Pain Management in Labor

Babies

Childbirth is a very personal experience.  First you need to choose a health care provider (nurse-midwife or physician) that will help guide you along the way including how to manage your childbirth discomfort.  When choosing between a medicated or a natural birth option, education will help you to know what to expect and how to cope with the labor forces.  Childbirth is physically and emotionally demanding.  Preparedness is key.

For those having their first baby, attending a childbirth class is encouraged.  There are several different types of classes.  One option is a hospital sponsored class which reviews childbirth, hospital procedures and focus on birthing with medication or an epidural.  There are also private classes that encourage different types natural childbirth.  One type is hypobirthing, using a program of self hypnosis and education to prepare for the experience.  A second is the Bradley method, focusing on breathing and relaxation techniques with a birth coach directing the relaxation and comfort of the laboring woman.  Education is fundamental in the birthing process.  Education can help alleviate much of the fear and anxiety and allow for a more positive birth experience.

Medicated Childbirth

Epidurals are very common pain relief during childbirth.  Epidurals are not given until a woman is in active labor, usually after 4 centimeters dilated.  An injection is made into the middle of the woman’s back and a catheter is threaded into the epidural space (not the spinal column.)  An intravenous bag of an anesthetic is dripped into the catheter supplying continuous anesthetic medication providing abdominal and lower leg numbness.   While epidurals give great pain relief there are some risks.  The epidural causes smooth muscles to relax including blood vessels, this can cause a sudden drop in blood pressure.  If this happens,  IV fluids and sometimes a medication to restore blood pressure is administered.  The uterus is also a smooth muscle and this relaxation may cause contractions to decrease.  Stimulation with pitocin is often necessary to restart your labor.  Many times the bladder is also anesthetized and will need to be drained with a catheter.  Due to relaxation effect, it may be harder to push the baby out.  The length of pushing may be longer and sometimes a vacuum extractor is used to help pull the baby out.

Another option for pain control is the use of narcotic medication.  Analgesics such as morphine and nubain can be administered by IV.  These medications can help diminish the contraction discomfort, reducing pain without losing consciousness.  The drugs promote relaxation in between contractions and help the laboring mother to feel more comfortable and in control during contractions.  If given in early labor, it may slow labor.  If given at the end of labor it may cause respiratory depression in the newborn.

Natural Childbirth

With natural childbirth, mom is not confined to the bed and may be out of bed walking, sitting on a birthing ball, or showering.  Kennedy Health System's maternity center features a Jacuzzi tub which uses water therapy to promote relaxation.  Being out of bed allows gravity to work with the contracting uterus to cause the baby's head to descend into the birth canal.  Being active and upright in labor encourages more effective contractions.   Massage and heat or ice packs are non medicated methods for relieving lower back discomfort.   Labor usually does not Last longer than 24 hours, with 1/3 of the time comprising of  contractions.  The other 2/3’s of labor is the resting period in between contractions.  Even if you opted for natural childbirth at first, if labor becomes prolonged or the pain is too great, medication or an epidural can be an option.

Remember the goal of the birth experience is a healthy baby and healthy mom.