| Q: |
What is the best form of pain relief in labor?
| | A: |
Since each woman and labor is very different, it is difficult to
say which is the “best” form of pain relief. This will also depend on an
individual's coping mechanisms and pain threshold. There are many different types of pain relief
including alternative therapies such as aromatherapy, acupuncture,
homeopathic kits, reflexology, and hynobirthing (using self-hypnosis to
reach a state of deep relaxation); natural methods, such as water,
massage, TENS, and the positions you adopt; and drugs such as Nubaim
(nalbuphine HCL), and epidural. Your caregiver will talk to you about
the different choices available and the advantages and disadvantages of
each one.
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| Q: |
Last time I made a real idiot of myself. I don't want to lose control again—what do you advise?
| | A: |
The best advice is to know your options, have an open mind, and
be guided by labor and how you are feeling. Being positive and having
appropriate support can not only result in a good experience, but can
reduce your perception of the pain, and feeling empowered helps you to
stay in control.
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| Q: |
Are relaxation and childbirth classes helpful?
| | A: |
Relaxation and breathing techniques
taught in prenatal childbirth classes are extremely useful when used
together and at the appropriate times in labor
. This, combined with working with your partner and the nurse or
midwife, can help to make the pain more bearable and thus the birth
experience more pleasurable. It is worth pointing out that people have
different pain thresholds and relaxation and breathing techniques alone
may not be enough to help you cope with the pain of labor, especially as
labor advances. Practicing breathing and relaxation techniques before
labor begins increases the benefit so classes are helpful.
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| Q: |
Can moving around during labor help with the pain?
| | A: |
Providing the labor is straightforward, it does seem to be the
case that being as active as possible can help the progress of labor.
Not only does this help with the pain, but it can also provide a sense
of control. As the labor advances, it may be difficult to get into a
position that is comfortable, and often women move around to try to find
the best one. Favored positions are standing, kneeling, or squatting,
and rocking the pelvis, either on a birthing ball with your legs astride
or leaning onto the bed. Rocking in a chair or using a birthing ball
may prove beneficial.
|
| Q: |
How can a birthing ball help during labor?
| | A: |
Using a birthing ball during labor has the advantage of opening
up the pelvis to allow the baby to move down more easily. You can take
your own birthing ball into the hospital, and this may be advisable
since supplies may be limited.
|
| Q: |
What is a TENS unit and how do they work?
| | A: |
TENS (transcutaneous electrical nerve stimulation) works by
stimulating the production of endorphins, the body's natural
painkillers, and also by blocking some of the pain pathways. Electrodes
placed on your back or abdomen are attached to a unit that fires
electrical impulses when a button is pressed, blocking pain pathways.
The strength and frequency of the current can be altered according to
your needs. This is a natural form of pain relief that requires no drugs
and is a good way to involve your partner, who can position the
electrodes.
The machines will
produce a tingly sensation, but this does not hurt. Some people do not
like the sensation, while for others it works very well, so it's a good
idea to rent a unit before labor to see if this form of pain relief
suits you.
The advantages of TENS
are that you are in control of your pain relief and are free to move
around while you are using it. These are mostly used at home since
hospitals often restrict their use.
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| Q: |
Will I be able to use my TENS unit at the same time as other types of pain relief?
| | A: |
TENS is commonly used in the early phases of labor. It cannot be
used with water (because it is electrical) or with an epidural (because
of the position of the electrodes on your back).
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| Q: |
My midwife says that I can have my baby at home, but what pain relief will I be able to have?
| | A: |
There are a variety of, mainly natural, forms of pain relief that
you can use in your own home. Alternative therapies, such as
aromatherapy, homeopathic kits, reflexology, and acupuncture can all be
used, as long as an appropriately trained person is providing them. Many
women having home births opt for warm water, either in the bath or in a
rented pool, since this is an effective form of pain relief. The
midwife can also help with position changes, massage, and
hypno-breathing techniques if natural forms of pain relief are not
working.
However, you may find
that just by having your baby at home, you are less likely to need much
pain relief. This is because evidence suggests that women who stay at
home for as long as possible during labor, or for the whole of their
labor, have a more positive experience, which includes needing less pain
relief. By adopting the correct positions, using massage, and breathing
and relaxation techniques, you may find that you limit the amount of
medical pain relief you need.
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| Q: |
Will I be able to cope through all the stages of labor using breathing techniques alone?
| | A: |
Relaxation and breathing techniques are extremely useful when
used together and used at the correct times. It is common for women to
breathe short, rapid breaths at the strongest part of the contraction.
Studies show that this can cause a panic-type response in your body that
can increase tension and heighten the pain. Learning to “sigh out
slowly” (SOS) and keeping your shoulders down can help you in labor, if
you have practiced during pregnancy. At the end of labor, when it is
necessary to control the head as it delivers, the doctor or midwife will
ask you to pant or blow. This is two short breaths out followed by a
longer breath out. Combining breathing techniques while working with
your partner and the midwife can help to make the pain more bearable and
thus the birth experience more pleasurable. It is worth pointing out
that people have different pain thresholds, and breathing alone may not
be enough, especially as labor advances.
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| Q: |
Can a water birth help with pain?
| | A: |
It is well documented that water can help with labor pains .
The heat of the water reduces muscle spasms, and the buoyancy of the
water relieves pressure on the pelvis, which lessens the overall pain
experienced. The water is kept around body temperature by topping up
with warm water and needs to be covering your belly to be effective.
Studies have shown that it can reduce the length of labors and the risk
of tearing. Babies can be born completely under water since they do not
gasp until they hit the cold air. Some hospitals allow your partner to
be in the tub for support while others do not.
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| Q: |
I want to remember everything about the birth—how can I achieve this?
| | A: |
Probably the most effective way to remember as much as you can
about your labor and the birth of your baby is to try to remain as
healthy and rested as possible prior to the start of your labor, which
will give you the best chance of staying strong and clear-headed during
labor. Feeling strong and having plenty of energy may also help you to
remain upright and active during the course of your labor, reducing the
need for opioids, narcotic medication, which can create a mild state of
amnesia, meaning that you may have some difficulty remembering the finer
details of the birth of your baby. It's also helpful to have a partner
or close friend with you throughout your labor so that they too can help
fill in any blanks later, and photographs and videos are good prompts
also. If you do find after the birth that there are parts you can't
remember, you could ask your midwife or doctor to let you see your birth
records. Or you could try to keep a birth journal between contractions!
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| Q: |
I want an epidural but I'm afraid about having one—should I be worried?
| | A: |
Epidurals work by blocking pain nerves as they enter the spinal cord (see How an epidural works).
The doctor performing the procedure will be very experienced as it is a
very small area they need to aim for. You need to sit very still in the
position demonstrated to avoid any problems. There is a slight chance
that if the needle goes in too far, it can cause a leak of fluid causing
a “spinal tap,” which can result in a severe headache. Other fears
include future a backache, which may be prevented by changing your
position frequently in labor. There is a very small risk (although this
is highly unlikely) that damage is done to the nerves.
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| Q: |
I'm scared to death about going into labor—will I get an epidural?
| | A: |
Fear of labor is quite common and to be expected, especially if
this is your first baby and everything is unknown. It might be best to
enter labor with an open mind; rely on your midwife, doula, or nurse to
help you. There are numerous “tricks of the trade” beneficial in pain
and anxiety relief in labor. Analgesia, including epidural anesthesia,
is available if you need it.
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| Q: |
Will having an epidural slow down my labor?
| | A: |
Often epidurals are not administered until active labor. An
uncommon side effect is lowering of the blood pressure which is treated
by IV fluids. As a result, labor may slow down and sometimes requires
oxytocin augmentation. As second stage (complete dilatation or 10 cm)
approaches, it is important to feel the sensations as baby reaches the
pelvic floor. An epidural may interfere with your ability to sense when
it is time to push or push when instructed. Typically, the epidural is
allowed to wear off as you reach 10 cm so you may not push for up to an
hour. When sensations return, you can start to better assist in the
process and push your baby out into the world.
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| Q: |
I'm very eager to stay active in labor—can I do this if I have an epidural?
| | A: |
One of the side effects of an epidural is that your legs may feel
numb and unable to hold your body weight. You will not be able to walk
with an epidural so you will be confined to bed but you can move from
side to side with some assistance. Trying position changes, using a
birthing ball, relaxation techniques, water therapy or other analgesic
options prior to the epidural is best if you really want to stay active
in labor.
Another option exists in
some birthing units; known as ITN (Intrathecal Narcotic), it is a
one-time injection given in the lower back into the space next to the
spinal cord. A combination of local anesthetic and a narcotic is
injected into this area and results in a rapid loss of feeling below the
waist. The duration of action is typically about two to four hours so
it is generally used for women who are in active labor and expected to
deliver their baby soon. Nausea and itching are two commonly reported
side effects but the pain relief is excellent with minimal effects on
the baby or upon the progress of labor. This option has been known as a
“walking epidural” because there is more mobility associated with its
use. However, some birthing units do offer “mobile” epidurals. These
work in the same way as a standard epidural, but you are given a lower
dose of the analgesic drug. This means that you are unable to feel the
pain of the contractions, but the nerves controlling your legs, abdomen,
and bladder are relatively unaffected so you are still able to remain
mobile during labor. This leaves you free to move around and be upright
during labor and can also mean that you do not need to have a catheter
inserted to empty your bladder. A mobile epidural can also increase the
likelihood of a vaginal delivery, since being able to move around will
assist the progress of labor, and being less numb means that you will be
able to push more instinctively during labor contractions. You may want
to check in advance with your midwife whether your local hospital or
birthing center provides this facility.
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| Q: |
When should I ask for medication in labor? I want to ask before it's too late.
| | A: |
Medications are given at different times for different reasons.
When pain relief is needed, the best time to administer it is from 4 cm
of dilatation to 7–8 cm. If your midwife or doctor feels you are likely
to deliver within an hour, nonpharmacologic pain medications would be
preferred. Tranquilizing medications such as Vistaril, for example, are
used to help mothers who need sleep before active labor or who need to
get some relaxation prior to active labor. Demerol, Morphine, Stadol,
Fentanyl, and Nubain are the most common analgesics used in labor. Used
in small doses, these medications do not take away the pain but take the
edge off the pain. When administered late in labor at 7 cm or more—or
if labor progress is rapid after these medications are administered—the
baby can be negatively affected. Fetal sleep patterns can predominate
after the mother receives a narcotic or synthetic narcotic pain
medication. If the baby is born within an hour after administration, an
opiate antagonist drug called Narcan is often required to help the baby
adapt to the outside world.
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| Q: |
I've heard that labor meds can make you feel sick, and the baby drowsy after birth. Is this true?
| | A: |
Narcotics are the most commonly used medication during labor. It
is usually given by injection and side effects include nausea, vomiting,
dizziness, or drowsiness; it can also delay the baby's breathing if
given within one to two hours of birth.
If the baby's breathing
is noticeably affected, an antidote injection is sometimes given to
reverse the effects of the narcotic, although this is not usually
necessary and would only be given if the baby didn't respond well to
other types of stimulus, such as gently rubbing the baby's back with a
warm towel, or gently stimulating and rubbing the feet of a baby, which
can be enough to make him inhale. Your baby's ability to breast-feed can
be affected if he is drowsy, and the nurses will provide extra support
to mothers choosing to breast-feed if they have had narcotics during
labor.
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| Q: |
I want to have a great birth but you hear such awful stories—how can I stay positive?
| | A: |
For every awful birth story there is an equally positive one—it
does tend to be the case that you are less likely to hear about the
positive birth stories since these aren't such good topics of
discussion! However your labor and birth proceeds, the birth of your
baby will be amazing because you will finally meet the little person who
has dominated your life for the past nine months.
It is sensible to
remain open minded about labor and birth, because it's impossible to
foresee exactly how things will go on the actual day. However, there is a
lot that you and your partner can do to help prepare yourselves for the
labor and birth so that you have the best possible chance of having a
positive overall birth experience. For example, you can both learn as
much as possible about the process of labor and birth so that you can
make informed decisions in labor. You can talk with your midwife, read
books, find information on the internet, and attend childbirth classes.
Also, knowing how labor progresses helps to demystify the experience and
therefore removes some of the fear that accompanies labor and birth.
Learning basic relaxation and breathing exercises
also helps
, because being able to relax as much as possible during labor
helps you to feel less anxious, which in turn can help the labor to
proceed as quickly and smoothly as possible. |
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