During the early part of your pregnancy, you may have been too busy spreading the good news to think about the actual delivery. But as the big day draws near, it’s only natural to worry about the pain of labor. Following is some information that may ease your anxiety.Well in advance
Developing a trusting relationship with your obstetrician and knowing what to expect during delivery will help ward off tension. Aside from teaching the physical stages of labor and delivery, childbirth classes can educate you about birthing options as well as exercises that can help reduce pain. Ask your obstetrician to refer you to a class or call the hospital for information.Self-help during labor
Besides practicing the skills you learned during your childbirth class, you might also try these tips:
Diversionary tactics. Many women help take the focus off the pain by redirecting it—onto a favorite stuffed animal, for example.
Climate control. Back pain during labor can be soothed with a heating pad or a warm compress. If you are too warm, a cool, wet cloth dabbed on your face and neck will feel good.
Creature comforts. Trying different positions during labor may help. Some women find that rocking in a rocking chair, for example, eases pain.Medical relief
Two different types of medications can take the edge off labor pain: systemic medications, which relax your entire body, and regional anesthetics, which numb specific areas of your body.Systemic options include:
Sedatives, tranquilizers and barbiturates. Although these medications do not control pain, they can help you relax or even sleep during the earliest part of labor, allowing you to conserve energy. Some may also quell nausea.
Narcotics. Narcotics offer reasonable pain relief and do not interfere with pushing ability. However, they have a sedative effect and may induce nausea, vomiting, dizziness, itching and occasionally respiratory problems. In many cases, they aren’t as effective as expected. Another concern is that they can slow the baby’s breathing at birth. Should that occur, medications can be given immediately after the baby is born to counter the narcotic effect.Regional anesthetics include:
An epidural block. Given during the active phase of labor, the anesthetic is injected into the space just outside the dura—the sac membrane that surrounds the spine. Then a catheter (a very thin, flexible hollow tube) is passed through the needle and taped in place. The needle is withdrawn and the anesthetic is administered as needed through the catheter. An epidural will numb you from the waist down.
Although many women can bear down effectively despite the anesthesia, some may be too numb to push the baby through the birth canal. In such cases, the obstetrician may need to use forceps or suction to pull the baby out.
A spinal block. In a spinal block, the anesthetic is injected into the spinal fluid to reduce sensation from the waist down. Spinals differ from epidurals in that no catheter is used, so the medication can be given only once. Occasionally, doctors order a spinal block late in labor and sometimes just before a forceps delivery.
The advantages of both an epidural and a spinal block include:
- The anesthesiologist may be able to regulate the drug’s effects by adjusting the type and strength of the medication.
- You are almost completely pain free yet alert during labor and delivery. You can rest during dilation, which means you may have more energy when it comes time to push the baby out.
The disadvantages include:
- An epidural can slow the baby’s heartbeat. This may be prevented with intravenous fluids.
- Loss of sensation may make it harder to push the baby out.
- During administration, you must remain in an awkward position for five to 10 minutes, then wait up to 20 minutes before the medication takes full effect.
A combined spinal/epidural block. Dubbed the “walking epidural,” this relatively new technique offers strong relief. Early in labor, the epidural needle is inserted and properly positioned. An extremely small spinal needle is then placed through the epidural needle into the spinal fluid, and a fast-acting narcotic is injected. Sometimes a very small dose of anesthetic is also given. Within minutes, your pain will be relieved yet you will still be able to stand and walk. The spinal needle is withdrawn, and the epidural catheter is inserted. The epidural needle is removed, and the catheter is taped in place. Later, when labor pain becomes more intense, the anesthesiologist can inject anesthesia through the catheter to numb you from the waist down.
Make time to discuss pain relief options with your obstetrician well before delivery. Be sure you understand each option thoroughly, including the benefits and risks of each, and feel free to state your preferences. Keep in mind, however, that certain medical conditions may arise during delivery that may prevent your obstetrician from following through as planned.
Well in advance
Self-help during labor
Systemic options include:
Regional anesthetics include: