Know your pain management options
It's comforting to know you have several options for managing the discomforts that occur during labor and birth. Generally, mothers and their health care providers want to use the safest and most effective method of pain relief for both mother and baby. Much depends on your preferences, the health of you and your unborn baby, and your health care provider's recommendation.
There are three main types of pain management for labor and birth:
- Nonmedicated measures. Sometimes called natural childbirth, nonmedicated measures provide comfort and relieve stress. Many women learn special techniques to help them feel more comfortable and in control during labor and birth. Some of these techniques include:
- Relaxation. Techniques, such as progressive relaxation (in which various muscle groups are relaxed in series), can help a woman detect tension and be better able to release that tension.
- Touch. This may include massage or light stroking to relieve tension. A jetted bath or a shower during labor may also be effective ways to relieve pain or tension. Ask your health care provider before taking a tub bath in labor.
- Heat or cold therapy. Used to help relax tensed or painful areas, such as a warmed towel or a cold pack.
- Imagery. Technique of using the mind to form mental pictures that help create relaxed feelings.
- Meditation or focused thinking. Focusing on an object or task, such as breathing helps direct the mind away from the discomforts.
- Breathing. Techniques using different patterns and types of breathing to help direct the mind away from the discomforts.
- Positioning and movement. Many women find changing positions and moving around during labor helps relieve discomfort and may even speed labor along. Rocking in a rocking chair, sitting in the "Tailor sit" position, sitting on a special "birthing ball," walking, and swaying may be helpful. Your labor nurse or health care provider can help you find comfortable positions that are also safe for you and your baby.
- Analgesics. Analgesics are medications to relieve pain such as meperidine (Demerol). The smallest dose possible is given because of the potential adverse effects of these drugs on the fetus. These drugs easily cross the placenta to the fetus and may take a long time to clear from the baby's system even after birth. Many analgesics can cause respiratory depression (slowing of the breathing center in the brain) in mothers and babies if given in large amounts or in repeated doses.
- Anesthesia. Anesthesia involves medications that cause loss of sensation, including pudendal block, epidural anesthesia and analgesia, spinal anesthesia and analgesia, and general anesthesia. The most common anesthesia is an epidural, also called an epidural block. This anesthesia involves infusing numbing medications through a thin catheter that has been inserted into the space that surrounds the spinal cord in the lower back, causing loss of sensation of the lower body. Infusions of medications may be increased or stopped as needed. Epidural anesthesia may be used during labor and for vaginal and cesarean births. The most common complication of epidural anesthesia is low blood pressure in the mother. Because of this, most woman need to have an intravenous infusion of fluids before epidural anesthesia is given.
A variation on the epidural is epidural analgesia, which is sometimes called a "walking" epidural because the medication infused through the epidural is an analgesic, which relieves pain but does not numb the body and allows movement. Combinations of medications may be used in the epidural--part analgesic, part anesthetic. As with a traditional epidural, the most common complication is low blood pressure in the mother. Epidural analgesia may be used during labor and for vaginal births.
Talk with your health care provider about these options and what will be best for your pregnancy and birth. Often, women find that a combination of methods for pain management works best. And be sure to keep an open mind about the alternatives. As labor progresses, you may find that you are managing just fine, or that you have more discomfort than you expected. By being flexible, you can opt for the pain management techniques that best fit your needs.