Birth Plans

Pain Management in Labor

When exploring your options, it may be wiser to first study the styles of pain management rather than the exact techniques of each style. This allows you to gain a better understanding of what each method or technique will require of you for its successful use during labor.

Epidural or Spinal Medication

The terms "epidural" and "spinal" do not refer to any specific medication, but the way in which the medication is administered - into either the spinal or epidural space in your back. These techniques are generally referred to as regional blocks because the medication prevents nerves from sending signals to the brain and so numbs or reduces pain in a region of the body (from the abdomen down). Administration will require you to sit or lye with your back rounded over for up to twenty minutes while an anesthesiologist inserts a catheter into your back. You will not be allowed to move during the insertion. Epidual and spinal are only available in hospitals, and must be administered by an anesthetist.

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Mental Relaxation Techniques

There are various mental relaxation techniques that can be used to promote relaxation during labor. Some techniques aim to focus your thoughts, others to distract you. To be successful at using mental relaxation techniques during labor, you will need to spend several weeks practicing with them. You can read some examples of mental relaxation.

Narcotic Analgesics

Unlike a regional block, a narcotic analgesic will reduce your entire body's ability to sense pain or discomfort. These medications are administered through a shot or IV and will wear off within a few hours. Because of health risks to the baby, most health care providers will not recommend these types of medications if you are within two hours of your baby's birth. Narcotic analgesics can be administered in hospitals or bith centers.

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Nitrous Oxide

Nitrous oxide provides a good, but brief relief from pain. Administered through a mask which you hold to your face yourself, you get relief when you want it. Because the half-life of nitrous oxide is so short, there is nearly none that reaches the baby. A highly portable and quite safe method, it is even empolyed at home births.

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Physical Comfort Measures

In general, any technique that you use for physical comfort in your day to day life can be used during labor. Hot and cold packs can be useful if you feel cramping or a back ache. Massage can help to refresh sore muscles. Sipping warm tea or cool water can keep you hydrated and energized. Using physical comfort measures successfully during labor does not take much practice, however you will need to find a way to remind yourself to use these techniques during labor. It may be beneficial to familiarize yourself with the tools available to you at your birth place. You may also find that reviewing suggestions for how to use comfort meausres helps prepare you for using these techniques in labor.

Position Changes

The way in which your body is positioned during labor can make a difference in the sensations that you feel. Some positions improve your baby's ability to navigate through the pelvis, other positions hinder his efforts. Some positions can help to reduce the pressure associated with a back labor, other positions make it easier to relax your body and rest. A support person can usually help you make position changes without having practiced positions, however to understand how to use positions effectively you may want to read about the benefits of specific positions during labor. It is also important to understand that some medical interventions will limit your ability to change positions.

Water

Most hospitals and birth centers have both tubs and showers for your use during labor. Many women find that they are better able to relax and can handle their contractions with less discomfort while they lie in a tub of warm water. A shower is equally useful in easing discomfort, and has the added advantage of the pressure of the stream of water that can be positioned to massage you just about anywhere you may need it.

Risks

Any medication you take during labor will affect the baby. Please refer to the appropriate pages to review the risks of specific medications.

Most non-medicinal comfort measures have no medical risks, however positions may be uncomfortable or the technique may not work effectively causing frustration.

Childbirth Medications Research

Hughes D, Simmons SW, Brown J, Cyna AM. Combined spinal-epidural versus epidural analgesia in labour (Cochrane Review)
This review begins with the following background information:

Traditional epidural techniques have been associated with prolonged labour, use of oxytocin augmentation, and increased incidence of instrumental vaginal delivery. The combined spinal-epidural (CSE) technique has been introduced in an attempt to reduce these adverse effects. CSE is believed to improve maternal mobility during labour and provide more rapid onset of analgesia than epidural analgesia.
After a review of the literature, the researchers have found that "There is no difference between CSE and epidural techniques with respect to: the incidence of forceps delivery, maternal mobility, PDPH, cesarean section rates or admission of babies to the neonatal unit."
The differences they did find were:

Bennett, A., Hewson, D., Booker, E., & Holliday, S. (1985). Antenatal preparation and labor support in relation to birth outcomes. Birth, 12,9.
Women who received epidurals were less satisfied with thier childbirth experience.

Joseph Gambone, D.O. and Katherine Kahn, MD, "The Effect of Epidural Analgesia for labor on the cesarean Delivery Rate," Obstetrics and Gynecology 83, no. 6 (June 1994): 1045-1052.

Thorp, MD, et al., "Epidural Anesthesia and Cesarean Section for Dystocia: Risk Factors in Multiparas." American Journal of Perinatology 8, no. 6: 402-410.

Thorp, Md, et al., "The Effect of Intrapartum Epidural Analgesia on Nulliparous Labor: A Randomized, Controlled, Prospective Trial," American Journal of Obstetrics and Gynecology 169, no. 4: 851-858.

"The Effects of maternal Epidural Anesthesia on Neonatal Behavior During the First Month," Developmental Medicine and Child Neurology, 1992.

G.A. Albright, Anesthesia in Obstetrics: Maternal, Fetal, and Neonatal Aspects (Menlo Park, CA: Addison-Wesley, 1978)

"The Effect of Lumbar Epidural Analgesia on the Rate of Cervical Dilation and the Outcome of Laobr of Spontaneous Onset," British Journal of Obstetrics and Gynecology (1980):87.

"The Influence of Maternal Analgesia on Neonatal behavior: Epidural Bupivacaine," British Journal of Obstetrics and Gynecology (1981): 87.

"Obstetric Consequences of Epidural analgesia in Nulliparous Patients," Lancet (1971): 7708.

"Lumbar epidural Analgesia in Labour: Relation to Fetal Malpositioning and Instrument Delivery," British Medical Journal (1977): 1.

"The Effect of Continuous Lumbar Epidural Analgesia in the Acid-Base Status of Maternal Arterial Blood During the first Stage of Labour," Journal of Obsterics and Gynecology British Common, (1973): 80.

"Regional Obstetric anesthesia and newborn Behavior: Effect Over the First Ten Days of Life." Pediatrics (1976): 58.