Mayo Clinic Guide to a Healthy Pregnancy: From Doctors Who Are Parents, Too!

CHAPTER 23. Pain relief during childbirth

What type of pain management is best during labor? The answer to that question largely depends on your preferences and on how your labor progresses. No two women have the same tolerance for pain. No two labors are exactly the same. Some women need little or no pain medication. Others find that pain relief gives them a better sense of control over their labors and deliveries. Ultimately, you need to choose what’s right for you.

The decision of whether to use medication during labor and delivery is yours. However, you should take into account your care provider’s recommendations, what’s available at your hospital or birthing center, and the specific character of your labor.

Sometimes you won’t know what kind of pain relief you want until you’re in labor. Each woman’s labor is unique to her. In addition, your capacity to deal with pain during childbirth can be affected by factors such as the length of your labor, the size and position of your baby, and how rested you are as labor begins. No one can predict how you’ll cope with the pain of your first labor, and subsequent labors often don’t follow the same pattern.

Before that first contraction kicks in, it’s a good idea to think about the method, or methods, of pain relief you might prefer. It may also be helpful to discuss your preferences with your care provider. Whatever birth plan you ultimately devise, keep an open mind about it. Labors often don’t go according to plan.

In addition, when making your decision, keep in mind that birth isn’t a test of endurance. You won’t have failed if you ask for pain medication.

ISSUES TO CONSIDER

To help you choose the pain relief method or methods that are right for you, keep these questions in mind as you review your options. Ask yourself:

 What’s involved in the method?

 How will it affect me?

 How will it affect my baby?

 How quickly will it work?

 How long will the pain relief last?

 Do I need to organize or practice the method in advance?

 Can I combine it with other pain relief methods?

 Can I use it at home before I go to the hospital?

 When during labor is the method available?

YOUR OPTIONS

Women have more options for managing the discomforts of childbirth than ever before. These options generally fall into two broad categories: pain medications and natural pain relief methods. Learning about your options ahead of time will help you make an informed decision about pain relief during labor and delivery.

Education itself is a form of pain relief. Fear, in addition to the discomforts of labor, dramatically worsens the pain. If you know what to expect during labor and delivery and you’ve reviewed your pain relief choices you’ll likely get through labor and delivery more smoothly than will someone who is tense and fearful.

Pain medications Medications to relieve pain are known medically as analgesics. Pain medications commonly used during labor come from the narcotics family of medications. In expert hands, they are very useful and quite reliable. The medications may given either by injection or intravenously. Depending on the types of drugs and doses used, medications given during childbirth can be used either to relieve pain (analgesia) or to remove sensation during cesarean birth (surgical anesthesia). Two examples of anesthetic techniques used in childbirth are epidural blocks and spinal blocks.

Natural methods Natural methods refer to labor and delivery techniques that don’t involve the use of pain medications. Natural pain relief methods take many forms, some dating back centuries. Relaxation and massage are two examples of pain relief options of natural childbirth.

PAIN MEDICATIONS

Pain medication can be a valuable tool during your labor and delivery. It helps reduce pain and allows you to rest between contractions.

You’re free to request or refuse pain medications during your labor and delivery, but remember that medications may have different benefits and risks at different times during labor. You always need to take into account the course and progress of your labor when choosing a pain relief method.

The stage of your labor at which you take certain medications is as important as the type of drug you take. A baby is affected by medication taken by the mother, but the extent of that effect depends on the type of medication, the dose and how close to delivery it’s administered. For example, if enough time passes between when you receive a narcotic pain medication and when your baby is born, your body will process the drug, and your baby will have minimal effects from the medication at birth. If not, the baby may be sleepy and unable to suck. Less frequently, the baby may experience breathing difficulties. Any such effects on the newborn are short-lived and can be treated, if necessary.

A care provider is with you during labor and delivery to ensure that your baby arrives safely and in good health. He or she is familiar with each medication option and can share this knowledge with you. Trust him or her to tell you when it’s safe — and when it’s not safe — to take medications during labor and delivery. Understand that you may not always be able to have a medication when you feel you need it.

Epidural block An epidural block is a regional analgesic or anesthetic that can be used during labor or before a cesarean section. The medication is injected into the lower back just outside the bag of fluid surrounding the spinal cord. It takes about 20 minutes to administer an epidural block and another 10 to 20 minutes for the medication to take effect.

Pros An epidural block alleviates most pain in your lower body without significantly slowing labor, and it’s safe for your baby. Medication slowly flows from the epidural pump through a catheter to provide continuous pain relief. You remain awake and alert while receiving the medication. By pressing a button, you may be able to give yourself small, additional doses of medication, if needed. A walking epidural is a combination of an epidural and a spinal injection that leaves you enough muscle strength to walk during labor. It is available in some medical facilities.

Cons An epidural may affect one side of your body more than the other. It may also decrease your blood pressure, which can slow the baby’s heart rate. Your care providers will monitor your blood pressure after epidural placement and treat low blood pressure, if necessary. Rarely, you may have a severe headache when you’re upright in the days after delivery. If an epidural is used during cesarean birth, the numbness it causes may affect your chest wall and for a while you may feel as if you’re having difficulty breathing. Because epidural anesthesia may block the ability to empty your bladder, you may need a catheter. You may want another procedure if the epidural doesn’t work as well as expected.

RECEIVING AN EPIDURAL BLOCK

To receive an epidural block:

·      1. You lie on your side in a curled-up position, or sit on the bed with your back rounded.

·      2. The doctor numbs an area of your back with a local anesthetic.

·      3. The doctor inserts a needle into the epidural space just outside the membrane that encloses the spinal fluid and spinal nerves.

·      4. A thin, flexible tube (catheter) is threaded through the needle, and the needle is removed. The catheter is taped in place.

·      5. The medication is injected through the catheter. The medication flows through the catheter to surround the nerves, blocking the pain.

Spinal block Spinal anesthesia is a regional anesthetic used shortly before a C-section or during active labor if delivery is expected within two hours. The medication is injected directly into the fluid surrounding the spinal cord in the lower back and takes effect quickly.

Pros A spinal block provides complete pain relief from the chest down for up to two hours. The medication is usually given only once. You’ll remain awake and alert.

Cons Similar to an epidural block, a spinal block may affect one side of your body more than the other, decrease your blood pressure — which can slow the baby’s heart rate — and cause a severe headache in the days after delivery. If the anesthesia affects your chest wall, you may temporarily experience a sensation of difficulty breathing, and because spinal anesthesia blocks the ability to empty your bladder, you may need a catheter.

Combined spinal epidural This is a newer technique that offers the rapid pain relief of a spinal block and the continuous relief of an epidural.

An anesthesiologist or nurse anesthetist carefully guides an epidural needle into your lower back. Then he or she places the narrower spinal needle inside the epidural needle (so you only need to be stuck once), guides it through the membrane surrounding your spine and injects a small dose of medication into your spinal fluid. The spinal needle is removed, but the epidural catheter remains.

In early labor, you rely primarily on the narcotics in the spinal injection for pain relief for the first hour or two. Then you have the epidural to fall back on once the spinal starts to wear off.

Narcotics Various narcotics may be injected into a muscle in your thigh or buttock or given through an intravenous (IV) catheter. If you have an IV, you may be able to control your dosage. The medication takes effect in minutes.

Pros Narcotics decrease the perception of pain for two to six hours. They promote rest without causing muscle weakness.

Cons Narcotics may cause sleepiness and temporarily depress breathing for you or the baby. Your baby may experience temporarily slowed reflexes as well.

Local anesthetic A local anesthetic doesn’t help with labor pain but may be used to numb the vaginal area if you need an incision to extend the opening of the vagina (episiotomy) or repair a tear after delivery. The medication is injected into tissue at the vaginal opening and takes effect quickly.

Pros Local anesthetics temporarily relieve pain in a specific area. Negative effects for mother or baby are rare.

Cons Local anesthetics don’t relieve the contraction pain. An allergic reaction is possible. Rarely, injecting the medication into a vein may decrease your blood pressure.

Pudendal block A pudendal block may be used shortly before delivery to block pain between the vagina and anus (perineum). A local anesthetic is injected into the vaginal wall, which takes effect in seconds.

Pros A pudendal block relieves pain in the lower vagina and perineum for up to an hour. Negative effects for mother or baby are rare.

Cons A pudendal block doesn’t stop the pain of contractions. The medication may affect only one side of the perineum. An allergic reaction is possible. If the medication is injected into a vein, it may decrease your blood pressure.

Tranquilizers Rarely, tranquilizers are used to relieve anxiety and promote rest in early labor. They may be given by mouth, injected into a muscle in your thigh or buttock, or given through an intravenous (IV) catheter. When injected or given intravenously, tranquilizers take effect in minutes.

Pros Tranquilizers relieve anxiety and promote relaxation for several hours or more.

Cons Tranquilizers don’t relieve pain. They may cause drowsiness, decrease your memory of labor, and decrease your baby’s muscle tone and activity at birth.

NATURAL METHODS

With natural methods, you forgo the use of drugs for pain relief and instead rely on other methods to lessen pain. Natural (nonmedicinal) methods of pain relief work in a variety of ways. They may stimulate your body to release its own natural painkillers (endorphins). These substances distract you from your pain, and they can soothe and relax you, allowing you to stay more in control.

Natural pain relief methods will help you manage pain, but they won’t stop it entirely. Before considering other options, many women will try nondrug measures first to relieve pain during labor.

Natural pain relief can be particularly useful both in early and active labor. It’s during transition, when your cervix opens (dilates) to a full 10 centimeters, and during pushing that women who choose natural methods typically feel the greatest discomfort.

Natural pain relief methods include breathing and relaxation techniques and many other methods.

Breathing techniques Breathing techniques, like other natural pain relief options, don’t involve drugs or require medical supervision. You’re in control. They involve the use of practiced, paced breathing during contractions.

Concentrating on your breathing helps distract you from the pain and relaxes your muscles so that tension, which heightens pain, is eased. Deep, controlled, slow breathing can also reduce nausea and dizziness. Most important, perhaps, concentrated breathing helps bring oxygen to you and your baby.

It’s best to learn about and practice breathing techniques before you go into labor. Breathing methods, such as Lamaze, are taught in most childbirth classes. Take your labor coach with you to class so that he or she can help you with the techniques during labor. The more you practice, the more natural it will be to use these methods once contractions begin.

Breathing exercises can work immediately, should you choose to use them. However, these methods aren’t always successful because they depend on your reaction to labor pain, which can’t be predicted, and on your ability to concentrate on something other than your labor pains. Breathing techniques can be combined with other types of pain relief.

Lamaze method Lamaze is a philosophy of childbirth and a breathing technique used in labor. The Lamaze philosophy holds that birth is a natural, normal, healthy process, and women can be empowered through education and support to approach childbirth with confidence.

Lamaze classes focus on relaxation techniques, but they also encourage you to condition (program) your body’s response to pain through training and practice. For example, you’re taught controlled breathing exercises, which are a more constructive way to deal with pain than are holding your breath and tensing your muscles.

Lamaze instructors teach expectant mothers to take a deep, cleansing breath to begin and end each contraction: Inhale through your nose, imagining cool, pure air. Exhale slowly through your mouth, imagining tension blowing away. The deep breath signals to everyone in the labor room that a contraction is beginning or ending and is a signal for your body to relax.

Different levels of Lamaze breathing are used in labor and delivery, as outlined below. When you’re using this method, start with the first breathing technique and use it as long as it works for you, then move on to the next level.

Lamaze level 1: Slow-paced breathing. This is the type of breathing you use when you’re relaxed or sleeping. Take in slow, deep breaths through your nose and exhale through your mouth at about half the speed of your normal rate. If you like, repeat a phrase with the breathing: “I am (inhaling) relaxed (exhaling),” or “In one-two-three (inhaling), out one-two-three (exhaling).” Or breathe in rhythm while walking or rocking.

Lamaze level 2: Modified-pace breathing. Breathe faster than your normal rate but shallowly enough to prevent hyperventilation: “In one-two (inhaling), out one-two (exhaling), in one-two (inhaling), out one-two (exhaling).” Keep your body, particularly your jaw, relaxed. Concentrate on the rhythm, which may be faster at the height of the contraction, then slower as it fades.

Lamaze level 3: Pattern-pace breathing. Use this type near the end of labor or at the height of strong contractions. The rate is a little faster than normal, as with modified-pace breathing, but now you use a pant-blow rhythm such as “ha-ha-ha-hoo” or “hee-hee-hee-hoo” that forces you to focus on the breathing rather than the pain. Repeat the pattern. Start slowly. Increase the speed as each contraction peaks and decrease as it fades. Keep in mind that when you increase the rate, the breathing should become shallower so that you don’t hyperventilate — if your hands or feet tingle, slow down. It’s possible to remove too much carbon dioxide from your body, which can lead to these symptoms. If moaning or making other noises helps, go ahead. Keep your eyes open and focused and your muscles relaxed.

Breathing to prevent pushing. If you feel the urge to push, but your cervix isn’t fully dilated and you must hold back, blow out tiny puffs with your cheeks — as if you’re blowing out birthday candles — until the urge to push passes.

Breathing for pushing. When your cervix is fully dilated and your care provider tells you to go ahead and push, take a couple of deep breaths and bear down when you feel the urge. Push for about 10 seconds. Exhale. Then take in another breath and push again. Contractions at this stage will last for a minute or more, so it’s important that you inhale at regular intervals and don’t hold your breath.

Your personal preferences and the nature of your contractions will guide you in deciding when to use breathing exercises in your labor. You can choose breathing techniques or even invent one on your own. Even if you plan on having pain medication during labor, it’s still important to learn breathing and relaxation techniques.

Relaxation techniques Relaxation is the release of tension from the mind and body through conscious effort. By reducing muscle tension during labor and delivery, you can short-circuit a fear-tension-pain cycle. Relaxation allows your body to work more naturally, helping you conserve energy for the work ahead. Relaxation and patterned breathing are mainstays of the self-comforting measures women use for labor. These methods and others are usually taught in childbirth classes.

Relaxation doesn’t mean fighting the pain, which would actually create more tension. It, instead, means allowing the pain to roll over you while you concentrate on tension-relieving and distracting exercises.

Relaxation is actually a learned skill and one that will be most effective if you practice it before the onset of labor. The more proficient you become at it, the more self-confident you’ll be during labor. Here are some tips for mastering self-relaxation:

 Choose a quiet environment to practice.

 Turn on soft music, if you want.

 Assume a comfortable position with pillows to support you.

 Use slow, deep abdominal breathing. Feel the coolness of the air as you breathe in. Feel the tension carried away as you breathe out.

 Become aware of areas of tension in your body and concentrate on relaxing them.

Progressive relaxation With this technique, you relax groups of muscles in a series between or during your contractions or at periodic times during labor when you feel yourself becoming tense. Beginning with your head or feet, relax one muscle group at a time, moving toward the other end of your body. If you have trouble isolating the muscles, first tense each group for a few seconds, then release and feel the tension melt away. Pay particular attention to relaxing your jaw and hands; many women unconsciously tense up their faces and make fists during contractions.

Touch relaxation This is similar to progressive relaxation, but your cue for releasing each muscle group is when your labor coach presses on that area of your body. He or she should apply firm pressure or rub using small circular movements for five to 10 seconds, then move on to the next spot. For example, your labor coach could start by rubbing your temples and then move on to touching the base of your skull, and then points on your back and shoulders, your arms and hands, and finally, your legs and feet.

Massage During labor, various massage techniques may help relax you. These techniques may include light or firm rhythmic stroking over your shoulders, neck, back, abdomen and legs; firm kneading, friction or pressure on your feet and hands; or a fingertip massage of your scalp.

Massage can soothe aching and tense muscles, as well as stimulate your skin and deeper tissues. It can be used at any time during labor. If done properly, the effects of massage can last for a considerable time. In addition to encouraging relaxation, massage blocks pain sensations. Some women feel most of the pain of labor in their backs, and for them a back massage given by a labor coach can really help. You may find yourself requesting that your labor coach push hard on your lower back, because counterpressure can be a very effective natural pain relief method for back labor.

Before labor, you and your labor coach may want to work together to establish the kinds of massage you prefer. But keep in mind that things will go much better if everyone remains flexible during labor.

Guided imagery This technique helps laboring mothers create an environment with a feeling of relaxation and well-being. Sometimes called daydreaming with a purpose, this method can be used anytime during your labor to help you relax. It involves imagining yourself in a comfortable and peaceful place. For example, you may picture yourself sitting on a warm, sandy beach or walking through a lush, green forest. Your chosen place can be real or imaginary. Sometimes you can enhance the imagery by playing tapes of surf, rain, waterfalls, birds in the woods or any soft music you enjoy.

Meditation Focusing on a calming object, image or word can help relax you during labor and reduce the amount of pain you experience. Focus on a single point. This can be something in the room, such as a picture you have brought along, or it can be a mental image or a word you repeat to yourself over and over. When distracting thoughts come into your consciousness, allow them to pass by without dwelling on them and bring your focus back to your chosen focal point.

Aromatherapy To trigger relaxation and ease pain naturally during labor, try using comforting smells. When you’re at home, light a scented candle or burn incense. When you’re at the hospital or birthing center, bring along a pillow scented with your favorite fragrance. Or have your labor coach use a lightly scented oil or lotion during massage. Aromatherapy may relax you and reduce stress and tension. However, being in labor can make you sensitive to certain smells, so don’t go overboard with fragrances. Simple scents, such as lavender, are probably best.

Music Music allows you to focus your attention on something other than your pain, and helps you to relax during childbirth. If you’ve been practicing relaxation techniques or breathing methods to music at home, bring the same cassette tapes or compact discs with you to the hospital or birthing center, or use them during a home birth. Many women use a portable music player to listen to their favorite music during labor and to tune out other distractions.

Other techniques Moving about freely during labor allows you to find the most comfortable positions. So, if possible, change positions frequently, experimenting to find the ones most comfortable for you. Moving also helps improve your circulation. Try a new position whenever you feel like it (see labor positions in Chapter 14). Some women find that rhythmic movements, such as rocking in a rocking chair or rocking back and forth on their hands and knees, can be soothing and a distraction from pain. Here are other methods you might try.

Heat and cold Applying heat or cold, or both, can be a soothing, natural pain reliever in labor. The goal of applying heat or cold is to make you more comfortable so that you can better relax. You may want to use a combination of both.

Heat relieves muscle tension. It can be applied through a heating pad, a warm towel, a hot compress, a hot water bottle or a heated rice-filled pack or sock. You can apply heat to your shoulders, lower abdomen or back to relieve pain.

Cold can be applied with a cold pack, a chilled soda can or a baggie filled with ice. Some women like a cold pack on their lower back to help relieve back pain. You may find that a cool, moistened washcloth on your face helps ease tension and cools you during labor. Sucking on ice chips also can help to cool you and create a distracting sensation in your mouth.

Shower or bath Many hospitals and birthing centers have showers in their labor rooms. Some even have bathtubs or whirlpool baths to help ease the discomforts of labor. The soothing, warm water helps relieve pain naturally by blocking pain impulses to your brain. Warm water is also relaxing. This is a method of pain relief you can try at home, too, before heading to the hospital or birthing center.

If you use a shower, you can sit in a chair and direct water onto your back or abdomen with a hand-held showerhead. Ask your labor coach to bring a bathing suit and join you.

Birthing ball A birthing ball is a large rubber ball and tool used in natural pain methods. Leaning or sitting on the ball can decrease the discomfort of your contractions, relieve the pain of back labor and aid in the descent of your baby into the birth canal. Your hospital or birthing center may provide one for you. Or you may need to purchase one and bring it with you. Have someone on your health care team show you how to get the most out of a birthing ball. Its use can be combined with other techniques, such as massage and touch relaxation.



If you find an error or have any questions, please email us at admin@doctorlib.info. Thank you!