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Pain in Labor


Women just after giving birthBring up the subject of pain in childbirth in a room full of women, and you’ll start a conversation that could go on for hours. Everyone has something to say on this topic—even people who never experienced labor themselves have a story to tell about their sister’s or friend’s experience with pain.

Women are given very mixed messages about pain in childbirth. They are told it will be tremendously painful and that you need to use drugs to control the pain. They are also told that pain is all in the mind, and that they should be able to control the amount of pain they feel.

Here’s the truth: labor is usually painful. Studies have shown that pain is registered the same by everyone. If you subject a wide variety of people to a pinprick, they will all physiologically feel the same amount of pain. What varies is how each person decides, consciously and unconsciously, to respond to it. The ability to respond less intensely to painful stimuli makes it feel like less pain.

The level of perceived pain is also affected by factors that are not necessarily under the control of the woman in labor. These factors include the baby’s position, the labor environment, who is with her during labor, whether or not she has given birth before, and how tired she is.

Why Does Labor Hurt?
Try squeezing a muscle in your calf or arm very tightly and holding it there for some time. After a while, it will begin to hurt, and maybe even cramp up. During labor, the uterus begins to squeeze very tightly, more than it ever has before, in order to move the baby down toward the birth canal.

Contractions of the uterus come in waves. In the beginning of labor, they are further apart and shorter in duration. As labor progresses, they go on longer, and there is less time between them.

Labor generally begins as a mild tightening, slowly building up in strength and intensifying to an almost tingling, burning sensation. Some women liken the pain of uterine contractions to strong menstrual cramps. Others say it feels like an incredibly powerful elastic band is squeezing their lower abdomens.

As labor progresses, the cervix begins to open up so that the baby will be able to pass through, and that causes new sensations. It can feel sharper and lower than the initial contractions. You may begin to feel pressure on the cervix, pelvic joints, and vagina. This pressure can feel almost needle-like.

Sometimes babies are not curled up in the neat balls that make for easier births. Their heads, instead of being tucked in, can press into the small of the mother’s back. This is known as back labor.

Another type of sensation is the stretching of the vulva in the final stages of labor, when the baby is passing through it. If you take your fingers and try to stretch your mouth open as wide as it can go, and then just a bit beyond that, you can get an idea of how that can feel. There is a stretching, burning quality to this type of pain.

The question is: how do you handle pain? We will look at both pain medication and natural ways of dealing with pain in labor. But, first, it is important to know that women do not need to have pain completely eliminated in order to report satisfaction with the birth experience. The pain of childbirth is not like the pain of injury, because it has a purpose and is productive.

Of course, women also don’t want pain to overwhelm and incapacitate them, and many are afraid that this will happen. Women receive little in the way of cultural messages that reassure them. Our culture teaches us to be fearful of losing control, and birth is a big unknown for most women.

Preparing yourself with an arsenal of nondrug pain-relief techniques can empower you and boost your courage as you approach the upcoming delivery.

Today’s Pain Medications: There are two major techniques used for women seeking drugs for pain relief during labor: narcotic analgesics and epidural anesthetics.

Narcotic Analgesics reduce pain and promote sleep. The most commonly used narcotic pain relief is Demerol. Other choices include Nubain and Stadol. Sometimes another drug, know as an antagonist, is added to the narcotic to decrease some of its negative side effects (such as nausea and dizziness).

While they do not completely alleviate pain, narcotics can either reduce pain or make it seem more tolerable by virtue of their relaxation effect. They are sometimes also used to lower high blood pressure during labor.

Narcotic pain relief is administered either by an intramuscular injection (usually in the buttocks) or via an intravenous (IV) line. It is best to avoid taking these drugs in very early labor, when they can slow things down.

Once you have reached the pushing stage, however, they can affect the baby’s respiration. When you take these drugs, so does the baby. The placenta reduces the effects, but about 70 percent of the medication reaches the baby. Narcotics slow down the baby’s heart rate and affect his respiratory system while he is still in the womb, and if given too close to birth, can also impact respiration after birth.

Babies of mothers receiving narcotics show general sluggishness and sometimes have trouble feeding in the early days. Taking these drugs can have an impact on early bonding, with both mother and baby feeling too dazed to respond well to each other. This can make breastfeeding a challenge at first.

One of the major problems with narcotics in labor is that it is not possible to predict how an individual woman will react to the drugs. Some women find the relaxation effects make it easier for them to carry on, while others find that they end up feeling fuzzy-headed and out of touch with their labor. Some women feel spacey, but experience no reduction in pain.

Epidural anesthesia, also known as an epidural, epidural block, epidural analgesia, and walking epidural, is injected into the spinal area to actually numb parts of the body. This has become the most popular form of chemical pain relief during labor. Unlike narcotic analgesia, epidurals leave women clearheaded and provide the most effective pain relief.

A local anesthetic is used to numb your back, followed by a needle that is inserted into the epidural area of your spine, where all of the nerves that register pain are located. The anesthesiologist will then thread a tiny catheter into this space, which is hooked up to a bag of medication. This medication might be an anesthetic, an analgesic, or a combination of both types.

A walking epidural is one in which low doses of medication are mixed with narcotics so that you don’t lose all of the sensation in your lower body. Its name is a bit misleading because most women are still not able to walk around much. They are usually able to feel their contractions, however, and can sometimes squat, kneel, or stand during labor.

You will be given intravenous fluids to hydrate you before you receive the epidural in order to prevent a drop in blood pressure that often occurs. Your blood pressure will require frequent monitoring. Since your body is numbed from the waist down, you will not be able to tell when you need to urinate. For this reason, a catheter will be inserted into your urethra. You will also need to be hooked up to an electronic fetal monitor (EFM) to be sure the baby is handling the epidural well.

Side effects of epidurals are unpredictable. The biggest side effect of all is that it can significantly slow labor down, and reduce the contractions. This can cause the baby to shift her position, or not go down into the pelvis. Since women usually can’t feel their pelvic floors, their ability to push is reduced. All of these side effects present an increased chance that one or all of the following procedures will be needed:
Three times the chance of augmentation of labor with drugs such as pitocin.
Three times the chance of a forceps or vacuum-extraction birth, procedures that typically require an episiotomy.
A 50 percent higher chance of having cesarean if the epidural was given toward the beginning of labor.

Other possible side effects to the mother include:


  • Failure to eliminate pain for no discernible reason, elimination of pain in only half of the body, numbing the entire spine, and problems locating the appropriate injection site. This can often mean the procedure needs to be repeated.

  • Loss of mobility, in many cases making it impossible for a woman to do anything but lie flat on her back. This has been shown to be one of the least effective positions for helping labor to progress.

  • A toxic or allergic reaction to the drugs used.

  • Itching or nausea caused by certain drugs such as Sufentanil, Demorol, Duramorph, Fentanly, and Stadol in about one out of four cases. Sometimes this is so severe the woman will need an antihistamine, which will make her drowsy.

  • Fever, which becomes increasingly likely if the epidural has been in for four hours or more.

  • Decrease in maternal blood pressure.

  • Serious headache or breathing difficulties, which can result when the anesthesiologist inserts the needle into a blood vessel or the spinal canal instead of the epidural space. In extremely rare cases this can also result in meningitis, cardiac arrest, or even death.


While little is known about the effects of epidurals on infants, potential complications include:


  • Heart rate deceleration and a drop in oxygen supply as a result of the mother’s reduced blood pressure.

  • Rapid heart rate and fever, often requiring antibiotic treatment.

  • Subtle changes in newborn reflexes and neurobehavior, including suckling ability.

  • Difficulty in self-soothing or being consoled.

  • Other links still being studied include increased rates of hypoglycemia in infants exposed to epidural, and increased addiction rates in children who are exposed to pain-relieving drugs during labor.


For more information on epidurals read The Hidden Risks of Epidurals.

Preparing for Pain in Labor: The efficiency of pain-relief methods during labor has been more studied than any other medical aspect of pregnancy—yet the adverse effects on mother and baby are one of the least studied. That’s one reason why so many women are turning to natural ways to reduce and cope with pain—methods that do not involve the use of drugs. If you become familiar with these techniques, you can minimize the chance that you will need to rely on medication during labor.

There are a number of ways to approach preparation for pain in labor, ways to mentally prepare yourself and also specific pain-relief techniques that you can begin to practice now to prepare for birth:


  • One-on-one continuous labor support has been shown to be one of the most effective methods for reducing pain in labor in a number of well-conducted studies. Consider hiring a doula if you have not done so already.

  • Studies have shown that women who take a childbirth education course use significantly less pain medication than those who do not.

  • Preparing a birth plan and visualizing the labor can help you to get ready for pain in labor.

  • Begin to get used to the idea of going with the pain, rather than fighting against it. Women who report painless labors describe themselves picturing what is happening in their bodies, and then relaxing and allowing it to happen.

  • Continue to raise your own awareness of any fears you have. Holding on to unexpressed fears may increase the sensation of pain and make it harder to cope.


Nondrug Pain-Relief Techniques: There are a number of highly effective natural pain-relief techniques that may be useful during your labor and delivery. Practice these ahead of time and purchase any materials you may need:


  • Bathing or showering in warm water is an amazing labor tool for pain relief that has been well studied. Choose a temperature that feels comfortable and soothing, but not too hot. If you are having a home birth, it is possible to rent large hot tubs that can be set up in your home or you can use your bathtub. If you plan to use the shower, a low, stable stool that you can put inside is helpful so that you don’t have to stand the whole time.

  • Effleurage is a light, rhythmic stroking of the abdomen, back, or thighs, usually done on bare skin with the tips of the fingers. You can do this yourself, or better, have a partner or doula do it for you. You can ask your partner to practice it now and learn, together, what feels right to you. Hold your fingers in an outstretched but relaxed posture. Run the tips of the fingers lightly over the chosen area. Try different motions, circular or up and down. Experiment with different amounts of pressure. Use a little cornstarch or lightly scented power on your fingers first, to reduce friction.

  • Massage is another way to relax and help tired muscles keep working. Again, it is helpful to have your partner practice this ahead of time in order to find what works best. For lower back pain or back labor, use the fist or the heel of the hand or a tennis ball to firmly massage the area. You may want to purchase massage oil.

  • Essential oils can evoke pleasant images in your mind, as well as help to cover up unpleasant hospital smells. You can put drops of oil on a napkin and keep it nearby, or on a damp washcloth for your forehead.

  • Different labor positions work at different times during the labor process to relieve pain and discomfort. For example, getting on your hands and knees and rocking back and forth often helps with the discomfort of back labor. Walking around can reduce the sensation of pain as well. Become familiar with the different positions ahead of time.

  • Have hot and cold packs available for use during labor. You can use a good old-fashioned hot water bottle or an electric heating pad.

  • Most childbirth education courses teach helpful breathing techniques specifically geared toward working through pain in labor. The discipline of yoga also teaches both calming and invigorating types of breath exercises.

  • Studies have shown that getting regular exercise during pregnancy reduces pain during labor. It is not too late to begin to do that even now. You might want to try daily walking.

  • You can take childbirth education classes that offer hypnosis. You may want to consider this option, or consider seeing a private hypontherapist who can train you to use autohypnosis or posthypnotic suggestion to prepare you to react to pain in a different way.

  • In China, acupuncture is used during cesareans instead of epidural anesthesia in 98 percent of cases. While acupuncture is not practiced during surgery here in the US, it can be used during labor. You will need to find a trained acupuncturist who is willing to attend the birth with you.

  • Acupressure may also be helpful, and it is possible that your partner can learn enough about it ahead of time to use during the delivery.

  • Bach flower remedies can be extremely soothing during childbirth, especially the highly popular Rescue Remedy.

  • Homeopathy is also useful. Arnica is one remedy that is particularly good for labor. Other pain remedies are both blue and black cohosh and Chamomilla. A homeopath can help you with correct dosage amounts.

  • Music can be soothing and distracting for some women, whereas other women may find they want silence for some or all of the labor process. Choose some favorites ahead of time and set them aside for labor. You may need to bring your own CD player with you if you are going to a birth center or hospital, or you can use an iPod, or MP3 player.

 

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