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Pain During Childbirth

What affects the way you experience PAIN?

We experience and describe pain in different ways.  Do you remember your last trip to the dentist or to have a blood test?  Some may recall it as an extremely painful experience, while others may say it was no big deal.  Some women recall the pain of labor as the worst they have ever felt, while others say it was no big deal?

Here are some things that can make labor seem more painful and what you can do about them:

• Fear of the unknown.  In addition to what you are learning in childbirth classes, read about labor, delivery and care of your newborn and ask your doctor questions.  The more you know the less scary it will seem.

• Feeling helpless.  Learn ahead of time what your options are.  Practice the pain-management methods we have learned in childbirth class.  This allows you to be a more active participant in your baby’s birth.

• Fear of losing control.  Remember your body has known how to grow this baby and will know how to give birth to it also.  Be aware of what your body is telling you and don’t worry about how your response may appear to others.   Groaning, moaning and grunting are all normal responses to pain.

• Being alone.  It’s vital to have support from family or friends during labor.  The hands-on care of a labor-and-delivery nurse will also help to reduce your pain.

• Fatigue.  Rest as much as you can in early labor and between contractions as labor progresses.   Resting after each contraction gives you energy to cope with the next one.  Change positions often will also help to prevent fatigue.

• Anxiety and tension.  Focus on breathing during contractions.   Use relaxation methods both during and between contractions. 

• Fear.  Focus you thoughts both during the last weeks of pregnancy on the first time you hold your baby.  What will your new baby be like?  Avoid focusing on how much contractions will hurt.  Remember each contraction brings you closer to holding your baby in your arms.  If you feel scared, talk about it.  Telling your fears or concerns gives others a chance to comfort you.

Resource:  Planning Your Pregnancy and Birth, Third Edition, The American College of Obstetricians and Gynecologists. Pain Relief in Labor

Choices
Giving birth can be a painful experience.  Women experience pain at different levels and respond to it in different ways.  The relaxation and breathing techniques you have learned in class may be all you need to cope with labor.  You may choose medication to help with pain relief.  Whether you do or not is a personal choice, rather than a medical decision
Suggestions to think about in deciding about using pain medicine.

• Choosing medical pain relief is not a sign of success or failure in childbirth

• All medications affect labor in some way

• All medications affect babies in some way

• Learn about the benefits and side effects of the medications you think you might choose

• Talk with your labor partner and your caregiver about any questions you have

• Work with your caregiver and your labor partner to design a plan for labor

• Have a back up plan for unexpected events

Pain Relief Options-Medications used during childbirth
Analgesic medications: Analgesic medications such as Demerol or Stadol can be injected (a shot) into a vein or a muscle to dull labor discomfort but not completely relieve.  Nausea may be a side effect you experience with these medications.  Phenergan is usually given at the same time to relieve the sick at your stomach feeling you may have.  Because these medications affect your entire body and cross the placenta they may make both you and your baby sleepy.  They are mainly used during early labor to help you relax and conserve your energy.

Local anesthesia: Local anesthetic medications may be used during delivery to numb a painful area or after delivery when stitches are necessary.  These medications do not relieve discomfort from contractions during labor.

Regional anesthesia: Epidural anesthesia is given by an anesthesiologist during labor make your discomfort less.  Medication is injected near the nerves in your lower back to block the discomfort of contractions.  Epidural anesthesia starts working 10-20 minutes after the medication has been injected.  Pain relief lasts as long as your labor, since more medication is given through the catheter.     

• Benefits:Usually provides excellent pain relief

• Small amount of medication is used, so you remain alert

• Small amount of medication reaches the baby

• Safer than general anesthesia, if cesarean section is required

Disadvantages:

• Does not provide enough or patchy pain relief

• Restricts walking or other movements that may help labor’s progress

• May affect urge to push and pushing ability

• Possible shivering and itching

• May require urinary catheter

• Requires constant monitoring to detect complications and/or progress

Potential Risk to the Mother:

• Fever

• Drop in blood pressure

• Baby not in a head down position, may be breech (bottom first) or transverse (laying on its side)

• Because it may interfere with the progress of labor, increased need for Pitocin

• Increased need for forceps and vacuum to assist delivery

• Increased need for cesarean section

• Post birth headache that may not be relieved by medication

• Backache continuing after delivery

• Severe complications are very rare but include paralysis and death

Potential Risk to Baby:

• Medication crosses placenta

• Special care and test for infections if maternal fever develops

• Complications due to forceps, vacuum or cesarean delivery

• Short-term changes including irritability and inconsolability

• Increased chance of fetal distress due to mother’s low blood pressure

• Slowed sucking and rooting reflexes sometimes making breastfeeding more difficult in the first 24 to 48 hours.

Spinal anesthesia also given by an anesthesiologist is primarily used for Cesarean Section deliveries.  Spinal anesthesia provides a deeper pain relief than an epidural and works quicker. Pain relief usually last about two and one-half hours.  

 Minimizing Risk of pain relief medications:

• Use the comfort measures you have learned in childbirth class.  With pain medication you will still need support and comfort during your labor.

• If possible, let labor start on its own.

• Stay home as long as possible.  Most women are able to find comfort at home in many more ways than in the hospital

• Keep moving as much as possible throughout your labor.

• If you have an epidural, wait to push hard until you have the urge to do so or the baby’s head is seen at the vaginal opening.

Labor, like life, sometimes brings surprises.  Feel good about giving birth!

Resources:
Reents, J.N. (2002). Epidural:  An Option for You? ePregnancy, 118-120

AWHONN. (2001).  Nursing care of the woman receiving regional analgesia/anesthesia in labor (Evidence-Based Clinical Practice Guidelines).  Washington DC: 

The Society for Obstetric Anesthesia & Perinatology, (2002)  Pain Relief Options During Childbirth.  http://www.soap.org/obpamph.htm

Lothian, Judith A., RN, PHD,LCCE, FACCE,  Pain Relief Medications, What you should know before your labor begins. Lamaze Parents Magazine.  2002 Fall/Winter Edition, p 46-47