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Healthy Pregnancy Series: Pain Management

admin April 20, 2011

“So, are you going natural, or getting the epidural?”  It’s a question commonly asked among women during pregnancy.  And you’ll hear all kinds of opinions on it:

  • “Get the epidural.  All that really matters is a healthy baby.  They don’t pass out medals in the recovery rooms, you know.”
  • “Go natural.  It’s so much better for the baby and for bonding!”

And so on.

I’ve heard it all too.  I was primarily advised by well-meaning friends and family with the first set of phrases in my first pregnancy…and got the epidural.  Then I decided to do things differently the second time, had a home birth (and clearly didn’t get the epidural).  I, personally, preferred a drug-free birth.

But you know what?  It’s not just about “drugs or no drugs.”  That implies that those who don’t get drugs are just trying to be martyrs, or that they’re suffering through it.  (Just like people think that those who don’t take OTC medicines are suffering through, but homeopathy offers great natural options!)  But it’s just not like that.  There are lots of natural ways to combat the pain, too.  Today we’ll talk about both: drugs, and drug-free options.

I’ll Take the Drugs, Please

Despite my preference for drug-free birth, there will be circumstances in which other women either choose or require drugs.  Women who experience emergency c-sections, for example; or women whose labor is extremely long and exhausting.  Drugs can have their place, and so we need to know what they are, how they are used, and what side effects are possible…just in case.  Most of the time, drugs are definitely optional, so it’s important to go into the birth with as much information as possible.

Epidural

This is the most common type of pain relief in labor.

Epidurals are usually a combination of different types of pain medication.  There is no “standard.”  Typically, they are a combination of a local anesthetic (like lidocaine) and a narcotic or opioid (like fentanyl); they may also contain another medication to help stabilize the mother (morphine, epinephrine).  The exact “cocktail” is chosen by the anesthesiologist.  It is then delivered through a tube inserted in a mother’s spine, and it numbs the lower half of the body.

Here are some of the benefits of epidurals:

  • Considered safest for the baby
  • Removes pain, but allows (in some women) some sensation, making pushing easier
  • Allows a woman to rest
  • Much faster recovery than with general anesthesia
  • Much lower negative reactions than with general anesthesia

Here are some drawbacks:

  • Doesn’t always work: can numb just one side, or not at all
  • Does not allow a woman to walk or easily change positions
  • Can make pushing more difficult since a woman can’t easily feel the urge to push (some women choose to have the epidural turned off for pushing for this reason), which increases the risk of needing forceps or vacuum extraction
  • Can work too well, and climb too high, making breathing difficult (especially while lying on your back)
  • Some women say it makes their babies sleepy and interferes with early bonding and the breastfeeding instincts
  • After it is turned off, you will not be able to walk without assistance for 4 – 8 hours, until it completely wears off (and you will probably feel weak for a while)
  • Can cause your blood pressure to drop (which is why it’s constantly monitored)
  • In rare cases, can cause permanent paralysis
  • Also in rare cases, can cause severe headache from spinal fluid leaking

Epidural is not without risks, obviously.  Many women do have a positive experience, but it’s not a decision to be taken lightly.

When I had one, it actually worked well for me.  I had no side effects (other than some trouble breathing when flat on my back, after several hours), and I could actually feel all the pressure of the contractions without the pain.  I knew when I was having one without being told.  Throughout labor, I had enough sensation to be able to change positions — slowly — without help, though I couldn’t get up.  I pushed for less than 10 minutes even with the epidural on.  After the birth, I did feel very shaky and weak for a couple days, but that was probably as much due to the stress of becoming a parent and being away from home and not having eaten anything for a full day, as anything else.  Still, I preferred birth without it!

Opioids

Another pain relief option is an opioid, like Demerol.  It’s less commonly used, but available.  An opioid does not actually numb you, it just “takes the edge off” the pain.  It is given by injection (usually into your IV) and it lasts for an hour or two.

Benefits of opioids:

  • Temporary: if you need a short break to rest and cope only
  • Not injected into your spine (safer method of delivery)
  • Does not interfere with the ability to push (since you can still feel most everything)
  • Can eliminate the need for an epidural

Drawbacks of opioids:

  • Does not really get rid of your pain
  • Can’t walk around after having it
  • Often makes you very dizzy or sleepy
  • Can cause nausea and vomiting
  • Crosses the placenta and can interfere with breastfeeding, the baby’s central nervous system, respiration, and ability to regulate body temperature

Opioids, although they’re billed as a “mid-step” between nothing and an epidural, are actually a lot less safe for the baby, a fact you cannot ignore.  It is probably better in almost all cases to skip the opioid and get the epidural if you really need pain relief (there is less indication that the epidural crosses the placenta and less risk to the baby).

I didn’t know all this the first time, and I had this too, hoping to avoid an epidural (which I maintain I would have…if they hadn’t insisted on breaking my water).  It made me really, really dizzy and sleepy.  I’m not prone to motion sickness at all, but if I were, I probably would have been sick because I was so dizzy.  It really did just “take the edge off,” it didn’t change the pain much at all.  It’s not worth it, in my opinion; the drawbacks definitely outweigh the risks.

Pain Management

I Want to Go Natural

Going natural doesn’t mean you do nothing.  There are actually lots of ways to help your pain without drugs.  It’s going to be different for every woman and can also vary by pregnancy or even the stage of labor you’re in.  The most important thing is to follow your instincts and go with what feels right.  For example, a lot of women find relief in walking around during labor.  I didn’t — it caused me to feel like I was having one giant, extra-painful contraction.  I avoided walking as much as possible!

Methods of natural pain relief:

  • Walking around
  • Sitting/rocking on a birthing (exercise) ball
  • Taking a hot shower (aimed at your low back)
  • Sitting up and rocking
  • Massaging your back (well, have someone else do it)
  • Counter-pressure on the back (especially for back labor).  Try tennis balls.
  • Massage oils for all-over massage
  • Chiropractic adjustment (some will make house calls)
  • Prayer/meditation
  • Focusing on the baby and “opening”
  • Changing positions
  • Soothing music
  • Foot massage (pressure points; can take your mind off the pain)
  • Getting in a pool of water
  • Staying hydrated
  • Eating small snacks, if you want to

Some women also like to do hypnobirthing.  This is a specific method of reducing (or, according to some women, eliminating) pain during birth.  I haven’t done it, but a lot of women swear by it.

I also believe that just knowing what to expect can help a lot.  Women are in pain because they are afraid.  They are told that birth is very painful and they’re just not informed about what will really happen.  We’ve become afraid of birth.  It’s just this unfortunate event that we have to endure in order to end up with a healthy baby.  I believe this leads women to fear the pain, tense against the pain (thus experiencing more pain), and basically, psych themselves out.

When I had my first birth and I didn’t know what to expect at all, I did exactly that — fear, tensing.  I remember that labor as very painful before I had the drugs.  I still remember being scared after that.

My second birth, when I fully trusted that I could do it, I remember being exhausted and feeling very intense.  I don’t really remember it as painful.  I remember small moments of “pain,” but even those I remember as feeling painful only because I was so tired and the intensity was so high.  That is how I would describe birth, really: intense and exhausting.  It is definitely both of those things!

I found that rocking on a birthing ball or sitting up on my bed and rocking helped me cope with the pain early on.  Sitting in a rocking chair did too.  For me, sitting and relaxing — yet moving in a soothing motion, just not on my feet — was key.  Later, getting into the birthing tub and surrendering to it was key.

Every woman’s experience will be different.  Inform yourself and trust your body!  Know what your pain relief options are (including drugs), in case you need them, but don’t take the decision lightly, especially before you even go into labor!  You don’t fully know how you will feel (there are women who think they have a lower pain tolerance who handle labor just fine with no drugs).

If you’ve had a baby, what did you choose?  If not, what would you like to choose?

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12 Comments

  1. Thank you so much for this post! I am pregnant with my first and would like to take a more natural approach. The fear of the unknown already has me a little nervous even though I'm only a few months along but that's something I'd like to learn to work through as much as possible so that it won't be a hindrance during the birth.

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  2. My choice will be the Bradley method. They offer you 12 weeks of classes, focus on a natural birth and walk you through what will be happening with your body, how to prepare your body, what to eat and what to expect during labor. I think this method is more in line with what women use to do during biblical times. I know people who have used this method and they can't recommend it enough. You can check it out on http://www.bradleybirth.com. I really like the fact that they don't just give you a crash course. This can be done at home or in the hospital too.

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  3. I had both of my children naturally & had great experiences both times. Fear is definitely the bigger issue over pain, in my opinion/experience. My first labor progressed very quickly & by the time the doula got to my house, I was in so much pain that I couldn't move. She simply reminded me to breath through the contractions & after that it was so much better. Definitely intense & exhausting, but the only other pain I really remember was pushing that head out! My second labor was much longer, but I already had it in my mind to breath, breath, breath & I don't remember significant pain from that birth either, except for the back labor. But again, my doula really helped me there. She had me drape over a birth ball & she massaged my back & hips. Then she put me in the shower & sprayed warm water on my belly. Such different but both great experiences. I highly recommend being fully present for your baby's birth!

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  4. One thing that helped during contractions with Christopher was squatting. I also sang/hummed some which was relaxing for me, but I don't know about the people around who had to hear me.

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  5. water water water was the best for my pain. my 2nd labor was super fast and intense, but what helped the most was when our tub was finally full and cooled enough for me to get in! i even ended up delivering in the water though i hadnt exactly 'planned' to, it just worked best that way! we are definitely planning on a tub for this next baby!

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  6. I had the Demerol first with my first born trying to avoid the epidural too and hated it! I tried to tell my nurse to stop putting it in when the syringe was half full still because it hit me hard and I got totally loaded! Then I swear she was laughing at me as she pushed the rest in! THEN, it didn't stop the pain! I just passed out of awareness between contractions and woke up for each one feeling them completely. And I was not able to move through them or work through them because I was too messed up and out of it. It also made it so I didn't know what the nurses and doctors were doing. I think they gave me pit against my wishes. So I gave up towards the end of labor, transition time probably, and asked for the epidural. Scared my husband to pieces! And wouldn't you know, that didn't work either! Only numbed one side. So they upped it! I couldn't walk for a full day. Had to call a nurse to take me to the bathroom. It was awful.

    The good news was it did not interfere with breastfeeding or bonding. But I wonder if all the meds affected my baby in other ways, he had other issues like jaundice.

    My next 2 births were drug free and they were wonderful! I loved being so present. And the pain is easily forgettable. Getting through the moment can be hard but I think the most important thing is a good support group, husband doula good midwife. All that. I had like a cheering section for both and it made things so much easier. Plus contractions arent constant (although they almost were with my third but I went from a 4 to complete in just over an hour) so the in between time can be almost euphoric feeling. Way better then any Demerol!

    Thanks for making is post, hope you convinced some moms to be to go drug free!

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  7. With my first baby I really wanted an epidural. I had laughing gas (and really didn't like it) and fentanyl (I really liked it) while I was waiting. By the time the anesthesiologist was ready, I was 8 cm and decided not to had the epidural. I loved this birth experience.

    With my second baby, I knew more about my options and decided to go with a midwife. I was still too scared to have a home birth so I chose to deliver in the hospital. I read a book on the Bradley method a week or so prior to giving birth and found it incredibly helpful. I focused on relaxing my body and not tensing with the pain, as you mentioned, and this worked well for me. I really did not want to have a water birth because I thought it seemed gross, but I managed to get the one hospital room with a tub so I got in to help manage the pain. I fully planned to get out before delivering but when the time came, there was no way that I was going anywhere. I delivered a 10lbs 9oz baby naturally using the Bradley method and water birth. I loved this birth experience too.

    I did prefer the natural birth to the non-natural as I felt that healing and postpartum went so much better than my first birth. I also felt unbelievably confident in myself as a woman and connected to women in history who delivered "naturally". Of course I am so thankful that we have the medical knowledge and help that we do these days but I think we rely on it too much. It is important that we are educated on our options.

    I am planning to have a water birth at home for my third baby, if I am so blessed to have more children.

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  8. We used the Bradley Method and had a doula for the birth of our son. We were able to birth without medicated pain management, but whenever I tell someone that I had my son "with natural childbirth" or "naturally," they seem to think that only indicates a vaginal birth. And they reply, "So you had an epidural?" No, siree. All 9 lbs. 2 oz. of my boy with no drugs. 🙂

    For pain management, I changed positions, and spent time rocking on the toilet and lying in the tub (which was the absolute best).

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  9. Thank you for posting this article. I really liked that you showed both sides – "I'll take the drugs" and "I want to go natural." I always try to empower my patients to look at both sides of any health related decision that they make. I also think you have an interesting point of view having personally experienced a birth both ways. As a chiropractor with a special focus on working with pregnant women, I have done a lot of research into the options and certainly want to have a natural birth. I also know that regular chiropractic adjustments will also be part of my plan. By ensuring the pelvis is in the proper alignment, chiropractic adjustments can make labor and delivery shorter and less painful.

    Reply

  10. […] This article provides a list of other things that reduce pain in labor including (I starred the ones that work for me): […]

    Reply

  11. i have read that eating dates starting on the 36th weeks will shorten labors on natural birth. im on my 17th week now. scared, yes ( as a first time mom) but i will definitely choose to be strong and face the natural birth!

    Reply

  12. […] This article provides a list of other things that reduce pain in labor including (I starred the ones that work for me): […]

    Reply

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I’m Kate, mama to 5 and wife to Ben.  I love meeting new people and hearing their stories.  I’m also a big fan of “fancy” drinks (anything but plain water counts as ‘fancy’ in my world!) and I can’t stop myself from DIY-ing everything.  I sure hope you’ll stick around so I can get to know you better!

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