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Guide for a Healthy Pregnancy

PAIN DURING CHILDBIRTH

How painful is giving birth?

You’ve probably heard a lot of stories about giving birth. The experience is very different for each woman. The amount of pain is different for everyone. The kind and amount of pain you have changes throughout your labor.

Why is labor painful?

During labor, your uterus pushes the baby down and stretches the opening of your uterus (cervix). Each time the uterus muscles flex, you may feel pain like a strong cramp. As your cervix and vagina stretch and open, you may feel a stretching, burning pain. Most contractions last 30 to 60 seconds, and you will be able to rest in between.

I would like help with the pain, but I don’t want to use medicine. What can I do?

Later in this chapter are tips for coping with the pain of labor. The less tense and afraid you are, the less painful your labor will be. Three things can help you labor successfully without using medications: knowledge about what to expect, belief in yourself, and emotional support and coaching during your labor.

Is there medicine I can take for pain if I need it?

There are many types of pain relief available in a hospital. The most common pain medications are narcotics and epidural anesthesia.

What are the pros and cons of narcotics?

Pros

• They give fast pain relief (usually between 2 and 10 minutes).
• Most can be given directly into your bloodstream through an IV.
• They may help you relax and be more comfortable.
• They don’t usually slow your labor.

Cons

• Narcotics do not last long (usually between 20 and 60 minutes).
• They may cause nausea.
• They may cause you to feel really “out of it” or sleepy.
• They may make the baby sleepy and make it harder for him or her to breathe right after birth or start breastfeeding.
• Narcotics don’t take away all of the pain. They may make each contraction less painful.

What is an Epidural?

An epidural numbs your body from the waist down. It involves putting a needle and then a small flexible tube into a space near the spine in your lower back. The pain medication flows through the tube and you lose feeling in your abdomen and legs. The medication will not make you or your baby feel sleepy or “out of it.” However, you will not be able to walk or get up to go to the bathroom. You may have a harder time pushing your baby out, because you won’t be able to feel the contractions.

How can I tell before labor starts what is right for me?

First, learn all you can about how much help and what possible problems can occur if you use the pain medicines that are offered. Then ask yourself the questions listed here. The answers will help you decide on the best way for you to keep yourself comfortable during your labor.

• How strong is my desire to give birth without using pain medicines?
• Will I be happier with my birth after it is over if I go through labor without using medicine or will I be happier afterward if I use pain medicines?
• If my labor is normal and I am in more pain than I expected, do I want my helpers to talk me through it or do I want them to offer me pain medicine?

Remember that nobody knows ahead of time how painful or difficult your labor will be. Knowing your desires is the best place to start. Then when you are in labor, you need to be flexible and trust your support persons and caregivers to help you make decisions that are right for your experience then. Following are some tips for coping with pain in labor.

COPING WITH PAIN IN LABOR

What can I do before labor?

• Stay active all during your pregnancy. You will have more strength to get through labor.
• Take childbirth classes. The more you know, the less you fear. Fear makes pain hurt more.
• Arrange for a birth coach or doula. Having a person whose only job is to support you will help you cope during labor and feel more satisfied with the experience.

What can I do during early labor?

• In early labor go for a walk or dance. The more you move, the less you hurt!
• Drink lots of fluids so you don’t get dehydrated and eat lightly if you are hungry.
• Take a warm shower or bath.

What can I do during active labor? Find your rhythm.

All women who cope well during labor go back and forth between resting in between the contractions and movements that help cope with pain during the contraction. Each person has her own rhythm that works. You may:

• Rest between contractions by being still or by rocking gently.
• Focus on your natural breathing. Awareness of breath relaxes you.
• Change positions often.
• Don’t be afraid to make noise. You might moan, hum, or repeat comforting words over and over as you go through each contraction.
• Believe you can do it. You can!
• Remember why you are doing this. Your baby will be here soon!

What can my birth coach do during labor?

• Help you find your rhythm and then help you during each part of it.
• Give you a back rub or hold your hand quietly.
• Offer you ice chips, water, or juice.
• Help you change positions and support your body.
• Keep the lights low and play soft music.
• Put a cold washcloth on your forehead.
• Put a warm washcloth on your lower back.
• Talk you through each contraction, supporting your movements and your noises.
• Cheer you on!

What can my healthcare provider do during labor?

• Answer your questions.
• Check your progress and give you direction.
• Assure you that things are going normally.
• Provide pain medication if needed.

For More Information

Pain and Pain Relief During Labor: www.childbirthconnection.org

EPIDURAL ANALGESIA

There are many options for managing pain during labor. You might decide before you begin labor that you want pain medication, or you may not want any medications. This section discusses epidural analgesia specifically.

What is epidural analgesia?

Epidural analgesia is a local anesthetic placed in a part of your back where it numbs the nerves that go from your pelvis and legs to your brain. The anesthetic is like the kind you get when you go to the dentist. With an epidural, you get an injection into the space around the nerves in your spine that makes your body numb below the site of the injection.

How does an epidural work?

All of the nerves of the body send their messages to the brain through the spine. Anesthetics are medicines that block the messages from traveling up nerves to the brain. When the pain messages are blocked before getting to your brain, you do not “feel” the pain.

How is an epidural done?

There is a very small space around the nerves in your spine. This is called the epidural space. A specially trained doctor or nurse places a thin tube, called a catheter, into this space. You will have to sit on the side of the bed or curl up on your side on the bed. The nurse or doctor will give you a shot of Novocain in your back. Then the nurse or doctor will put a long needle through the area that is numbed into the epidural space. When he or she has found the space, the thin tube will be threaded through the needle, and the needle is removed. A pump is then set up to deliver the anesthesia through the tube into the epidural space during your labor. After birth, the tube will be taken out. The numbness will begin to go away. You will be able to move your legs and walk in a few hours.

How well does an epidural work?

For some women, an epidural works very well. Within 15 to 20 minutes of starting the anesthesia, they lose feeling below the waist. Many women are so comfortable they can talk, watch television, or even sleep. Occasionally, the epidural does not work as well, and you may continue to feel pain or pressure even though your legs are numb. There is no way to guess who will get a “pain free” epidural and who will have an epidural that does not work completely.

Are there risks with having an epidural during labor?

Your labor progress depends on lots of things: the size of your pelvis, the size of your baby, the position of your baby, and the strength of your contractions. Most of this is out of your control. Sometimes an epidural can help and sometimes it makes labor longer and more complicated. The following page will help you balance the risks and benefits of using an epidural.

Risks of Insertion and Placement of Anesthesia in the Epidural Space

• The epidural is inserted sterilely, but there is a small chance of infection at the site where the needle is inserted. A serious infection could cause paralysis or, very rarely, death.
• The needle could hit a nerve and cause nerve damage or paralysis. In most people, the spinal cord is above the area where the needle is placed, which is why this problem is rare.
• If the epidural is incorrectly placed too high in your back or into spinal fluid, you may lose the sensation of your breathing and need help to breathe regularly.

Risk during Labor

• If your bladder is full, you will not be able to feel it, so you will need a catheter to drain the urine.
• Women who have an epidural have a higher chance of getting a fever during labor, and then the baby may need additional blood work and observation to rule out infection.
• Women who have an epidural are more likely to need medication to make contractions stronger.
• Your legs will be numb. If your baby gets stuck in a “crooked” position, you will not be able to move around to “jiggle” the baby into a good position. This may increase your chance of needing a cesarean section.
• It may be hard to feel your contractions when you need to push. Pushing takes longer.
• Women who have an epidural have a higher chance of needing a vacuum or forceps to help give birth.

Risks Afterward

• The most common risk of an epidural after the baby is born is a “spinal headache.” This only happens one or two times for every 100 epidurals that are used. This is a terrible headache that comes 1 to 2 days after the epidural is removed. If you get a spinal headache, you will need to return to the hospital to have a special procedure called a “blood patch.” The patch usually helps right away.
• Many women report ongoing back pain after an epidural, but we do not know if this is because of the epidural or because of other things that may have happened during their labor.
• There is a very, very small risk of permanent paralysis – loss of the ability to move your legs.

What are the benefits of an epidural?

• If the epidural works well, you will not feel the intense pain.
• Sometimes – especially with a first baby – early labor may be long. An epidural can give you a chance to rest so that you can gather your strength for active labor and birth.
• If you are very anxious, an epidural may help you relax. In some women it appears that the epidural may actually make your labor go more quickly.
• If you need a cesarean section, your epidural can be used to make you numb for the surgery.
• Women with twins or babies in a breech position who plan a vaginal birth may use an epidural so they are prepared for a cesarean section if their baby (or babies) has problems during labor or birth.

For More Information

Childbirth Connection:
Options: Labor Pain (Epidural and Spinal)