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.