When it comes to having a baby, one of the bigger decisions a woman will make will center around pain management during labor and delivery.
Everyone experiences labor differently, and some may manage pain better than others. Emily Ellington, a certified nurse midwife at Novant Health Southeast OB/GYN in Matthews, believes it is important for patients to be well educated and aware of all the options for managing pain during childbirth. She recommends starting these conversations with your doctor in the third trimester of pregnancy.
There are several different options for pain management in labor.
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Epidurals are the most popular
According to the CDC, 61% of women opt for epidural and other sources cite higher usage. An anesthesiologist will place a catheter, a thin tube the size of pencil lead, in the lower back which will numb the lower body. It allows for a continuous flow of medication that can also be controlled with a button by the expectant mother.
“A great epidural is one where you have the sensation of pressure,” said Ellington. “We want it to take away the sensation of sharp pain, but still allow you the pressure of knowing the baby is descending and being able to feel the sensation of pushing.”
Epidurals may lower your blood pressure, which can also slow the baby’s heart rate. You will be closely monitored by your nurse and also given extra IV fluids beforehand to decrease the risk. The epidural catheter is removed right after delivery and a new mom can often be up and walking, with the help of nursing staff, about two hours later.
Ellington recommends waiting to get an epidural until you’re in active labor, when contractions are strong enough to cause cervical change. Even if you were not planning on getting an epidural, you can still decide to get one if your labor is not moving quickly. Typically, things move at a slower pace with your first pregnancy, allowing for more time to change your mind.
“I usually recommend to my patients to see how you’re doing. If you’re coping well and you’re moving along, keep going. If you ever get to the point where you’re suffering, that can be fixed,” said Ellington. “We’re there to support you.”
Novant Health Matthews Medical Center is among just 17 North Carolina hospitals to receive the coveted U.S. News and World Report High-Performing Hospitals designation for maternity care.
IV medications can be used in the early phases of labor
IV medications can also be used in early labor, which is when you are having irregular, mild contractions. You’ll be given short acting medications like Nubain, Stadol or fentanyl, for a couple of hours of pain relief. Your body metabolizes these medications very quickly, and the delivery team will likely stop giving the medication once you have dilated to 6 centimeters. It’s best if the medication is worn off before the delivery because they can make the baby sleepy.
This is typically a good option in the early stages of labor and may be used if you are progressing slowly and plan to give birth without an epidural but still feel a lot of pain. IV medications can also help if you are not experiencing cervical change and it’s still too early for an epidural, but contractions are uncomfortable.
Laughing gas can help take the edge off
Nitrous oxide, or laughing gas, is another option during labor and delivery. It’s widely used overseas and gaining popularity in the U.S., available at some, but not all, Novant Health hospitals. It can be used at any stage of labor and because nitrous oxide is broken down in the lungs, very little of it reaches the baby. You would be given complete control over the mask and when you use it, empowering you to take control of the pain. Laughing gas will not give you a numbing sensation but can be used to take the edge off during contractions. It will not slow labor or keep you from getting out of bed and moving around.
Don’t expect the same experience you get with laughing gas at the dentist’s office. You’ll get less during labor and Ellington said it won’t make you laugh or feel loopy.
Spinal blocks are best during a cesarean section
For those having a C-section, planned or not, in most cases a spinal block will be given. Like an epidural, an anesthesiologist will inject medicine into your lower back. This will immediately numb you from your abdomen to your legs and lasts a few hours. If an epidural catheter is already in place and a c-section becomes necessary, the anesthesiologist can usually give you a stronger medication to relieve pain.
In very rare situations, general anesthesia may be given, putting you in a deep, sleep-like state.
You don’t have to rely on medication
There are plenty of options outside of medication. Expectant parents can opt to give birth without, relying on other relaxation tactics throughout delivery. With so many different choices to manage pain, some are now choosing a medication-free labor.
“A lot of moms now are opting to go without an epidural,” said Ellington. “I would say most first-time moms go into it thinking ‘I’m going to try without it.’”
Guided breathing and meditation can be useful relaxation techniques during natural childbirth. A support person, a family member or doula, who knows you well can intervene if you get into a negative headspace or need help working through pain.
Knowing and understanding the physiological changes you will go through can help in processing why you are feeling pain during certain stages of labor and delivery. Ellington stresses listening to your body, movement and changing positions can help alleviate some pain.
Hydrotherapy is also available at some Novant Health facilities. Getting in the tub can provide some relief but once it is time to push, you’ll be assisted to the bed.
Regardless of what you choose, Ellington says you should speak with your care team about what is available to you and safest.
“The more you know, the more you can prepare and have an idea of what you feel like you would be able to handle during labor,” said Ellington.
So, while it might be overwhelming, arming yourself with the knowledge to make a birth plan will help you decide what pain management tools are best for you and your new baby.
