospitals; others are available in all hospitals and birthing centers.
Regional anesthetics These remove feeling from part of your body by blocking the transmission of pain from nerve fibers. There are several different sorts. Caudal anesthesia is given by an injection into your spinal area around the sacrum, and numbs your vagina and perineum. This may be used for short-term relief if you need to have a vacuum extraction or forceps delivery.
For a pudendal block, anesthesia is injected straight into your vagina near the pelvic region, blocking the pudendal nerve. This numbs the lower part of your vagina, and may be given if you have an episiotomy, although it isn’t used often.
Most widely used is the epidural block. This prevents pain from spreading beyond your uterus by acting as a “nerve block” in your spine. A well-managed epidural removes all sensation from your waist to your knees, but you remain alert. Doctors may recommend an epidural if you have a difficult labor, preeclampsia, or severe asthma, if you have a forceps delivery, or if you have complications while delivering twins. Most mothers who have a cesarean now have an epidural instead of a general anesthetic so they’re awake during the birth. First of all, you’ll be given a local anesthetic in your back to numb the area for the injection. The anesthetist then inserts a fine, hollow needle into the epidural space and a thin tube known as a catheter is threaded down inside the hollow needle. The needle is removed, leaving the catheter in position. The catheter is then taped firmly in place. Anesthetic is syringed down the catheter, which is then sealed, although it can be topped off if necessary. If you do want to have an epidural, you need to let the hospital know in advance since it has to be given by a skilled anesthetist, and usually takes 10-20 minutes to be set up. The anesthetic takes effect within a few minutes.
Narcotics The most commonly used is meperidine, a morphinelike drug. It’s given by injection in your thigh or buttock, or via intravenous drip if you have one in place, in varying dosages during the first stage, and it dulls the pain by acting on the nerve cells in your brain and spine. If you choose to take a narcotic, your doctor will start with a lower dose and raise it as needed. It is usually given with an antihistamine to reduce nausea. Narcotics usually take about 5-10 minutes to work and last 3-4 hours.
RELIEF WITHOUT DRUGS
Make sure you know as much as you can about your chosen painrelief method, and you’ve shown your birth coach the technique, before you go into labor. If you need any special equipment, make sure it will be available in the hospital. One method on its own may not be enough-you may need a combination for more complete relief.
Positions Walking around, leaning against your partner or the wall, and rocking your pelvis will probably feel much more comfortable than lying on your back. There are some positions that may feel more comfortable than others, since they relieve the pressure on your back.
Massage This is a wonderful way of relieving discomfort, whether you’re lying, standing, or squatting, and it’s greatly reassuring. It’s particularly good if you have a backache in labor, as about 90 percent of women do, or if you suffer from a backache labor. Your partner will need to practice the technique beforehand.
Water Lying in warm water can be very relaxing and soothing. When in water, you’re virtually weightless, and this brings relief between contractions. More and more mothers are using birthing pools under supervision and many hospitals are installing the facility. If you want to use a birthing pool, check early on in your pregnancy so that you can be sure one will be available.
Visualizing Creating images in your mind can be a very effective way of calming fear and reducing pain. As your contraction begins, imagllle something that you find particularly soothingfor example warm, bright sunshine. Contractions in the first stage are opening your cervix and you may find the image of a bud of your favorite flower opening very slowly, petal by petal, helpful. Many women find thinking about ocean waves comforting, matching the flow of the waves with their own contractions.
Sounds You may find it helps to diffuse the pain and anxiety of labor if you make different sounds. Sighing, moaning, groaning, and grunting are all ways of releasing tension-don’t feel inhibited about the noise you make, or worry too much about disturbing others.
Many women find that listening to music is helpful. Your partner can play different pieces on a portable player, according to how you’re feeling. Light, uplifting music may help you rise above your contraction. When your contractions intensify, more dramatic music, building to a crescendo, may help you cope.
Hypnosis This isn’t something to try on a whim, as you need to be able to respond to hypnosis very easily. Women who go into a deep trance have been able to have a forceps delivery, stitches, or even a cesarean without feeling pain. You’ll need to have some practice sessions, and both you and your hypnotist should be completely familiar with what you’ll have to do during your labor and delivery.
Acupuncture Only choose this method if you’ve already found that it can relieve pain in other situations. You’ll also need an acupuncturist who’s familiar with labor and delivery. Acupuncture treatment may not completely relieve pain, but it will certainly reduce it, and also helps to stop nausea.
TENS (Transcutaneous Electrical Nerve Stimulation.) In this technique, pain impulses conducted by nerves are blocked by an electric current, which also stimulates the production of the body’s own endorphins. You have a battery-powered stimulator that’s connected by wires to electrodes placed on either side of your spine. You’ll be given a handset that regulates the amount of stimulation, allowing you to control the amount of pain-relief that you receive. If you’re interested in this, ask your midwife or obstetric physiotherapist well in advance if the TENS method is available at your hospital.
Hospital Birth
Even though more and more women are choosing to deliver their babies in birthing centers, most babies are born in a hospital. The majority of women opt to give birth in a hospital, either because they are encouraged to do so by their medical advisers or because it’s their preference. Most hospitals are now paying much more attention to the mother’s wishes, so there’s no reason why you shouldn’t enjoy giving birth to your baby in a hospital setting.
WHAT TO EXPECT
The hospital surroundings will be unfamiliar, and this can make you feel anxious, but here are some tips to help you make yourself more comfortable. You’ll probably have been told to leave all valuables at home, but when you get to the hospital, you may be asked to remove any remaining personal items such as jewelry. If this worries you, ask if you can keep your personal belongings with you in a bag. If you wear contact lenses, ask about the hospital’s policy beforehand-they may prefer you to bring your glasses instead.
After admission When you arrive at the hospital, you’ll need to go through brief hospital admission procedures. Your midwife or doctor will ask you about how your labor is going-how often you’re having contractions and whether your water has broken, for example. Then she will examine your abdomen to confirm the situation, feel your baby’s position, and check your baby’s heart. Your blood pressure and temperature will be taken, and you’ll be given an internal examination to see how far your cervix has dilated. They will probably ask you to wear a fetal monitor for about 20 minutes, but afterward you should be able to move around as much as you wish.
Giving birth If you’ve decided that you prefer to manage without drugs for as long as you can during labor, the midwives will usually be more than happy to help you cope using other methods of pain relief. Bear in mind, though, that drug relief is available if you want it, and you can ask to start with smaller doses if you don’t feel you need the full measure.
Once your baby is descending, you may be helped into a semireclining position. If you’re in any danger of tearing, you may need to have an episiotomy when your baby’s head is crowning. If forceps have to be used, an episiotomy is more likely. Your baby will be delivered onto your abdomen, and while you take your first look at each other, you’ll be given an injection of Syntometrine into your thigh. This is to make sure that your uterus will contract firmly, reducing the chance of severe bleeding after the delivery of the placenta. Your baby will then be given the Apgar tests while you are cleaned up. If you need to have stitches, these are usually done at this point, either by the midwife or the doctor.
THE ADVANTAGES
For some mothers, a hospital birth gives the best chance of a successful and happy outcome. Having your baby in the hospital is the safest option if you suffer from a medical condition such as heart disease or diabetes, if you’re expecting twins, if your baby is known to be breech, or if, as a first-time mother, your obstetrical history just presents too many unknown factors.
Should anything go wrong during the labor and birth, emergency medical assistance is on hand right away, and there’s a wide range of pain-relief medication readily available should you want it. You may feel happier knowing that your baby can be given treatment in an intensive care unit if the need arises.
By staying in the hospital after the birth, you may get more rest than you would at home, especially if you have other children.
THE DISADVANTAGES
Once you’re in the hospital, it’s easy to feel overpowered by the atmosphere, although some are getting more relaxed about childbirth. Bear in mind that hospital staff have to follow rules and routines, and you’re going to have to fit in with them. But that doesn’t mean that you should have to do anything you aren’t happy about. Your partner may feel a bit awkward and separate from the birth of his child, so try to include him in whatever way you can. It helps to find out as much as you can about the hospital procedures and setup beforehand so that you’re more prepared once you go into labor.
Up to 40 weeks
It can be hard to calculate the exact date of conception, although most women have their fertile time about 14 days after the first day of their menstrual period. Because of this, doctors use an artificial but convenient time scale of 40 weeks, calculated from the date of your last menstrual period. A baby actually reaches “full term,” meaning it’s fully developed, after about 38 weeks.
Your Baby’ s Progress
During this month your baby will usually shed most of the lanugo (fine hair) from his body. There may be some small patches left in odd places and perhaps some in his body creases. His skin is smooth and soft, and there is still some vernix caseosa left on it (mostly on his back), which will help his passage down canal. He’ll be almost chubby before birth. His fingernails are long and may have scratched his face-they’ll need after birth. His eyes are blue, although they may change in the weeks after birth. When he’s awake, his eyes are open. In these last weeks, your baby produces increasing amounts of a hormone called cortisone from his adrenal glands. This helps his lungs to mature and prepare for his first breath.
Meconium Your baby’s intestines are filled with a dark green, almost black, substance called meconium. This is a mixture of the secretions from his alimentary glands together with the lanugo that’s been shed from his body, pigment, and cells from the wall of his bowel. It’ll be the first bowel motion he’ll pass after birth, but he may pass it during delivery.
Immune system His own system is still immature, so to make up for this he receives antibodies from you via the placenta. These protect him against anything that you have antibodies for, such as flu, mumps, and German measles. After he’s born, he’ll keep getting antibodies from you via your breast milk.
His Support System
The placenta now measures 8-10 inches (20-25 cm) in diameter and is just over an inch (3 cm) thick, thus creating a wide area for the exchange of nourishment and waste products between your system and your baby’s. There’s now more than a quart (liter) of water in the amniotic sac.
The hormones made by the placenta are stimulating your breasts to swell and fill with milk. This also causes swelling in your baby’s breasts, whether it is a boy or a girl. This will go down after birth. If your baby is a girl, the stopping of these same hormones following delivery may cause her to have a light bleeding from her vagina (like a period) a few days after her birth.
Up to 34 weeks
Thirty-four weeks after your last period, your baby is perfectly formed. All her proportions are exactly as you’d expect them to be at birth. She still has some maturing to do, though, and some more weight to gain before she’s ready to be born.
Your Baby’s Progress
Her organs are now almost fully mature, except for her lungs. These aren’t yet completely developed, although they’re making increasing quantities of surfactant, the fluid that will stop them from collapsing once she begins to breathe air. She makes strong movements that can be felt on the surface of your abdomen. Almost all babies born at this time survive.
Her skin, nails, and hair Her skin is now pink rather than red, because of the deposits of white fat underneath it. Fat deposits , build up under her skin to provide energy and regulate her body temperature after she’s born. The protective vernix caseosa that covers her skin is now very thick. Her fingernails now reach the ends of her fingers but her toenails are not yet fully grown. She may have quite a lot of hair on her head.
Her eyes Her irises can now dilate and contract. They’ll contract response to bright light, and also to allow her to focus, although she won’t need to develop this skill until after she’s born. She can close her eyelids, and she has begun to blink.
Her position Some babies take up the head-downward position about now, but there’s still plenty of time-most don’t engage until after 36 weeks. She may remain in the breech (bottomdown) position until birth, although most babies do turn on their own.
Her Support System
From this month the placenta layers may start to thin. To make estrogen, the placenta converts a testosterone-like hormone that’s made by your baby’s adrenal glands. By this month these glands are as big as those of an adolescent, and every day they produce 10 times as much hormone as an adult’s adrenal glands. They’ll shrink rapidly after birth.
The amniotic sac, or bag of waters, contains a large amount of fluid, most of which is the baby’s urine-she can produce as much as a pint (half a liter) of urine every day. Excess vernix caseosa, nutrients, and products necessary for the maturing of the her lungs are also in the amniotic sac. The umbilical cord is large, strong, and tough. A firm, gelatinous substance surrounds the blood vessels and prevents kinks or knots in the cord that could affect your baby’s blood supply.
Up to 30 weeks
Your baby’s now so big that when your or midwife examines you, they can check position and the way he’s lying. This is the month he can do a somersault.
Your Baby’s Progress
Great changes take place in your baby’s nervous system this month. His brain grows larger (to fit inside the skull it has to fold over and wrinkle up until it looks like a walnut), and his brain cells and nerve circuits are all fully linked and active.
Also, a protective fatty sheath begins to form around his nerve fibers, just as a similar sheath formed earlier around his spinal cord. This fatty sheath keeps developing until early adulthood. Thanks to this, nerve impulses can travel fasten and your baby is now able to cope with more complex type of learning and movement.
Your baby starts getting ready for birth. (If he were to be born prematurely at tlais stage, he’d have an excellent chance of survival. Even though he might have some breathing problems and difficulty in keeping himself warm, modern care facilities would help him thrive.) He’s beginning to gain some fat underneath his skin, which starts to smooth out, lose its wrinkles, and look more rounded. His coat of hairy lanugo may reduce to just a patch on his back and shoulders. The membranes that sealed and protected his eyes while they were growing will have fulfilled their function by the beginning of this month. His eyes are now fully formed and his eyelids have separated, allowing his eyes to open. He continues to develop the swallowing and sucking skills he’ll need as soon as he’s born.
His breathing - By now he’s developed his mature breathing rhythm, and the air sacs in his lungs start to get ready for the first breath he’ll take in the world outside your womb. The air sacs line themselves with a coating of special cells and a fluid (surfactant) that will prevent them from collapsing.
His movements - He’ll find he has less room to move around and may move less. He’ll wriggle uncomfortably if you’re in a position that doesn’t feel good to him.
Orientation - During his weeks of “gymnastics practice,” your baby has done more than increase his muscle tone-he’s developed the ability to position himself in space. He’ll probably continue to lie with his head upward during this month, although if he’s maturing fast he may turn upside down and settle into place for delivery (engage) earlier than usual. This is more common in first babies. Babies can continue turning up to 36 weeks.
Up to 26 weeks
Your baby is growing taller and stronger; and her movements are becoming more complex. She’s also showing signs of sensitivity, awareness, and intelligence. A baby born after 24 weeks of pregnancy could survive with specialized intensive care in a neonatal unit.
Your Baby’s Progress
She’s still red and skinny, but she’ll soon start to put on weight. Her skin may look very wrinkled, but this is because she doesn’t yet have much fat to plump it out. Her body is growing faster than her head, and by the end of this month her proportions are about the same as those of a newborn. Her arms and legs have their normal amount of muscle, her legs and body are, in proportion, and her bone are beginning to harden in the center. Lines start to appear on the palms of her hands. The brain cells she’ll use for conscious thought now start to mature, and she begins to be able to remember and learn. (In one experiment, babies in the womb were trained to kick in reponse to a particular vibration.)
The genitals of a boy and girl look completely different by this time; if your baby is a boy, testosterone-producing cells in the testes increase in number.
Her hearing Your baby can hear sound frequencies that you can’t hear. She’ll move more in response to high frequencies than to low ones and she’ll move her body in rhythm with your speech. From this month she will begin to respond to drum beats by jumping up and down. Some mothers say they’ve had to leave concerts because their unborn babies wouldn’t keep still.
If she hears a piece of music often, she may realize it’s familiar to her when she grows up - even if she can’t remember ever dat hearing it. Some musicians have said that they “knew” unseen pieces of music, and later found out that their mothers played the these to them while they were in the womb.
She’ll also learn to recognize her father’s voice from this month onward. A baby whose father talks to her while she’s in the womb can pick out her father’s voice in a roomful of people immediately after she is born. She’ll respond to it emotionally. For example, if she’s upset, she’ll stop crying when she hears her father talking and calm down.
Her breathing Inside her lungs, more and more air sacs are forming. They’ll continue to increase in number until she’s about eight years old. Around them, the blood vessels that will help her to absorb oxygen and expel carbon dioxide are multiplying. Her pair nostrils have opened, too, and she’s beginning to make breathing movements with her muscles, so that her system has plenty of breathing practice before she’s born.
Up to 22 weeks
By this time your baby has grown enough to have developed a nervous system and muscles that allow him to move around in your womb. Because he’s still so small, he can swim up and down and be in any position at any time.
Your Baby’s Progress
Up until about 19 weeks after your last period, your baby grows very rapidly. Now this growth rate slows down, apart from his weight gain, and he matures in other ways. He begins to build up his defense systems.
A sheath begins to form around the nerves in his spinal cord to protect them from possible damage. He also has his own primitive immune system, which will help to defend him from some infections. To make body heat and keep up his temperature, your baby needs some specialized fatty tissue. This is provided by a substance called “brown fat,” which began to form during the fourth month. Now, deposits of brown fat begin to build up in areas of his body such as his neck, chest, and crotch. This will continue until term. One of the reasons that premature babies are so vulnerable is that they don’t yet have enough brown fat, and so cannot keep themselves warm.
His skin will continue to grow, although it’ll be red and wrinkled because there’s so little fat underneath it. His body begins to get plumper from now on. The sebaceous glands (oil-producing glands in the skin) become active and make a waxy, greasy substance called vernix caseosa. This protects his skin during its long immersion in the amniotic fluid.
Your baby’s body is also covered with fine hair called lanugo. Nobody is quite sure why babies have this hair, but it may help to regulate the body temperature, or it may help hold the protective vernix caseosa in place.
His movements As his nerve fibers become connected and his muscles continue to develop and grow stronger, his movements become more purposeful and coordinated. He embarks on his own gymnastics program-stretching, grasping, turning-to build up his muscles, improve his motor ability, and strengthen his bones. These movements can make your abdomen sore.
Sex organs A boy’s scrotum is solid at this stage. A girl’s vagina starts to become hollow and her ovaries contain about seven million eggs, which will be reduced to about two million at birth. By the time she reaches puberty, she’ll have between 200,000 and 500,000 eggs, and she’ll release only 400-500 of these during her adult life-around one per month until menopause. Nipples and underlying mammary glands develop in both sexes.
Up to 18 weeks
The second trimester starts from the fourteenth week of pregnancy. Your baby is steadily growing, and if you have a scan now, it’ll be possible to tell your baby’s sex. If your doctors think it necessary, they may suggest you have various tests around this time to rule out any abnormalities.The length of your baby’s thighbone will be measured, as well as the diameter of her head. The head measurement will be used to confirm the EDD.
Your Baby’s Progress
She’s looking more human now, with legs longer than her arms and the parts of her legs in proportion. Her skeleton continues to produce more bone, and those parts with sufficient calcium can be seen on X-rays. She now has the same number of nerve cells as an adult. The nerves from her brain begin to be coated in a layer of myelin (protective fat). This is an important step in their maturation because it helps the passage of messages to and from the brain. Connections between nerves and muscles are set up so that your baby’s well-formed limbs can move around their joints when the muscles are stimulated to contract and relax. Now that her arms are long enough, her hands can grasp each other if they touch accidentally, and she can form fists. Her movements aren’t yet under the control of her brain, though. Nor do you notice them yet because she’s not big enough to activate nerve endings on your uterine wall. Second-time mothers tend to feel their baby’s movements sooner.
Your baby’s external genital organs are taking on a more distinctive appearance. A girl’s vaginal plate, the beginnings of her vagina, is clearly developing, and a boy’s testes are well on their way to descending into the scrotum.
Her Support System
The placenta is making the increasing amounts of hormones (chorionic gonadotrophin, estrogen, and progesterone) that are needed throughout pregnancy. It’s also making an assortment of other hormones that keep your uterus healthy and play an essential part in the growth and development of your breasts in preparation for feeding your baby. The placenta forms a barrier against general infection, although not against viruses such as rubella (German measles) and AIDS, and poisons such as alcohol and nicotine. By the end of the sixteenth week, the placenta has grown in thickness to about half an inch (1 cm) and three-and-ahalf inches (7-8 cm) across.
The placenta continues to grow until, at term, it weighs a pound (500 g), and measures an inch and a half (3 cm) thick and 8-10 inches (20-25 cm) across. It’s firmly attached to the uterine wall (usually the upper part).
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