At some point in some labors a woman may be faced with the recommendation to use medication to assist with labor. For the mother who planned a natural birth, this can be frustrating and disappointing. It can also be somewhat confusing for the labor supoort. How do you know if it is time to use medication, or if she needs you to help her give birth naturally? Unfortunately there are no hard and fast rules for when to use a medication. If you find yourself in labor not knowing what to choose, the following considerations may help you decide how to proceed.
Before deciding one way or the other make sure you understand what the purpose is for the medication. What do you hope will happen if you use it? Then find out if there are other ways you could try to achieve the desired goal. Find out what the next step would be if the medication is not effective, and find out what you need to do to make the use of the medication the most effective. Help her weigh the risks and the benefits. If the goal is to lessen pain she may feel trying different positions has a better ratio of risk to benefit. However if the goal is to get some sleep so her body can continue with a non-surgical birth, she may feel the risks of not using the medication and not sleeping are higher than the risks of using a small dose of medicine. You may find it takes time to assess the situation and make an informed decision, and that is usually OK. Most of the time there is not a problem putting off a medication for an hour or two while you wait to see if something else will be effective. Take the time you need to explore your options.
How does the timing of the labor affect her desire to use a medication? She may find it more appropriate to use a medication if labor has lasted longer than 18 hours than when she was two hours into labor. Some medications should not be used at certain times. Help her ask questions regarding the timing of this medication and effects on the rest of her labor, so she can make a good decision.
If the medication being considered is for pain, pay attention to how she is managing labor. It is not realistic to expect comfort measures to keep you relaxed and pain free during contractions (even though some women experience labors with little or no pain). If the comfort measures allow her to relax and not be overwhelmed between contractions she is actually doing very well. Most women who choose to give birth naturally go through a time in their labor when they feel like they just need “a little something.” It isn’t that they need pain medications; they just need a little extra help getting over the current hump. Sometimes all it takes is reassuring her and helping her abdominally breathe. A good technique is to give her half an hour to an hour to try different techniques and positions to see if something is more comfortable before committing to using a medication. You may find something that works much better for her, or you may find she is pushing before the hour is through.
Get her in the tub or shower: Water can work wonders to relieve discomfort in labor. It is so effective some midwives refer to it as a “waterdural.”
Go for a walk: If she is willing to move, get her walking. Even if it is a very slow walk between contractions the pelvic movement will be good for aligning the pelvis and she may just find her contractions are more comfortable in an upright position.
Change positions: She may not want to move, but encourage her to try. Changing positions can work wonders because it can help the baby change alignment. This is especially helpful if you are waiting for an urge to push or dealing with a long transition.
Go to the Bathroom: It can be difficult to determine the source of a strong pelvic pain. If she has not emptied her bladder in an hour or more, get her to the toilet. Keeping the bladder empty will make more room for the baby to maneuver and reduces pressure for the mother.
Vocalization: If she has not been making noise, encourage her to open her mouth and breathe loudly with her contractions. Her breathing will naturally become low moaning tones (if she is screaming get her to open her mouth and just breathe heavy). This can provide a tremendous release of tension and give her a way to let out the stress of her contractions.
Empathize: Labor can be very frustrating and it is OK for her to spend a few minutes working out the frustration she feels. Let her cry and reassure her that she is doing a good job, it is just the hardest work she will ever have to do. If possible point out the progress she has made, but do not try to talk her out of being upset. If her crying persists for longer than 10 minutes she may need help refocusing her energy to a more productive activity.
One Contraction at a Time: If she is very overwhelmed, keep her focused on the next contraction. Make a plan for her or with her and then help her work that plan (for example: “when the contraction begins you are going to sway your hips, just sway your hips”). When the contraction is done praise her for the good work and remind her that is one contraction that just accomplished a lot of work. Do not plan beyond the next contraction.
Distraction: If she just needs to get through the next few minutes try getting her to close her eyes and shut out what is happening around her. If she is able, help her to use visualization or other relaxation technique. If she is not able to focus with her eyes closed have her look at you, right in your eyes and focus on your breathing. Have her try to match her breathing to yours – keeping it deep but manageable.
Regardless of the decision, understand that you are helping her make the best decision she can with the information available. It is not fair to second guess her decisions after the labor when you have more information. If after labor you decide you would have supported her differently that is ok, and given all the information you now have you and she will probably make a better decision if the situation ever happens again.