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Archive for the ‘Labor Pain Relief’ Category

Less than three weeks ago I gave birth to my third daughter. Exciting, right?! Well, I’m excited. She’s adorable and it was literally the perfect birth. Absolutely perfect. Once I finish writing my birth story I’ll post it for anyone who wants to read about a home birth. Anyway, since I’ve now had three natural births, one in a hospital and two at home, I think it’s time to write about pain management during labor.

Although the majority of women in the U.S. choose to get an epidural to block feeling, there are definite risks to the procedure, both for the mother and her baby. I don’t think anyone would disagree that a drug-free vaginal birth is by far the safest. Unfortunately, not many women believe that they are capable of a drug-free birth. Most, if not all of this is due to our cultural opinion of birth. Nearly everyone, from doctors to the media, treats labor and birth as a medical condition that requires medical intervention and a highly-specialized doctor present to “get the baby out.” However, a healthy woman, left to herself or with a trusted labor assistant, will also give birth, and generally much more quickly and peacefully.

With all that being said, let’s talk about labor pains.

Now, labor is a lot of work. It is hard work. And for good reason. During labor our bodies go through incredible physical and hormonal changes as the baby moves down the birth canal to be born. How many are in awe that a baby is able to fit through an opening that is so small? I know I am! With all the changes occurring within a laboring woman’s body, there is also a level of discomfort. Each woman experiences it differently; some refer to the sensation as an intense ache on her pubic bone, some women describe extreme pain.

Whatever experience you’ve had or heard stories about, there are ways to alleviate painful sensations during each contraction (also called a surge or rush by many natural childbirth books – I like those terms much better, don’t you? They describe labor much more accurately than contraction does. What a distant, medical word) – without drugs. Here are some ways to handle the surges:

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1. Relax

Seems counterintuitive, right? When we experience pain or discomfort our natural reaction is to tense up in a “fight or flight” mentality. Our adrenaline kicks in and we’re ready to react. Normally, this is a good thing. However, labor is not something we can escape from, and it is not something to fear. We are bringing new life into the world, and that is a wonderful thing! Tensing muscles during a surge will only make the pain worse. Our tendency is to tense up, then when that makes it more painful we tense up more, which creates even more pain. It turns into a vicious cycle in which a woman even begins to tense up in anticipation of the next contraction.

In order to break free of that cycle, it helps to relax our muscles, especially in the abdomen, butt/vaginal area, and jaw. If you’re having trouble relaxing those muscles, allowing your mouth to fall open in a “duh” expression helps open up the birth canal as it lessens tension in your vaginal muscles. I know, it sounds weird, but those two sets of muscles are connected. It is possible to relax all these muscles even while you’re using others, such as while standing or kneeling.

2. Breathe, Breathe

“Breathing” does not mean the short, “hee hee hoo hoo” breaths that classes like Lamaze teach (well, they used to, at least; maybe they’ve changed). Patterned breathing techniques like that are only used to try to distract a woman from her contractions. When I say “breathe,” I mean deep, full, belly breathing. The kind we all used to do as children, before our culture taught us to never let our bellies stick out. Breathe like an opera singer or a baby. With each breath use as much lung space as possible. If you do it correctly, your belly should rise with each breath, but your chest barely moves. Try to visualize sending air down into your vagina instead of your chest. Deep breathing takes more oxygen into your body, which alleviates pain. Focusing on the breathing is also calming and brings your focus inward as you “give in” to what your body is doing.

3. Set the Mood

Just as there is a certain ambience that creates a romantic mood, there is an ambience that is good for labor. There are exceptions, of course, but most women need dim lighting, a peaceful atmosphere, and a very few trusted people in the room with her. If laboring at home, you can set up candles, play music, and hand-pick who is allowed to be there. If at a hospital, it will probably take a little more effort, but it is possible. Some hospitals provide cd players and bedside lamps, but others don’t. Find out beforehand and, if they don’t, you can bring your own stereo or light if you desire. Having only a few trusted people is also nearly impossible at a hospital, but you can limit who enters the room and when. In this case, a spouse or friend may have to keep unwanted people out. Also, if a nurse is rude or makes you uncomfortable, you can tell them to leave. Remember: you are paying them to help you during labor. Don’t be afraid to request a different nurse.

4. Move Around

I’ve written before that lying flat on your back is the worst position to labor and birth in. It not only closes the pelvic opening so that the baby has a hard time getting out, but it also makes contractions much worse for the vast majority of women. Early in labor, walking is great because it helps the baby move down and into a good position for birth. Later in labor, moving around to find the most comfortable position will help alleviate pain. Also, your body will tell you if you’re in a bad position for the baby as she moves down toward birth. Listen to your body, and if you don’t feel like being in a certain position, move (between contractions!) to a different one. Here are a few positions women find comfortable during late labor:

-standing, leaning forward against someone
-kneeling on all fours
-kneeling and resting upper body on a couch or bed
-sitting on the toilet, an exercise ball, or a birth stool
-resting in a tub of warm water
-lying in a side-relaxation position (on your side, slightly leaned forward, with top leg propped on a pillow and another pillow under chest and head)

5. Visualization and Listening

Many women find exercises such as visualization or self-hypnosis to be very helpful for labor. Hypnobirthing is an entire childbirth class that helps a woman learn self-hypnosis. There is also a good book on Hypnobirthing if you are unable to find or afford a class. Other classes, such as for the Bradley Method, teach visualization exercises. One popular one is called The Rainbow Visualization. Have your birth support read it to you in a calm, low voice in the months leading up to the birth, and then during labor they can read the whole thing or just the parts you find most soothing. A familiar voice is a very calming thing to listen to during labor. Have someone tell you a story, or read poetry or passages in Scripture to you. You can even recite favorites to yourself.

6. Massage

Nearly every woman loves some type of massage. During labor there are certain places that, if massaged, make labor easier. A skilled doula or labor assistant will be able to try various things to discover if one feels particularly nice. But, you don’t have to have a trained professional do it. Whoever you choose to be with you during labor can do it. One of the universal labor massage areas is the sacrum. This is the part of the lower back that lies roughly between the hipbones, just above the tailbone. Many women find that pressure on this area during contractions and even during pushing feels good. If your birth partner is unsure, have them start out firm but not too hard, then if you want more pressure, ask for it. Other good places to massage are the hands (especially between the thumb and index finger), feet, and ankles.

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So, there you have it! During labor remember: relax and give in to labor – you can’t escape it so work with it!; breathe into your pelvis; set the mood; don’t be afraid to move around; listen to a soothing, calm voice; and utilize the hands of whoever is in the room with you!

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One of the most common interventions requested by a laboring woman in the US is an epidural. Many cannot imagine going through labor without receiving one. However, not many women know what it is, why it started as a labor drug, and what the benefits and risks are in using an epidural. So, here we go! Let’s explore this intervention.

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What is an epidural and why is it used?

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The first epidural was administered in 1885, when a doctor in New York injected cocaine into the back of a suffering (not pregnant) patient. Much later, doctors decided to try it on laboring women, and since then the use has skyrocketed.

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The goal of an epidural is to provide pain relief for a laboring mother who feels that she cannot cope with the labor process. It is administered through a spinal block, meaning that the drugs are injected directly into the spinal column instead of orally or through the bloodstream. The woman sits on the bed and a large needle is placed into the small of her back. Some women say they feel pressure when the needle is inserted.

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The drugs in an epidural are local anesthetics, which are most often given in combination with analgesics. The anesthesia numbs the lower body. The analgesia reduces the perception of pain, similar to narcotics. They include drugs such as epinephrine and morphine.

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Does an epidural work?

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Well, it depends on who you ask. About 25% of epidurals are “perfect.” Meaning, they provide pain relief for as long as needed, there was no feeling on both sides of the body, and the needle was placed correctly without accidentally hitting a nerve or causing damage. The other 75% either wear off quickly so that more drugs need to be added, only numb one side of the body, or cause nerve damage.  10% of epidurals don’t work at all. However, so many women are terrified of birth thanks to the media, doctors, and horror stories from other mothers, that we continue to ask for epidurals because we think we cannot handle the excruciating pain we know it will be.

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How does it affect normal labor?

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Many studies have been performed on how an epidural affects normal labor for a healthy woman. One of the first noted is that the use of an epidural prolongs labor. This is most likely due to several factors that work together: a woman is limited in her movement, her uterine muscles are somewhat numbed by the drugs and are unable to contract properly, and the woman cannot feel when her body is ready to push, so has to rely on nurses to tell her when. All of these factors play into the lengthening of labor.

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Epidurals also increase the need for Pitocin to restart labor once it has stalled. Contractions caused by Pitocin are much harder and longer than normal contractions, so this also frequently leads to the need for more drugs via epidural.

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When a woman is in labor, her body releases endorphins that help her to transcend pain. They send her into an altered state that allows her to tune in to her body and her baby. The rest of the world fades away and she is in her own world throughout the labor. It is nature’s pain relief. An epidural reduces the release of these labor hormones and makes women more docile and silent during labor. Sarah J. Buckley, a leading Australian physician, mused that “perhaps the widespread use of epidurals reflects our difficulty with supporting women in this altered state, and our cultural preference for laboring women to be quiet and acquiescent.”

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In addition to these ways in which an epidural affects labor in general, there are several other ways in which epidurals negatively affect both the mother and baby. Now, I do not list these to frighten anyone unnecessarily, but I do believe that it is extremely important to fully know what you’re agreeing to before allowing someone to mess with your body.

Side effects

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Mother:

Close to a quarter of all women who receive an epidural experience complication. And they can be serious. A woman who has had an epidural is three times as likely to die as a woman who did not have one. One in five hundred women will experience short-term paralysis that can last days, and in half a million epidurals, one will be left permanently paralyzed.

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The most common side effect is a drop in blood pressure. Because it is so common, nurses generally administer fluids via IV before placing the epidural, although still roughly half of women experience low blood pressure. This leads from mild side effects such as feeling faint, to more serious problems such as maternal cardiac arrest and lowered blood supply for the unborn baby. Shivering, nausea, vomiting, and severe headaches are also common after an epidural. One major UK study found that a woman was twice as likely to hemorrhage after giving birth with an epidural than was one who did not have an epidural.

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Finally, epidurals increase the risk of other interventions, especially a cesarean, which is major abdominal surgery, presents it’s own set of risks to both mother and baby, and requires weeks of recovery.

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Baby:

Although I have heard both doctors and mothers say over and over again that epidural drugs do not reach or affect the baby, study after study shows otherwise.

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First, the placenta is not a barrier between the mother and baby. It is a conduit. What goes into the mother also reaches her unborn child. That is why, during pregnancy, women are cautioned to eat a healthy diet, and to avoid or limit over-the-counter-drugs, caffeine, alcohol, sugar, or exposure to chemicals and smoke. Why, then, do all of those rules go out the window during labor when there is no medical need to use any drugs except in women who truly do have medical complications?

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…regional anesthetic agents do not remain regional in their distribution. Measurable levels of these drugs appear in maternal blood from 1-7 minutes after instillation and measurable levels appear shortly thereafter in fetal blood regardless of the type of regional anesthesia or the agent employed.

~Dr. Howard Fox, University of Kansas Medical Center, Division of Neonatal Medicine

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If the drugs do enter the baby within 10-15 minutes after an epidural, what do they do?

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A lot, actually. Fetal distress is one of the most common side effects of epidurals in labor, and it is also the most common reason cited for emergency c-sections. Changes in the fetal heart rate are very common, which indicate that the baby does not have adequate oxygen or blood. Babies exposed to epidural drugs can also experience respiratory problems, and at birth have even higher drug levels in their systems than even their mothers do.

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I cannot tell you how many times I’ve heard and read women declare that they had to have an emergency c-section due to fetal distress, and that they were so thankful they were in a hospital so that the doctor could save their babies. What they don’t realize is that the drugs given to them by that doctor were the very things that caused the emergency in the first place.

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Is there any way to relieve pain without drugs?

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Absolutely! Pain relief in itself is not necessarily a bad thing. When drugs are not used, a woman, given freedom to labor how she chooses, will move into positions she finds most comfortable. Be that walking, sitting, resting in warm water, on hands and knees, or in one of the myriad other positions she will find a way to adjust herself that feels right. Her movement also helps her baby move down the birth canal into the correct position for birth. This is not possible with an epidural because women are confined to their backs on a bed, which by far the worst possible position for giving birth because it closes the pelvic opening, making it much more difficult for the baby to get through. Lying on her back also ensures that she is working against gravity, rather than with gravity.

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Many midwives and doulas use soothing herbal scents or tinctures to help soothe a laboring woman, as well as massage or acupressure. Laboring women also frequently find music and dim lighting to be calming as they work to bring new life into the world. Fear of labor and laboring in an unfamiliar place with unfamiliar people can increase both pain and length of labor. Seeing birth as a normal and natural part of your passage into motherhood helps tremendously.

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Additional side effects

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In order to be completely thorough, here are additional side effects for both mother and baby not mentioned above, in no particular order:

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Severe postpartum depression

Death of baby

Increased likelihood of: being induced, using forceps, and episiotomy

Feelings of emotional detachment

Decreased mother-infant bonding

Complications to baby

Chronic back pain

Fetal drowsiness

Chronic migraine headaches

Chronic “pins and needles”

Loss of consciousness

Convulsions

Septic or bacterial meningitis

Fecal and urinary incontinence

Seizures/Trauma

Inability to push out baby

Misplaced catheter

Accidental injection of anesthetic into bloodstream

Punctured dura

Allergic reaction

Fetal hyperthermia

Neonatal jaundice

Poor fetal muscle strength

Neurological complications

Permanent nerve damage

Loss of sensation and sexual function

Damage to spinal cord

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The decision whether or not to use an epidural is completely up to you. In some cases it is truly necessary, such as for a cesarean birth. Other times it is personal preference or because another intervention made contractions too much to handle. Just know the possible negative side effects so that your choice is fully informed. And also realize that introducing one intervention often leads to more interventions that you may not have planned on or wanted.

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References:

The American Pregnancy Association

Born in the USA by Marsden Wagner

“The Hidden Risks of Epidurals” by Sarah J. Buckley as reported in Mothering Magazine

“Effects of Maternal Analgesia on Neonatal Morbidity.” By Howard Fox, University of Kansas, Neonatal Division

The Bradley Method by Marjie Hathaway, et al.

Pregnancy in America, documentary 

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