Pain Relief Options During Labor
Before It Begins
According to a study completed in 2010, child birth is a phenomenon experienced by about 80% of women in the United States of America. Signs of labor include: regular contractions, increased lower back pain, pelvic pressure, breaking of the bag of water, vaginal bleeding and/or a change in fetal movement. Although 80% of women experience child birth, each pregnancy and labor is unique, and each woman has her own goals when it comes to pain relief during labor. The most advisable approach to labor is to BE PREPARED. Once you become pregnant, the fact that you are going to experience labor should not be a surprise. Things you ought do in order to prepare for labor include:
Take a class
- A good class will give you an idea of what to expect when labor starts. It should also review when you should contact your provider or seek medical attention and provide a tour of the facility you are planning to deliver at. They will also go over the different items (tools, machinery etc...) that you might encounter during labor and address what you want to pack or have prepared for your birth, as well as go over coping mechanisms and ways that a partner might try to comfort you during labor.
Come up with a plan
- The first thing to plan is what your approach to labor pain will be. There is no right or wrong option. The decision to use an epidural, pain medication, or to have an unmedicated birth is a personal decision, and is sometimes effected by certain pregnancy contitions. Discuss your desires with your partner and get input from your provider as to what your options might be for pain management during labor. As you will read, medication options vary depending on where you give birth. Not all facilities offer all of the options that will be discussed.
- Once you have decided on your planned approach to coping during labor, create a birth plan. This is a form that will briefly summarize your wishes during labor, delivery, and postpartum. Share this with your birthing team so that everyone is on the same page and aware of your desires. The best birth plan is a flexible one. Labor is unpredictable, and everyone's goal is that the outcome of your delivery is a healthy mom with a healthy baby. Sometimes that means the birth plan goes out the window for the safety of either mom, baby or both. For this reason, I like to refer to the birth plan as the birth goal.
- Another thing that sometimes gets overlooked is making arrangements for your other child or children, if this is not your first child. Labor can sometimes take days, or start in the middle of the night. Plan ahead for these possibilities, as it can be distressing for both parent and child if prior arrangements have not been made.
When It Begins
Keep in mind that early labor can take place over the course of hours or even days. Each pregnancy and labor is different and comes with its own set of risks and concerns. Please consult with your provider on when to seek medical attention, but please seek medical attention if you think labor has started, your bag of water has broken, you are experiencing vaginal bleeding or have concerns about your health or the health of your fetus.
Once contractions have started, if you are greater than 37 weeks pregnant and without any pre-existing conditions that would require you to go to the hospital immediately, relax. This is supposed to happen. Hydrate yourself with at least 12 oz of water every hour and try the following:
Possible distraction techniques include the following:
- Play Cards
- Do a Puzzle
- Watch a Movie
- Listen to Music
Reduce stress and anxiety
There are numerous things that can be done to reduce stress and anxiety during labor. As previously discussed, being prepared can put your mind at ease and prevent you from having to make exhausting decisions and arrangements while experiencing labor pain. Being able to just take one contraction at a time and not have to worry about anything else greatly increases a woman's ability to cope. Other things to reduce stress might include: being in the comfort of your own home, having a support system or birth partner, and resting as much as possible.
Alternative/Non-Medication Pain Relief Measures
Once you are no longer able to ignore or distract yourself from the pain you are experiencing, begin using non-medication based coping mechanisms. Coping mechanisms can be learned in birthing classes and online. In fact there are numerous techniques already developed to help women achieve their goal of an unmedicated birth. These techniques are also good for coping during early labor or when it is not quite time for the epidural. Other non-medication based coping mechanisims consist of:
What Non-Medication Technique Did You Find Most Helpful?
As It Continues
If your labor continues to be irregular, or greater than 8 minutes apart, you have tried all of the previously mentioned coping mechanisms and find that they are no longer helping, you are exhausted, or haven't slept in over 18 hours; it might be time to consider medication. This is not a suggestion to throw in the towel and ask for the epidural, but instead consider taking both Extra Strength Tylenol (Acetaminophen) and Benadryl (Diphenhydramine), per the manufacturers instructions on the bottle. Both of these medications are, at the time that this article is being written, considered safe during pregnancy, and have been for many years; but ultimately get the approval of your provider prior to taking any medications during pregnancy. Try discussing this option at a prenatal appointment, before the start of labor. Labor often starts, or becomes more noticeable over the weekend, after office hours, or in the middle of the night when you are finally settling down and less distracted. For this reason it would be wise to already have discussed your plans with your provider, and have prior approval for the use of pregnancy safe medications at home, during the early phase of labor.
Why should over-the-counter medications be the next step in your pain management approach?
If your contractions are irregular, or greater than 8 minutes apart, chances are that you are not yet in active labor. Don't feel defeated or discouraged. All of the contractions that you have had, and the pain you have been managing is not for nothing. Your cervix is softening, thinning and hopefully starting to dilate during this period. Also, the baby is descending into the birth canal and causing your cervix to migrate forward towards the vaginal opening. All of this is tremendous progress, Great Work! Some women experience this early or prodromal labor over the course of days, so it is not feasible to go without sleep for multiple days in a row. During this phase of labor, safe, mild, over the counter medications such as Tylenol and Benadryl just might help you get the few hours of rest that you need. When you rest you do not tense your muscles thus allowing your body to work as it is meant to and continue to progress towards delivery uninhibited. Taking medications at this point is also a helpful decision making tool because either one of two things will happen.
- Best case scenario, you will get a few hours of sleep and regain the energy and mental fortitude necessary to cope with the discomforts of labor and increase the likelihood that you will make it through labor without hospital administered medications (if that is your goal).
- Worse case scenario, you take the medications and get no relief or rest. Sounds like a waste, right? But no, it is not! If this happens, you should now be reassured that you are not having "false" labor and you might want to consider heading to your planned facility for evaluation, if you aren't already there.
What happens next?
Once you arrive at your birthing center a cervical exam, sterile speculum exam, or ultrasound will be performed in order to determine what stage of labor you are in, or whether or not your bag of water is indeed broken. If you are found to be in early labor, less than or equal to 3 cm dilated, you will probably be asked to hydrate and walk for a period of time then have your cervix rechecked for change. If your cervix remains unchanged, or if it was not dilated upon your initial assessment you will more than likely be encouraged to return home and might be offered medications for pain. At this point you must decide whether or not you will use hospital administered pain medications as part of your labor plan, or if you already intended on using such medications, if now is the time.
Hospital-Administered Pain Relief Treatments During Labor
Once you have decided to use hospital administered pain medications there still remains quite a variety of options. These options will be discussed in order from that which provides the least relief to the most. During your labor it is safe, smart, and even advisable to progress through the pain relief options from least to most effective in relieving your pain if you hope to get through labor without the use of the epidural. You need not try each and every option, but can choose what is right for you. Knowledge is power, and knowing what options you have gives you the chance to make an educated decision, as opposed to having to make a sound decision while in pain. Keep in mind that there may be a certain length of time necessary to wait between doses or between switching from one medication to another. On the other hand, if you plan on getting the epidural, it is optimal that you get it once you are in active labor (at least 4 cm dilated with regular contractions that are causing cervical change), or when you have tried all other interventions you were willing to try and can no longer cope with the pain, regardless of your cervical dilation. Just take into consideration that getting the epidural prior to being in active labor, and even sometimes when you have reached active labor, increases the likelihood that labor inducing medications such as Pitocin will need to be used to reach delivery.
If, after being evaluated, it is determined that you are in early labor and you do not feel like you can continue coping by just using the non-medication pain relief options previously discussed, you might be offered the following (again listed from least effective to most effective):
- Oral Tylenol and Benadryl
- An oral narcotic such as Percocet, Vicodin, or Norco with Benadryl
- An injection of Morphine with Phenergan
You might have noticed that each of these options contain a pair of medications. In each pair, the first medication listed is for pain relief and the second medication causes drowsiness and is used to help you get some much needed rest. If you have already tried Tylenol and Benadryl at home you can move up to something stronger. Depending on the policies of the facility where you intend to deliver, you might either be able to receive the narcotics orally or via injection and return home with instructions on when to call your provider or return to the facility; or you will remain in house for monitoring and will have the progression of your labor rechecked after a certain period of time or when your pain returns.
If you are admitted to the hospital in active labor, or with your bag of water broken, your decision on which coping mechanisms to use will yet again depend on whether you are planning to get the epidural or not.
If you are planning an unmedicated birth, the only hospital administered, non-medication based intervention remaining is sterile water injections. The injection of sterile water, by a provider, in specific locations in the lower back is used to relieve back labor. This is more commonly offered by midwives and may not be an option everywhere.
If you reach the point where you determine that medication is needed, depending on where you deliver, you may have the following options (again listed from least to most effective in relieving pain):
- Nitrous Oxide or "Laughing Gas"
- Narcotics including, but not limited to: Morphine, Fentanyl, Stadol, and Nalbuphine
- Pudendal Block
Availability of the above medications differs depending on what country, state, region, facility type, and sort of delivery provider you are using, and so on. Prior to going into labor, find out which options will be available to you. Nitrous Oxide is a self administered, short-acting, breathable gas which effects your perception of the pain. Narcotics may be long lasting, such as Morphine, or short acting, such as Fentanyl, or fall somewhere in between. Narcotics are given to the mother either intravenously or intramuscularly and enter into her blood stream and are expected to dull the sensation of the pain, not eliminate it completely. Some of this medication does also enter into the fetal circulation causing drowsiness. Therefore your provider will determine which medication is indicated, based upon how long it lasts and how far along in your labor you are. The goal is to have the medication all or mostly worn off prior to delivery so that the baby will not be drowsy at birth. The pudendal block is an injection of a numbing agent into a set of nerves, through the vagina; and is usually given during pushing to provide pain relief to the vagina, perineum, and rectum for delivery. Lastly, the epidural often contains a numbing agent and a narcotic being administered through a catheter placed in the epidural space that will continue to infuse for the duration of your labor. You should optimally expect about 80% relief of pain where you continue to feel tightness and pressure, but nothing sharp or crampy, and can continue to move your legs and reposition yourself, some facilities even offer "walking epidurals". The sensation of pressure will help you push more effectively. Minimal amounts of epidural medication reach fetal circulation since the medication is not administered into the mothers blood stream.
The practice of Obstetrics is ever evolving and the options and recommendations will probably change and differ from country to country. At this time, this is a comprehensive list of options, both medication based and non, available in the U.S.A. Please comment below and feel free to share any differences or options available to you that are not listed.
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This content is accurate and true to the best of the author’s knowledge and does not substitute for diagnosis, prognosis, treatment, prescription, and/or dietary advice from a licensed health professional. Drugs, supplements, and natural remedies may have dangerous side effects. If pregnant or nursing, consult with a qualified provider on an individual basis. Seek immediate help if you are experiencing a medical emergency.