From An Epidural To All Natural, Find Out Your Pain Management Options During Childbirth

Are you undecided about which labor pain management options you should choose? Or maybe you’ve “been there and done that” but the second time around (or third or fourth...) you’re hoping to have a better childbirth experience?  We’ve combed through all the options out there, talked to the experts and put together this comprehensive list to help you make the best decision for you and your baby.
Melissa Chapman

We’ve all seen those images in film or on television -- women with bulging bellies, writhing in pain, sweating profusely with their legs in stirrups, simulating labor pains and usually crying out for an epidural. While these images need to be taken with a grain salt, being that they are often overly dramatized to titillate the viewer, ask any woman who has pushed a baby from her loins and she will undoubtedly tell you that, unfortunately, there will be pain.  Here are some options to help you cope with labor pains so you can get to the good part -- snuggling with your newborn baby.

Going the Epidural Route
According to Panchali Dhar, MD, author of Before the Scalpel: What Everyone Should Know about Anesthesia, (Tell Me Press) and a double board certified doctor in Internal medicine and Anesthesiology from New York Hospital and professor at Cornell-Weill Medical School, there are many advantages to choosing an epidural to relieve labor pain.

After a woman in labor receives an epidural, she can lie in bed comfortably on her back and relax. She will be able to move her legs with no loss of strength, notes Dr. Dhar. This is because the dose of anesthetic given through the epidural catheter is just enough to relieve the pain of contraction.  The anesthetic does not cross the placenta and hence does not affect the fetus. There is no sedative effect for either mother or fetus. This allows the expectant mom to sleep if she wishes or converse with her loved ones.

“Another advantage of the epidural is that it allows a woman to “push” when it is required. It does not decrease the strength of pushing," says Dr. Dhar. “Contrary to popular belief epidural anesthesia does not slow down labor or increase the chance of cesarean section.  In fact, because the woman is awake and alert after delivery, the epidural allows immediate bonding between mother and child!”
 
Dr. Dhar points out that every medical intervention has risks. One million pregnant women request epidural anesthesia each year in the United States and, while the incidence of complications is very low, they can include infection, bleeding, and nerve damage. 
 
If you’re considering an epidural Dr. Dhar suggests you keep these tips in mind.

1. Decide whether or not you want an epidural anesthetic during labor. If you wait too long before you decide to have one, it may become a difficult placement. Sometimes it just might be too late. Epidural placement requires patient cooperation. Movement because of pain from frequent contractions makes it technically harder to place.

2. Have realistic expectations about epidural anesthesia. You will still feel the pressure from contractions, but should not feel pain or weakness.

3. Discuss with your obstetrician and the anesthesiologist what your pain tolerance level is at the beginning of labor. This will help you decide when you want the epidural placed.

4. Learn about what to expect during epidural placement- best placement position, sterility, local anesthetic to numb the area, pressure while the epidural needle is advanced, how the catheter is taped along your back, and if the epidural catheter will be connected to an anesthetic delivery pump.

5. Discuss your options with an anesthesiologist if you are really anxious about labor pain management. You can always make an appointment.

Deep breathing and relaxation
Tiffany Blackden, whose Colorado company GTS Therapeutics (www.fortcollins-massage.com) teaches relaxation and massage classes for couples and their doulas, believes no-drug labor is an option that expectant moms should consider. In fact, she opted for no-drug labors with both of her kids. She recommends The Bradley Method(R), which is a 12 week class where couples will learn relaxation techniques, nutrition, exercise, labor rehearsals and anatomy to eliminate fear and ignorance surrounding birth.

Blackden states the uterus is a muscle and needs oxygen and fuel to contract effectively. Healthy breathing patterns means mom and baby get the oxygen they need to operate efficiently with labor. Deep breathing also suppresses stress hormones (adrenaline and cortisol) to help the uterine fibers to contract more effectively. Ms. Blackden also notes that no-drug labor also allows an expectant mom to move freely and get in positions helpful for healthy labor and assist if the baby needs to get out faster. These positions include getting into a hands and knees position if the baby's shoulders are stuck, or squatting if the baby has heart rate decelerations and needs to be born quickly.
 
“Take the time to research about the birth of your baby,” says Ms. Blackden, who believes it’s important that expectant moms learn about their anatomy so they understand what's going on and can practice effective labor tools. “This may just be one day, but the birth of your baby will literally live in your memory and bodies (yours and the baby) for the rest of your life."

For more information about the safety and effectiveness of natural childbirth Ms. Blackden suggests these books; The Thinking Woman's Guide to a Better Birth by Henci Goer, Ina May's Guide to Childbirth by Ina May Gaskin and Natural Childbirth the Bradley Way by Susan McCutcheon.  

Tips to consider when planning a natural birth:

According to Dr. Dhar while there are millions of women who choose not to have anesthesia during labor and may opt for deep breathing exercises, which help focus the mind during each contraction.  Talk with your doctor before so your doctor is aware of your decision.

“Remember that each person has a different pain threshold. What is excruciating pain for one woman may be tolerable for another,” says Dr. Dhar. He also notes an epidural might also be required in some instances (epidurals help lower high blood pressure of pregnancy) or if the decision is made to have a cesarean section.

“There are many women who begin labor determined not to have anesthesia, but eventually change their minds as the pain level increases. Often times epidural anesthesia actually helps take the mind off the pain, relaxes the body and muscles and helps labor progress faster.”

Opting for a Midwife
According to Wendy Gordon, a Certified Professional Midwife at Vivante Midwifery & Women's Health (www.VivanteMidwifery.com) in Oregon, expectant moms may want to consider hiring a midwife to assist in their labor pain management. A midwife, either in or out of the hospital, typically provides one-to-one care and knows how to use non-pharmacological methods of pain relief and allows the mother to choose the best positions for labor and birth to help her baby come out. Midwives are trained to detect problems during pregnancy, birth, and the postpartum period and will transfer care to an obstetrician or other specialist if they occur.

“Regardless of whether you want 100% natural birth or an epidural at the first labor pang, organize your providers and birth location to give you the best chance of getting what you want, “says Gordon. She also suggests expectant moms check Ricki Lake’s documentary, The Business of Being Born. “And remember, 98% of the baby shows on TV are sensationalized to entertain you -- this is not what real labor and birth is like!”
 



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