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)
I just had my first baby November 22. I did not want an epidural at all. My husband and I took child birth classes, and I even told him at one point not to let me get an epidural because I was afraid I would regret it afterwards. But, then I was in labor. I was so surprised at the intensity of the contractions. I tried newbane (sp?) and that wore off quickly and I begged for the epidural. My first one didn't work, so they gave me more. My doctor told me, there is no point in trying to be hero, you don't get a prize if you go drug-free. I was very glad I chose to get the epidural. And even despite the fact that the first one didn't work and I was in agony for several hours, I do not regret my decision. I was very happy with my birthing experience.
I went natural with my daughter and plan on doing the same with my next baby. There's something in the experience of natural childbirth that's nearly impossible to explain to someone who's never done it, and I wouldn't want to miss out.
I'm an OB nurse and I've also seen too many things go wrong as a direct result of an epidural or other pain medication. My baby's safety is more important to me than my comfort. It doesn't bother me if other women choose pain medications for their labors, it just isn't for me.
@mikenpeg@xanga - Zofran is amazing for severe "morning sickness"
I used an epidural during my labor for both daughters. The first time it worked like a dream. I didn't feel a thing, except for a tiny bit of pressure when I delivered her shoulders. It was an amazing experience.
But for my second daughter it was totally different. My labor progressed very quickly and by the time I finally received my epidural, it was too late. My pain was already past the point of being managed. I felt every contraction and I might as well have delivered naturally. It was horrible, because I hadn't planned on a natural birth, therefore had no coaching on how to deal with the pain.
If I do ever decide to have another child, I'd like to think that I would plan for a natural {*no drugs*} birth, and also receive all of my OB care through a midwife team. Now that I know exactly how it feels to deliver a baby without the help of drugs I am confident that, with the right coaching, I could do it again, and enjoy the experience a lot more!
@Riftsong@xanga - I like what you wrote. It's surprising to hear an OB nurse say what you did though!!
Time and time again, and even through some comments here, it appears that people are NOT told the side effects and the dangers of meds and epidurals. I always feel a bit sorry for the mothers who say "I know I want an epidural as soon as possible". I think that's because people are afraid of labour - thanks to our society and it's fear of birth. I wish more people would learn to see birth as a normal life experience that we are gifted to be able to do. Yes, there are times where meds or an epidural are necessary - judicious use of it is good and warranted. BUT - you gotta wonder --- do we REALLY know the long term side effects on these babies where epidurals are administered early?? We've already seen research that is linking neurological disorders with epidurals --- and I'm sure more is coming. We pay a price when we toss out the normal way of birth and embrace all the technology without a second thought.
I had planned on not getting an epidural. I wasn't totally opposed to the idea, but, I wasn't planning on getting one. Well, after 40 hrs of labor, I was exhausted and my contractions were terrible (like nobody's are,haha). I tried Nubain first, LOVED IT but then it wore off and they told me another "dose" wouldn't be as effective. I still wanted to hold off on the epidural, but after some brief convincing by the midwife (she wanted me to sleep, since I hadn't in 2 days) I got one. It was wonderful!! I slept off an on for about 3 hours 'till it was time to push. Then the bliss was over! I am convinced the epidural wasn't helping at all when I was fully dilated. I pushed for 2 hours and finally my beautiful daughter came out, face up! No wonder pushing was hard and the contractions were all in my back! Anyway, next time I decided to not use ANY pain meds. I'm gonna be stubborn about it too. I didn't have a bad experience at all with pain management, I just wanna experience it without!
I was all for getting an epidural. Modern medicine? Bring it on!
Then I get to the hospital 9cm dilated and there's not a chance for anything at ALL.
It was the worst experience ever, and more pain than I can even describe---especially when the baby was in distress and they needed to get him out, the vacuum kept popping off his head, and they gave me an episiotomy without freezing, then I still ended up with a 4th degree tear. Absolutely brutal. Then I lost too much blood and was such a mess "down there" that I was in the OR for 2 1/2 hours and got two blood transfusions, one of which I had a bad reaction to.
Next time around -- if there ever is a next time (and right now, it's not looking that way!) -- I'm hoping labour is a little nicer on me and doesn't go so quickly. But since the first time around was early and VERY quick for me, I don't expect anything better after this. This time around, labour was only about 4 hours long, and baby arrived about 30 minutes after I got to the hospital. Next time, if it's even quicker, I'll have to practically live at the hospital to be there in time for pain management, which I would DEFINITELY want after this horrible experience. That's why I'm thinking that if I want another child later... I'll adopt.
With my first, I didn't have any painkillers - but they did end up giving me a sedative because I had been in labor and hardly slept for 2 days. They couldn't send me home, however, b/c if I changed posistions his heart rate would drop to the 40s. So, I had to lay on my left side the whole time and I think that made it a lot worse. Not being able to move around at all. But I was still able to do it pain med free.
I had a waterbirth with my second (and no pain meds) and absolutely loved it. I hemorhaged pretty badly though, so my OB didn't want me doing a waterbirth again.
The third one I did med free again. The birthing ball really helped me during his labor. He was totally different than the other two. The first two labors lasted a few days each ... the thrid was a total of 6 hours from when the contraction woke me to him being born (about an hour after getting to the hospital).
With the current pregnancy, I am seeing a different doctor (midwife actually) and she is going to let me do the waterbirth again. I am so pleased with that!
I know things don't always go as planned though. My sister, who has had 2 children, planned on doing it med free but ended up with horrible back labor for both of them that she just plain couldn't tolerate. I don't think people should feel badly if they plan to do it med free and end up getting the med anyhow. You never know how you will truely handle it until you are in the middle of it.
i had joy naturally with no pain medications. i was also in a birthing center, with 2 well-trained and experienced midwives that i trusted, so it was a very low-stress environment. relaxing through my contractions wasn't easy... but it was possible without drugs. preparing yourself for what you'll feel (even preparing yourself for the inevitable... "i'm giving up!" moment) is so vital. yes, there were moments when i thought... "i can't do this. i have to quit." but they passed... and really had more to do with being tired at times than with the actual pain itself.
the only part i would describe as painful would have been the transitional contractions. the pushing itself (even though there was some tearing) felt intense, but not painful in the least bit. i think the things that naturally happen to numb the area are your best bet defense against what some would call "painful".
having said as much, my water broke at 6, i was ready to push at 8, and she was born at 8:22. some call my birth a "lucky" experience. i think a lot of it has to do with grace and mercy that i can't fathom... but i also choose to believe that a small part of it has to do with being prepared... being in shape throughout the pregnancy, pre-natal exercises that some say help to move labor along... and then during labor, good positioning, the freedom to walk around, etc.
the catch is that i don't think i'm special. or better than other women. my natural child birthing experience doesn't make me feel superior. instead it instilled in me the conviction that most women can have this kind of birth, and i want to do anything within my power to make this possible for them!
@nicolevw@xanga
@Riftsong@xanga - i really respect your opinions.
@mcallima@xanga - natural child birth may not award some kind of medal... but considering the risks that the epidurals carry with them, there is an unfathomable satisfaction in knowing that we didn't take any chances. we said... "yes! this hurts", but the possible cons of the epidural far outweighed any immediate satisfaction we'd receive. we didn't do it for a pat on the back. many of us did it because in our minds... it was the only right thing to do.
and that's the harshest thing i'll say on the subject.
@nicolevw@xanga - Amen and thank-you! lol! Though I may not have considered myself really gifted, I always knew that labor was nothing to be afraid of- I would get through it, one way or another. Now I know I am gifted and I CAN do it! You never really know what you can do until you are in the middle of it.
@JadaFish@xanga - Well, I can tell you the same thing my midwife told me after Gabe was born, "At least you know you'll never have to work that hard for a baby again!" Well, that's the theory anyways!
First baby, epidural, induced labor.. at hospital
Second baby, 2 weeks ago
HOME BIRTH, totally AWESOME..so natural and totally worth EVERY ounce of pain. I HATE pain, but Through God's help i was able to have natural birth and it was so worth it. i only had 9mins of pushing and it was hard, i won't lie, but it was done and over with and totally worth it. i also had a Aqua Dola, which is a birthing tub, but i hated it, because it brouht labor on, so my favorite position was standing next to my counter ;)
After having 2 babies, different, i challenge you ladies to try natural labor, your body works its way up to the hard contractions and it's worth it when they put that precious little baby on your belly and you just get this rush of joy..they are so precious...
Has anyone ever heard of an orgasmic birth?
Women who, while giving birth, orgasm because it is that pleasurable.
Look it up on google, it's a very cool concept.
After considerable research on the negative effects of the various medications on the babyand the risks to me, I chose to deal with it naturally. There are, needless to say, times in life where pain is so intense it is simply undescribable. However, if I was to have another child I would do it naturally again. Of course, had I been in labor for 48 hours I might not feel the same. I lucked out - a lot - giving birth to my daughter only took 3.5 hours.
I went without an epidural til i was 6 cm. The pain honestly wasn't as intense as I thought it would be; it was eased with sitting on the toilet, rocking chair or birth ball. I was prgressing fast- 1-2 cm an hour. My nurse told me when i was 6 cm that when she checked me again i might not be able to have my epidural. I was going to tough it out, but then I got a HUGE contraction and said "screw it!"
The epidural was my best friend.
For baby #2: (Due in September, just found out last night!!) Same plan- go au naturale as long as possible, or up til 6 cm. The thought of having an unmedicated delivery petrifies me.
@thinkpinkpanther@xanga - i saw that on 20/20 last week. Interesting concept but I dont' derive pleasure from pain!
@mcallima@xanga - that is exactly what my doctor told me, too! I'm so glad I listened
my original plan was to get the epidural when the pain became too hard to handle and this happened as soon as my water broke, the contractions had no breaks in between and just got worse and worse, BUT i got the shot about 1 or 2 hours after i asked for it because there were too many people giving birth with c-sections that needed the numb shot specialist to stand by or so i was told. by the time i got the shot, i was already dialated to 9cm and gave birth after an hour.
I had an epidural...
Mostly because my midwifes fucked up my birth...
They knew that my daughter was in the wrong position for day prior to my labor... and they didn't try to change her position.
I didn't know that that was what you were SUPPOSED to try...
so instead they gave me an epidural.. and then after 8 hours decided that it was best to lie to me and tell me that my baby was in distress and then whack my stomach open and give me a c section.
I say nay to epidurals now. Unless you have a doctor that you can COMPLETELY trust...
Next time I have a baby I'm doing it all MY WAY. I'm doing a vbac (whether they like it or not) and I'm not having an epidural (whether they want to listen to my screaming or not).
That's just my experience though. As a 16 year old in labor... the hospital I went to was VERY prejudice against us young people having babies.
@MelodicPuppy@xanga - I didn't realize that it was on 20/20 last week, I wish I had known that...
I went all natural with both of my girls. Yes it's painful, but somehow I pulled through. Most of the time I ignored everything and focused on what my delivery doctor was saying to me. I stayed focused and just hoped that things would go smoothly. I am not against the epidural though!!
Pain management: scream.
And of course..can't forget that epidural.
Yeah, that's what my midwife said too. Then she also said that chances are higher that I could have another posterior birth. It has something to do with the shape of the pelvis! Ughh, hope that doesn't happen again!! I must admit that I was a tad proud that I managed to push her out though:) 2 of my friends had posterior babies and they needed c-sections. Ok, so I realize that tons of ladies have vaginal posterior deliveries.... I was just thrilled not to need a c-section!! Next time I hope to push for 10 min, hehe 20 min tops!! :) Wishfull thinking!!
@JadaFish@xanga - Well, one my brother-in-laws was posterior (at least they think so- it all happened so fast) and he was born before the midwife made it, so posterior can happen fast too.
I hope you get your wish for a short pushing stage! I pushed Gabe out in 8 minutes and after that looooooooong transition stage, it was SUCH a blessing!