Pain relief options during labor

[RNPamP]

Hi to all you L&D nurses, I have a question for you. I am an RN, I work in PACU, and my husband and I are thinking about starting a family relatively soon. My question is, what is the full range of pain relief options during labor? You hear so much about epidural vs. natural birth, but I was wondering what the options are in between, and what are the associated risks to mom and baby. This may be a simplistic question, but honestly I don't remember much about L&D from school; it was an early course in my program and the whole thing is kind of a blur Thanks for any info you can provide!

[NPinWCH]

This topic covers 3 in a series of 6 two hour classes I teach, but I'll try to keep the answer as short as possible.

If I could tell every woman who is planning on having a baby 1 thing it would be Labor Hurts! With or without pain meds it is going to hurt. I like to tell my class that it helps to make the choice ahead of time, but remind them that they can at anytime change their minds. There IS pain in delivering a child, the only way to avoid pain related to childbirth is to avoid pregnancy.

IV pain meds usually stadol and nubain, help you relax and make you "not care" as much about the pain, but they don't make you feel less pain. They do interfere with your bodies ability to create it's own endorphins, which actually increases the amount of pain you feel when the med wears off. The second dose won't work as well since your natural endorphins have decreased and you are likely in more pain anyway since labor has hopefully progressed.

Like most narcotic like drugs you can feel sleepy, out of control and have nausea/vomiting. They cross the placenta, so the baby gets it too, and like all narcotics they can cause respiratory depression in the baby at birth as well as decrease the babies alert period and cause problems with the initiation of nursing.

Epidurals usually take away a significant amount if not all the pain. You can still feel pressure as the baby gets lower, and lately I've had many primips who haven't felt anything since the epidural infusion started start screaming about pain during the pushing phase. They perceive the pressure as pain, which then keeps them from pushing effectively, which increases the risk of assisted delivery with certain docs.

Epidurals can also be "spotty" and may not work as well for everyone. They may lower moms BP, which causes a drop in the babe's heart rate, which of course increases interventions. The newest studies point to a decreased alert period and difficulties nursing in babes born to moms who had fentanyl epidurals. Since they decrease sensation they may decrease the ability to push effectively, though studies show only about 30-40 min increase in pushing times between women with epidurals and women without. (Though that 30-40 min can seem to last forever when you are exhausted.)

All pain meds (IV/Epidural) limit your ability to follow your bodies clues. Our bodies KNOW how to labor. Given freedom I have NEVER seen a woman sit still for labor. She moves, rocks, walks, rests on her side, her knees, leans against someone or something. She sits up, she lies down, she simply doesn't sit still. Do those things make the pain go away? NO. Will breathing techniques make the pain go away? NO.

They do help her cope, they help labor move quicker, they relieve fatigue (ever try lying in the same position for more than an hour or so?), they increase O2 intake, increase circulation, shift babes position, encourge the baby to descend, encourage stubbornly positioned babies to rotate and empower the mother.

Penny Simkin talks about finding the 3 Rs for your labor. Find a Rhythm. It may change at points in labor, but use one until it isn't working anymore. Find a Ritual. This also might change, but pick something to do and do it with every contraction. (Swaying side to side, moaning, slow dancing, rocking, squatting...) Use Relaxation. This one stays the same...your uterus is tense, but try to relax everything else, keep a positive attitude (I will never have THAT contraction again...I'm almost there...).

I would encourage you to find a Childbirth Educator and take a class. Reading up on things is wonderful also. Penny Simkin is a good start. I encourage women to take an active role in their labors...after all it is yours and labor is work. Since when did work become passive???

Hope this helps, and good luck on your soon to be family addition :balloons:

[May_baby]

Very thorough response.

Thanks!

[jannrn]

Just to give you another side of the story, take a read at some of the birth stories on this website, and where some women see labor very differently than most in America. You'll be guaranteed to hear many a horror story, but here you can see it is not always so.

http://www.unassistedchildbirth.com/

Warning: controversial...

[SmilingBluEyes]

I could not have said it better than RNinWch did. Well said.

Also the site jan provided, excellent perspectives on unassisted childbirthing and the joys experienced by families in this undertaking.

It is truly sad to me, so many women/families feel they have to fight to "take back their power" in the birth experience in America. Such a complicated, difficult and painful issue for me.

[SmilingBluEyes]

I highly recommend ANY works/books by Penny Simkin. EXCELLENT information/advice from a very learned professional. I have a couple of her books myself. Wonderful reads.