Healthy Pregnancy Series: Pain Management

“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.

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?