By Barbara Smith Decker
One of the best ways to reduce pain during labor and delivery is to prepare for it. Knowing what to expect – and understanding your options for managing childbirth pain – will help you feel more relaxed and empowered when the time comes.
The amount of pain a woman experiences during labor depends on the baby’s size and position, the mother’s pelvic dimensions, strength of contractions, cultural and personal expectations and levels of fear and anxiety. Each woman’s labor is different and how she experiences pain is different.
Pain management begins with a positive attitude, knowledge and motivation,” says Dr. William Camann, co-author of the upcoming book, Easy Labor. “The best way to approach labor is with an open mind to ensure the safest outcome for the baby.”
Currently, the most popular approaches to managing pain during childbirth are coping methods (such as labor-coaching, meditation, hypnosis, spirituality or other “natural” methods) and medications (including anesthetics and/or narcotics).
Since the advent of ether 150 years ago, medications have been used to lessen sensation by numbing parts of the body with anesthetics and reduce anxiety and pain perception using narcotics. The choice of drug and its dosage is based on the risks and benefits to both mother and baby.
Research shows that medications are safe when administered at the proper time and dosage during the labor process. Epidural anesthesia, the most commonly used form of labor pain relief in the United States, is currently used in almost two-thirds of labors. Narcotics may be added to an epidural anesthetic to make it take effect faster, last longer and afford the woman more mobility because less anesthesia is needed.
Trends in Pain Medication
As research, technology and drug use have advanced, a number of trends have emerged:
Complementing traditional “natural” childbirth techniques with pain-relief medications has become increasingly mainstream. Breathing and relaxation techniques, continuous labor support from a trained partner, movement and positioning, laboring or birthing in water, massage and hypnosis are among the traditional and most popular non-drug methods of pain management.
Reduced dosage of pain medications allows greater motor function in the legs, ability to push and smoother progression of labor. One example of this lesser dosage, commonly referred to as the “walking epidural,” gives women enough mobility to change position in bed – but, despite its moniker, not enough muscle control to walk.
Woman-controlled doses allow the laboring mom to dispense her own intravenous medication, thereby customizing her own degree of pain control. Woman-controlled epidural anesthesia is gaining popularity, but is not yet available in all hospitals because of equipment cost and the need for staff training.
Combined spinal epidural anesthesia is used in place of an epidural. With the insertion of only one needle, the spinal injection allows for pain relief within minutes, and the epidural catheter requires a lower dose, affording the woman more mobility than with traditional epidurals.
Earlier administration of epidurals. Very recent research shows evidence that epidurals can be given much earlier in labor, without higher risk of Cesarean delivery or longer labor. As of yet, the standard practice of not administering an epidural until a woman enters active labor has not been widely affected.
“The decision to have pain medication is up to the patient,” says Laura Riley, M.D., recent head of the American College of Obstetricians and Gynecologists’ Committee on Obstetric Practice. “But what you get and when you get it is what you negotiate with your doctor, and that depends on what is available in the setting where you deliver.”
As with all types of medicine, a patient’s options are dependent on the knowledge and training of the practitioner. The bottom line is you need to know what is available and what you want. While it’s hard to plan for an experience that you’ve never had and can’t predict, you can decide on which elements of pain management you want to incorporate into your birthing experience.
To get what you want, you need to know your doctor or midwife and the birthing place. “If you don’t want an epidural, then you don’t want to go to a place with a high rate of epidurals,” says Dr. Riley.
Questions to Ask Your Health-Care Provider
To find out how closely your health-care provider’s views align with your own, ask questions like these:
What are the usual pain relief measures you recommend for the women you work with? How successful are these methods, and what are their side effects?
If I got an epidural, when would you give it to me?
What are my options if I don’t want an epidural or spinal block?
Will you be on duty during my entire labor? Will the staff attending me stay through delivery or change according to their shifts?
What percentage of the women you work with give birth without pain medication?
What do you think about traditional, non-drug pain management options, such as water birthing, hypnosis, massage, relaxation and breathing techniques?
Questions to Ask Before Choosing a Birthing Place
Before making a decision on a birthing place, tour the hospital or birthing center and ask about your options:
• Find out which kinds of pain relief medications are available.
• Check out which non-drug pain relief alternatives are offered.
• Ask what percentage of women receive epidurals, have C-sections, receive surgical interventions, labor without pain medications, etc.
You may also want to evaluate your health insurance and “upgrade” your policy to include providers and services outside of network.
When the “big moment” arrives, explain your key expectations and preferences to the doctor or midwife and labor staff attending you. If appropriate, give them a written birth plan that explains the kind of support and pain relief you want (see Resources). But remember, should medical intervention be necessary, be adaptive enough to follow the advice of your doctor or midwife to ensure your own health and that of your baby.
Easy Labor: Every Woman’s Guide to More Joy and Less Pain during Childbirth, by William Camann, M.D., and Kathryn Alexander, Ballantine Books, slated for publication in December 2005. A comprehensive look at all aspects of medical and alternative labor pain relief.
PainFreeBirthing.com – Uses animation to show how different pain medications work and offers links to non-drug pain relief techniques.
Midwife.org/focus/ – Connects to the consumer pages of the American College of Nurse-Midwives, which offer tips on making choices regarding pregnancy care, labor and birth.
Barbara Smith Decker is a freelance writer and mother of three children.
From United Parenting Publications, June 2005.