| Pain Relief in Labor
There are many ways to lessen the pain of
contractions during labor. First and foremost are the relaxation techniques and mastery of
them learned during prenatal classes. The unknown generates fear, which heightens the pain
of labor. During prenatal classes you will learn breathing techniques such as Lamaze and
discuss the conduct of labor and delivery i.e. what commonly goes on in L&D. Within a
few short weeks the unknown becomes familiar and labor becomes a well-rehearsed event.
This puts you in control of your labor and maximizes a healthy and memorable experience.
Many women prefer to walk around during the
early phases of labor. We strongly encourage this. Sometimes a warm shower or lower back
massage will ease the discomfort early in labor. Sometimes early labor is really false
labor and over a few hours will ease or resolve. If membranes rupture i.e. your water back
breaks labor usually ensues within 24 hours. There is no contraindication to walking so
long as baby appears healthy on the fetal monitor during initial assessment and pain
medicine has not been given.
The type of pain medicine given during labor
depends upon many variables including degree of pain, stage of labor, physical condition
of mom and the condition of the baby as assessed by fetal monitoring. Most physicians
recommend at this time starting an IV because medications are being administered. An
epidural will never be placed without IV access. Unless a "walking epidural" is
placed pain medicine given intravenously, intramuscularly or as an epidural pretty much
eliminates the option of walking. It is important to have discussed all these options with
your doctor during your prenatal visits prior to labor.
Pain medicine may remove all sensation of
contractions or may ease the pain without complete loss of sensation. Narcotics such as
Demerol or morphine may be given together with a sedative such as Phenergan in the early
stages of labor. These medications lessen the pain. The sedatives compliment the narcotics
and help maximize your response. Other medications commonly used are Stadol and sometimes
Benadryl.
Regional anesthesia can lessen or completely
block the pain of contractions. Epidural block is the most famous. It is usually
administered by an anesthesiologist through the lower part of the back between the
vertebrae and backbone. Other forms of regional anesthesia include a pudendal block which
helps numb the vulva and perineal region of the body. The obstetrician usually gives this
during the pushing phase of labor. Epidural and spinal anesthesia are the most commonly
used regional blocks for cesarean section.
Rarely is general anesthesia used and never is
it used to manage labor. It causes complete loss of sensation as well as consciousness
i.e. mother goes to sleep. It is used only when the emergent situation arises such as
severe hemorrhage (bleeding) or fetal distress. On rare occasions the placement of an
epidural or spinal cannot be done leaving general anesthesia as the only means of
performing a cesarean section. These situations luckily are very infrequent.
EPIDURAL BLOCK
An epidural is pain-relieving medicine
administered with a special needle by the anesthesiologist into the lower back. A tiny
thin catheter is then placed into the lower back through which medicine can continuously
infuse via a pump during labor. Within a few minutes the pain of contractions eases and
often completely disappears. Mom may still be aware of her contractions and with lower
doses of medicine she will be able to push. Sometimes an epidural will be shut off to
allow return of sensation enough to allow pushing during the second stage of labor. Unlike
narcotics, which enter the bloodstream and go directly to the baby, the epidural medicine
is confined to the epidural space. Heart rate changes are rarely seen after epidurals
unless a mother's blood pressure drops. (See below)
RISKS
As mentioned above narcotics and sedatives
enter the bloodstream and travel to the entire body. You may feel drowsy or dizzy. The
baby also goes to sleep. This is only a problem if delivery is imminent and the babies
reflexes and breathing are slowed at the time of birth. Because of this risk narcotics are
rarely used prior to delivery. If too much medicine is given a mother's heartrate or
breathing may also slow down and this is potentially very dangerous if not discovered and
reversed.
The pain medicine used in epidurals rarely
pass to the baby because the space is localized and for the most part cut off from the
maternal bloodstream. Because the medicine used relaxes muscle (the uterus) it may also
relax the muscle surrounding blood vessels and cause a drop in blood pressure. This in
turn may cause the baby's heart rate to decelerate. As mentioned, if the block is too
great it may interfere with moms ability to push and prolong the labor. To prevent the
above events IV hydration is given prior to an epidural
The American Society of
Anesthesiologists provides information on pain relief in labor. The following links will
help you get there.
LINKS
- Media Statement on Pain Relief for Labor
- http://www.asahq.org/Media/Epidural.html
- Planning Your Childbirth
- http://www.asahq.org/PublicEducation/Childbirth.html
- Plane ando Su Parto
- http://www.asahq.org/PublicEducation/parenthood%28spanish%29.html
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