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.
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.
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.
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.

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).
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.

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.
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.
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!
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.
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.
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.
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.

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.
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.

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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