A concern that most pregnant women have is
how they will cope with the pain of labor and childbirth. Because
you cannot tell in advance how much pain or discomfort you
will have during birth or how you will cope with it, you should
think about the possibility that you may need some form of
pain relief.
Your preferences will be taken into account in
deciding what type of pain relief is best for you, but many
other factors, including your well-being and that of your baby,
will affect this choice. Keep in mind that often your
health care provider will not be able to tell you exactly what
kind of pain relief you will receive until you are in labor
or are ready to deliver. Many times these choices must
be left open and flexible until your health care provider sees
how your labor is going. Also, you may not always be
able to have medication just when you feel you need it.
Click on the topics below to learn more about
pain relief options during labor and delivery.
Types of Pain Relief
Having
pain, or getting relief for it, should not be thought of
as a sign of failure or a reason for guilt. Each person's
perception of pain is unique. Each woman's labor will
be different and everyone expereinces pain differently. That's
why it is important that the decision you make about pain
relief be the right one for you.
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Behavioral Techniques
Many women take childbirth preparation classes
in order to learn what to expect during labor and delivery,
as well as breathing methods, relaxation techniques, and other
ways of coping with pain and discomfort during childbirth. These
classes can be quite valuable, and some women are able to use
these techniques to get through childbirth without the need
for pain medication. Other women find that using these
techniques combined with some medications is helpful in relieving
the discomfort of labor and birth. Throughout delivery,
your health care provider(s) will be available to you to provide
reassurance and suggestions for relief of pain.
Childbirth preparation techniques can help a
woman manage pain during labor and birth, but they usually
don't completely remove it. If, while using these techniques,
you still have a level of pain that you are unwilling or unable
to tolerate, pain relief medication is available. It
is up to you and your health care provider to weigh the risks
and benefits of each method of pain relief.
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Pain Relief Medications
Pain-relieving medications fall into two general
categories:
- Analgesia is the relief of pain
without total loss of sensation. A
person receiving an analgesic medication
usually remains conscious. While
analgesics don't completely stop
pain, they do lessen it.
- Anesthesia refers to the loss
of sensation. You will not
lose consciousness unless you are
given general anesthesia, which is
usually reserved for cesarean
or emergent delivery.
The decision to use a pain medication
and what type to use will depend on several
factors. Your health care provider
may work with an anesthesiologist--a
health care provider who specializes
in pain relief--in selecting the best
method for you, depending on how your
labor or delivery is going and what your
state of health is. And, of course,
the effect of the medication on your
baby must also be considered.
Finally, keep in mind that not all types of pain
medications are available at all institutions, and not all
health care providers are able to give every type.
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Systemic Analgesia
Systemic analgesics provide pain relief over
the entire body without causing loss of consciousness. They
act on the whole nervous system, rather than on one particular
area. Systemic analgesics are often given as an injection
into a muscle or vein. Sometimes other drugs are given
with systemic analgesics to relieve tension or nausea. While
systemic analgesics do not completely get rid of pain, they
do lessen its intensity.
Systemic analgesics may cause drowsiness and
may make it hard to concentrate. Because these drugs
can slow the baby's reflexes and breathing at birth, they are
usually avoided just before delivery.
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Epidural Block
Epidural block, another form of local anesthesia,
affects a much larger area than any of the methods described
above. It numbs the lower half of the body to a varying
extent, based on the drug and dose used. An epidural
block is injected into the lower back, where the nerves that
receive sensations from the lower body meet the spinal cord. This
kind of anesthesia is helpful for easing the pain of uterine
contractions, the pain in the vagina and rectum as the baby
descends, and the pain of an episiotomy. While the drug
is working, though, you may lose some muscle control in these
areas, making it harder to "bear down" during delivery or to
move your legs. Epidural blocks are also effective in
blocking pain during cesarean birth--delivery of the baby through
a surgical incision made in the mother's abdomen and uterus.
An epidural block is injected into a small space
around the spinal cord in the lower back. You will be
asked to sit or lie on your side with your back curved outward,
and to hold this position until the procedure is complete. It
may take a while for the drug to take effect. After the
needle is inserted, a small tube may be inserted through it,
and the needle will then be withdrawn. That way, small
doses can be given through the tube at a later time without
your having to have another injection. These smaller
doses are less likely to cause side effects in the mother and
the baby.
Epidural block can have some side effects. It
may cause the mother's blood pressure to drop, which in turn
may slow the baby's heartbeat. Usually, preventive steps
are taken to avoid this problem: before the mother receives
the medication, fluids are given through an intravenous, or
IV, line (a thin tube attached to a needle in a vein) in her
arm, and she is positioned on her side to help circulation.
With epidural analgesia,
it may be harder for the mother to bear down and help the baby move through
the birth canal. It may be necessary for the baby to be delivered with
forceps or vacuum extraction, special instruments that are placed around
or attached to the baby's head to help guide it out of the birth canal.
If the covering of the spinal cord is punctured
when the drug is given, the drug may enter the spinal fluid
or a vein. The patient may then get a severe headache,
which can last for a day or more. In rare cases, the
muscles in the patient's chest may be temporarily affected,
causing breathing problems. If the drug enters a vein,
it could cause dizziness or, rarely, seizures. Special
precautions are taken to avoid these problems.
Epidural block is not for every patient. If
a woman is bleeding heavily or if the baby has an abnormal
heartbeat, epidural blocks may not be used.
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Spinal Block
A spinal block, like an epidural block, is
given as an injection in the lower back. However, a spinal
block has to be injected into the spinal fluid, so the needle
is inserted a little deeper (though it does not touch the spinal
cord itself). Because the effects of the drug do not
last long, and because a spinal block is usually given only
once, this form of anesthesia is best suited for pain relief
during delivery (not labor), particularly if forceps or vacuum
extraction is needed. It is the pain relief method most
often used for cesarean birth.
A spinal block numbs the lower half of the body. It provides
good relief from pain, starts working quickly, and is effective
in small doses.
Spinal block can sometimes cause some of the
same side effects as epidural block: headaches or a drop
in the mother's blood pressure and the baby's heartbeat.
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Local Anesthesia
Just as a dentist will inject a drug into your gums to numb your teeth, your
health care provider can inject a local anesthetic into the vagina or the
area surrounding it to ease pain during delivery. Local anesthetics
usually affect a small area, and so are especially useful when the health
care provider has to make an episiotomy--a
small cut, or incision, made in the perineum (the area between the vagina
and the rectum) before the baby passes through. Local anesthetics are
also helpful when this incision, or any tears that might have occurred during
birth, are repaired.
One advantage of local anesthesia is that it
rarely affects the baby. After the anesthetic wears off,
there are usually no lingering effects. The main drawback
of these drugs is that they do not relieve the pain of contractions
during labor.
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General Anesthesia
General anesthetics are medications that make
you lose consciousness. When general anesthesia is used
during childbirth, the mother will not be awake or feel any
pain during delivery. It is not used to relieve the pain
of labor. General anesthesia is rarely used for routine
vaginal deliveries. It is often used for cesarean delivery
or other urgent situations.
These drugs are given in one of two ways: through
a face mask or injected through an IV line. Once the
drug is given, it works very quickly, and is usually given
just before delivery.
When general anesthetics are used during childbirth,
the patient's stomach may not be empty. While she is
under anesthesia she may vomit and breathe in food and stomach
acid, which can harm her lungs and cause pneumonia. There
are some precautions that will help avoid this complication. Your
health care provider may tell you not to eat anything once
labor begins. If general anesthesia is likely to be used,
you may be given an antacid before delivery. After you
are asleep, a tube will probably be placed in your throat to
help you breathe.
General anesthesia is not a good choice for some
women. Serious side effects, though rare, can occur. Be
sure to tell your health care provider if you or anyone in
your family has ever had a drug reaction or a problem with
any form of anesthesia.
After general anesthesia wears off, you will
feel woozy and tired for several hours after waking up. You
may also feel sick to your stomach; this feeling usually fades
within a day. Also, your throat may be sore from the
tube that was inserted to provide oxygen.
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Recovery from Pain Medications
What you experience as you recover from pain
medications will depend on the type that was used. In
any case, once it wears off, you may feel some pain around
the vagina, perineum, lower abdomen, or back, depending on
how much the muscles and tissues were strained during delivery. If
you are in pain, ask your health care provider if you can get
some medication.
Finally . . .
Many women worry that anesthesia given during
labor or childbirth will somehow make the experience less "natural." The
fact is, no two labors or deliveries are the same, and no two
people have exactly the same ability to tolerate pain. Some
women require little or no pain medication, while many others
find that pain relief gives them a better sense of control
over their labor and delivery.
Be prepared to be flexible. Some of the
techniques described here may appeal to you more than others,
but your health and the health of your baby must be considered
when it comes time to decide if a pain medication is needed
and, if so, which one will be best.
