Tuesday, 06 January 2009
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Pain Management in Labor
by Nurse Jenna 
Though a baby can bring some of life’s greatest joys, having a baby is painful. People experience pain differently and have different pain tolerances, so it is not surprising that they also have different plans for how they choose to cope with pain of childbirth. Some women have an idea before they go into labor about the type of pain management they want, while others decide to “play it by ear.” Regardless, knowing what pain relief methods are available in advance is useful, even if you ultimately decide against it.
If you are planning to deliver in the hospital, you will usually be asked what your pain management plans are when you are being admitted. This does not mean the decision is final, or that you cannot alter your original plan. It just helps your doctors and nurses have an idea of how to best help you have the delivery you would like. Some women want an epidural as soon as possible, others choose to have a natural birth. Neither is right, or wrong, but you will get better care if you keep your providers informed of what you think you want to do.
However, you should go in knowing that there is a point in labor where it is “too late” to get an epidural or IV narcotics. If delivery is imminent, there may not be time to change your mind. It is unusual to miss the window of opportunity for an epidural with a first baby, but it can happen and with subsequent pregnancies, labor can frequently progress too quickly for an epidural placement.
Many women choose natural childbirth and have their babies without any pain medication. Some things to help alleviate the pain without pharmacological intervention include walking and frequent position changes. Breathing techniques and repetitions of a word or phrase can be helpful for relaxing and putting your mind in a more meditative state. A bath, shower, or massage can also provide some distraction and ease muscle tension.
Sedatives are sometimes used in early labor to women get rest and there is the possibility of being sent home on a sedative and/or narcotic for what is termed “therapeutic rest.” This enables you to get some sleep so that you have energy when you are in more active labor.
Narcotics can dull the sensation of pain in labor, but it does not eliminate it entirely. Medication is usually given through an IV, but also can be given in the form of an injection. Often women drift off to sleep in between contractions after receiving narcotics, but the medication is not strong enough to enable them to sleep through the contractions. Narcotics can cause respiratory depression in the baby if a woman delivers shortly after their administration, so they are more commonly used when delivery is not yet foreseeable.
An epidural is when medication is inserted through a needle into the epidural space of your back in between your spinal bones. A thin, plastic tube is left in place after the needle is removed. The medication continues to infuse through the tube in your back until after the baby is born. The medication numbs the nerves to your abdomen, pelvis, and legs. Though epidurals work well to relieve the pain of contractions, they do not eliminate the pressure sensation as the baby moves down. This pressure can also be very uncomfortable, but it enables a woman to feel and use the muscles to push the baby out. Epidurals are most often placed during active labor.
What type of pain management did you/will you use in labor? Did it go as planned?
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About the Author
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- From: NurseJenna
- Name: NurseJenna
- About Me: Hi Everyone, I'm a Registered Nurse in labor and delivery and also a Family Nurse Practitioner. I'm here to offer any advice or answer questions about pregancy, labor and delivery, or your newborn. I hope your find my suggestions helpful whether you are awaiting your little one, or trying to get a good night's sleep after coming home. Please feel free to ask me any questions and I will do my best to get you the answer, or at least let you know where to find it.
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Comments (52)
With both of my boys I had the epidural which I planned on having from the start. I had awful contractions that hurt like hell and I needed relief!!! Once the epidural kicked in I was able to relax and get some rest. It was nice to feel the pressure bc it let me know it was time to start pushing. I wouldn't switch their labors for anything.
I knew before I ever even went into false labor, that lasted for 3 days, that I was going to be getting an epidural. I definitely knew, without a doubt, no pulling out, after 3 days of false labor, enough was enough, haha.
So, I had an epidural and everything ended in a c-section.
i knew from the start i needed epidural. thank goodness whoever invented that
I planned to have the epidural then changed my mind and tried to stick it out. My anxiety disorder kicked into high gear as the contractions got stronger so I went back to my original plan at the suggestion of my OB. I do not regret it one bit. I will not waiver with this pregnancy and will get the epidural again.
I just stood by my sister through her first baby delivery. she requested an epidural halfway through, but ended up waiting two hours before they finally showed up with it.
she gave birth an hour later. in retrospect, she now believes she was ready to push when they were administering it. so she could've done the whole thing without it.
I'm not a mother, but I've been told that the worst "rock and a hard place" moment of labor is usually a sign of it being the end. add to that the numerous untold negative effects of labor painkillers, and I'm thinking when the time comes, I'd like to brave it.
EPIDURAL ALL THE WAY! I knew before I got pregnant that I would want the epidural. Even though my water broke, my labor had to be induced with pitocin, so my contractions were hard and fast. I got the epidural within an hour of getting the pitocin and three hours later my little boy was born. I was so grateful for the epidural.
I planned not to have anything and I didn't get anything. BUT! Quick disclaimer here- sometime during my 26 hour labor, my midwife told me she had a shot that would take the edge off the contractions and make me drowsy enough to sleep between contractions. I was at 6 cm. at the time. I think. Maybe it was 7. At that point, I told her I'd keep going as I had been. I was in the beginning of my transition stage. Things are supposed to speed up and get more painful around then, right? Ha! My transition ended up lasting over 6 hours! The last hour and a half were the worst. The last time the midwife checked me before the delivery, I was 9 1/2 cm. and I almost cried. Not because I was happy either. At that point, I wanted the shot. Of course, I couldn't have the shot. I was too close to being fully dialated, even though, I thought, if it took this long to get this far, what's gonna keep keep that stinkin' half a cm. from taking a few more hours? Thankfully, the first urge to push was only moments away and Gabe was born after only 8 minutes of pushing!
Now, I'm so glad I didn't get the shot! Call it my ego, but I think I would have really kicked myself afterward. I went into it so set on not having anything that I would have been really dissapointed with myself.
What I did find that worked (for me, at least) for handling the pain was "baby dancing", rocking in my glider, soaking in a HOT bathtub, and more "baby dancing." The dancing part mainly being standing, or leaning on something with my hands, and swiveling my hips and pelvis around. Yes, it feels kind of like erotic dancing and you think maybe you shouldn't be doing it in front of your midwife, but it works! And it helps bring the baby down. By, the way, I was at home, so I felt much more freedom to do what I felt like doing.
So if I did it again, would I get the shot when first offered? No, I wouldn't. I wouldn't change a thing! I got through it without it and I feel really good about being able to do it. But I have to say that I can't say anything about anybody else when they get a shot, epidural, etc., because I've been there.
Had the narcotics shot and hated it. Had an epidural a few hours later and it was glorious! Had an epidural with my daugther, too and am hoping to have one with all subsequent deliveries.
I was a Pre-K teacher at a big childcare center with 250+ kids. With all the moms who gave me advice, no one told me NOT to get an epidural. I could have gone either way I think. Most ppl I know who didn't get it end up not really remembering much of what happened. Haven't made a decision about the next one.
I'm using hypnobirthing for natural childbirth. i really, really want to avoid an epidurial but i might take a shot to have the edge taken off if labor takes awhile.
I went in to labor and delivery planning to "play it by ear". Well, after spending the night parked at 4cm and not budging for anything the Dr and i agreed to break my water- which broke very easily meaning it was on it's way to breaking itself. I was told in an hour I would feel an increase in pain. 20 minutes later I was screaming and begging for the epi. Sadly, I was already at an 8 so no pain meds for me. by the end of the hour I was at a full on 10 and pushing. It hurt so bad. I am a very small person- barely over 5 ft and 100lbs. My vagina is super tiny- before becoming sexually active I could barely fit a tampon up in there. . . pushing a baby out? it hurt so SO bad. I have a very high pain tolerance too and I just about wanted to die. I screamed and sobbed the whole entire time. NOT GOOD. if I can convince myself to go through the whole thing again I'm making sure the whole staff knows it's IMPERITIVE for me to get the epi and that I MUST have it before my water breaks since seemingly once my water is broken my cervix pretty much explodes open. . . ow.
For my first, a half dose of narcotics made me feel drunk.
For my second, the endorphins (my body made) were heaven sent.
Childbirth is an once in a lifetime experience. Why dull the experience!
For my next birth, I am planning to using zero pain drugs.
I didn't use any pain meds and delivered my daughter naturally. I used many of the natural pain relieving techniques that you mentioned, and yes everything went as planned. I would do it again in a heartbeat!
My original plan was no drugs, and I made sure that EVERYONE knew this. I had to have my labor induced with Pitocin, which was horrible! At one point I got a shot in my IV (without being asked about it they just did it) then I broke down and got an epidural only it didn't work! I still felt everything! So the next time that I have a baby I am not going to get the epidural because if it didn't work the first time there is a good chance that it will not work again.
I love natural child birthing techniques. I had an epidural for my first child even after wanting to birth naturally my contractions were coming on top of each other for about 5 hours and I had a lip around my cervix. I was told the epidural would help relax me and if I didn't have it I would end up having a C-section...so I had an epi, they turned the meds off right before I started pushing but it still made the pushing hard. I couldn't feel the contractions and people were just telling me when to push. I also couldn't feel "where" to push. I ended up in the pushing phase for 3 hours, but thankfully still gave birth vaginally. I felt so disconnected from the whole thing and didn't feel like I bonded well with the baby right at first like I had imagined.
Baby 2.....I was REALLY motivated not to have pain meds, labor was 4 hours long......no problem there, I didn't have time. I enjoyed that birth so much. I pushed for only 10 minutes, I was elated and full of energy and in awe that I was able to do such a huge thing without pain meds, my body was a glorious machine!
Baby 3.....wanted pain-med free birth....labor lasted a total of 2 1/2 hours, so quick, but very painful, but so worth it. I remember everything about these births more than the first, I love birthing naturally and hope to do so for as many children as God blesses our family with!
I had a 30 hour labor without an epidural, then ended up with a Csection.
I am FOR SURE getting an epidural. I can't deal with a lot of pain, I would probably start throwing up. =[
@I_Am_Waves@xanga - Me too - it was 40 hours of induced labour and then a c-section, such a nightmare. Hopefully having a planned section this time.
eh, this kind of makes me want to not have kids =(
Do you want to save yourself?
I have many airsoft gun/combat gear
@Tavia_n_Jones@xanga - Wow, you are lucky to have such short labors! But I agree, aren't our bodies incredible?!
I played it by ear. I walked around for the first three hours of intense labor then I had a last minute epidural.I almost went to long without getting it and even after they got it prepared I almost could not get one because I was moving around too much.I am not getting an epidural ever again though as i kept falling asleep between contractions and when my son was finally born i was too out of it to hold him and examine him and see him and on top of that directly after my epidural I had to start pushing and it only took like ten minutes I think it would have taken less had i actually been able to feel anything. With my next child I want to do a natural water birth.
I just had my first child 9 weeks ago. I used Hypnobirthing and had an all-natural water birth. It was WONDERFUL! I'm also a small person but didn't have any problem. Doing it without drugs was especially good for afterwards--I had energy during and after the birthing, my daughter came out very peaceful and alert (and remained awake and alert for 2 hours after!), and she also was able to latch on nursing quite easily. Granted, my labor was 4 hours start to finish (she was born 1 hour and 5 minutes after we arrived at the hospital!), but it really was managable with the hypnobirthing techniques.
Everyone told me to have the epidural (and also that I'd change my mind about natural childbirth during the labor!) and I'm so glad that I didn't listen. The medication in an epidural temporarily paralyzes the nipple errector muscles as well as the muscles around the baby's mouth, so many have a hard time latching on and thus learning to nurse. Also, the complications from having something put into your spinal cord cavity...YIKES!
The key to natural childbirth is preparation and relaxation. It's an amazing experience and I will totally do it again!
I had TWO epidurals with my son,the first one quit working about an hour after I got it and as it was my first child I was in crazy pain and wanted management. When I have another child Im opting out of pain management through meds. Im opting for water delievery. When I had my son I sat in a bath for two hours before getting an epidural. It helped more than the epidurals. After my second epidural I couldnt feel anything below my belly button and didnt know when/how to push. It was miserable. My son was CROWNING and I didnt feel a thing.
Natural birth. No drugs/ painkillers. I can't speak for people who have epidurals, but in my experience, natural was great. I felt good afterwards, baby was alert and ready to nurse. I don't fear birth at all. Oh, but I do hate being pregnant. If you find a drug that takes all-day morning sickness away, let me know. :)