Pain Management During Labor and ChildbirthRani Long |26, January 2000
Pain management is, no doubt, the number one topic when it comes to labor and delivery. After all, when you try to envision the feat your body will perform, you'll be glad you did your research.
Some natural childbirth advocates claim that medication-free labor can actually be painless, that your body is made to perform this task and that it doesn't need to hurt. Perhaps so. But my body, for example, is just not accustomed to the task of passing an eight-pound object through it, so I educated myself on the options.
I've often heard the epidural fervently called a blessing, both from women I know and from reading many childbirth stories. My own particular fear regarding the epidural was, not so much the side effects as, the huge needle that's used to insert this pain relief into your spine. "They're going to stab me with a horrible sharp needle to take away my pain?," I thought skeptically. Some women say that, in fact, it did cause them a lot of discomfort.
A flexible catheter is inserted into your spine to numb your lower body, then taped into place so that you can move around on the bed. They will also give you an IV drip if you get an epidural.
I am living proof that, when done right, the epidural is indeed a blessing. I was so inwardly focused on getting through the pain of contractions that truly, just knowing that relief was coming made any effort worth the cost. I sat on the edge of my bed and leaned forward, praying a contraction would not come. But it did, and with all my might I remained still as first a very small needle of local anesthetic was applied;and because of this, I never felt the big needle. No, I really didn't! I got two more contractions, then felt cool fluid racing down the inside of my back, and the relief was magnificent.
There can be side effects. I was just lucky not to get any adverse ones, except for the accompanying numbing of legs which will eventually confine you to bed. It was a sort of disturbing wooden feeling, but it was better than pain. Some people get headaches up to a week afterwards. The possible danger regarding the baby is that an epidural can slow down labor. It did for me, and Pitocin was eventually used to get things going again. Still, my own baby was born perfectly alert, a lovely color and so healthy that to this day he's barely even had a diaper rash.
The last two things I can say about the epidural are these: many doctors turn it off before the pushing stage, so that you will have more strength to push. My midwife turned it off, to my chagrin. So find out ahead of time what your doctor's usual policy is--you may really want it for the big finale. Also, there is a 15% chance of ineffectiveness--sometimes it skips certain areas that it should numb. So it's not always a miracle. But a the most effective option if you want to be wide-awake and mostly pain-free.
Narcotics such as Demerol and Stadol can be given in the active phase of labor, usually through an IV, and they supposedly "take the edge off" the pain. Along with that comes sedation or drowsiness. I was given Demerol after my son was born, and was in a lot of pain from tearing and stitching. I was given enough Demerol to knock me unconscious for five full hours, missing my son's first bath, first meal, first hours. The medical staff seemed surprised at my reaction. So again, talk to your physician about possible effects and if these drugs are right for you. They can also, if given too close to delivery, cause respiratory depression in the newborn.
There are sedatives available, such as Seconal. This is given orally, and is not pain relief -- it just helps the laboring mother to rest a bit as it causes drowsiness.
Tranquilizers Phenergan and Vistaril offer no pain relief if used alone. They do alleviate nausea than can be caused by a narcotic, and increase the mother's ability to relax.
Local anesthetic Lidocaine is used to numb the skin for episiotomy and repair by injection directly into the perineum. Again I insert my own experience with this -- no one waited for the pain relief to kick in, so make sure your doc waits a bit!
The pudendal block, often given for cases of forceps deliveries, is injected through the vaginal wall, blocking the pudendal nerve that runs along each side of the cervix. This allows patients to actively push, and can help when an episiotomy is being repaired. It does not, however, help the pain of contractions.
A spinal, much like an epidural, is injected into the spinal canal, and is used for C-sections. It offers relief from the chest down, and allows the mother to be alert for the birth of her baby. It, like the epidural, can lower a woman's blood pressure, and can cause the "spinal headache". It is different in that it's not used for labor, just delivery.
Pain is often associated with someone who is injured or dying. Childbirth is all about vibrant life. It's important to try and keep the birth experience positive by remembering that you get a huge prize for your efforts.
Being armed with knowledge about your labor relief options, whether they are medicinal or natural, helps you to feel in control, and that sense of control works wonders in your perception of pain.
Being flexible and taking your cues from the course of your own unique labor, rather than all of your preconceived notions, helps to prevent a sense of disappointment that things are not going your way.
Last, remember that people always say it's worth it when they finally see their warm, bright-eyed little baby, and it really is.
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