A Guide to Knowing Pain Management Options BEFORE Your Contractions Begin

[1:17] Our Reviewer of the Week, kompatrit, said "So grateful for this podcast for making my unmedicated birth possible! Found this podcast at 4 weeks pregnant with an unexpected baby! I’m only 21 and had ZERO knowledge of anything birth or baby related and was so in the dark. This podcast has provided me with so much confidence and knowledge, I’m now 32 weeks and planning for an unmedicated hospital birth! Thank you so much for all your podcast and the birth course!"

[2:07] I want to talk to you about pain management options during labor because this is kind of one of those things that is out there and we kind of sort of talk about it or kind of think about it, but maybe we don't understand fully what's involved.

[3:02] What are your options? When it comes to pain management, there are things you can do that are administered in a hospital setting, and there are things you can do that are more natural coping techniques. 

[3:45] The most common pain management method in the hospital is the epidural. It doesn't tend to affect the mental space since the drugs that are used goes to a specific part of your body. Whereas if you're taking something like fentanyl or morphine, those kinds of drugs physically how you're feeling.

[4:44] What is an epidural? It blocks the sensation and movement of the limbs specifically from the waist down so that you're not feeling contractions, but it does make it so you can't feel your legs.

  • Regular Epidural: The anesthesiologist numbs the area with an injection and then they puncture through with a bigger needle that has a catheter that gets strung through that needle and heads downwards in a downward direction so that when the medicine goes into that catheter, it drips down and into the body and is a continual numbing.
  • Spinal Epidural: The method is the same except it is a very thin catheter, and that would be attached to the wall or medicine bag or wherever they have you that will drip that medicine continuously through there. It only lasts for about 90 minutes. It's called a walking epidural because it has been known to have some feeling in your legs and sometimes moms can even walk around. (In my experience, I don't know if these are approved in the United States.)

[8:20] Why does the nurse ask you to sign the paperwork upon arrival? A nurse will ask you to sign a consent form when you come into the hospital. Number one, you're more in your right mind than later on and having to like think through and work through contractions. So they want you to have an opportunity to really know what you're signing and all that. The other reason though is because as things get more intense for you, if you tell the nurse, "I need an epidural" they can call the anesthesiologist, but nothing can be done until the paperwork is signed. So make sure you sign it first because once you decide you want an epidural, an anesthesiologist may not be available because they've got two people ahead of you waiting for epidurals, then there can be kind of that lag of response time.

[10:16] The epidural medication is delivered through that catheter over the next couple of contractions (10 to 20 minutes), and you'll have less and less sensation until you really should lose all sensation. If you have an epidural, it's IMPORTANT that you move your body. Have somebody help you physically lay on the right side and then lay on the left side. Use your peanut ball. You want medicine to go to both sides of the body so make sure that you're rotating. It's also helpful to open up the pelvis so make sure that you have that peanut ball.

[11:23] Keep this in mind! Even if you are a mom that is planning for an epidural, you're going to have to feel contractions nine times out of ten (unless you have a planned cesarean). You are going to experience some amount of contractions, so it would be silly to not prepare yourself to figure out how to breathe with your body and work with your body, and it's silly to me that providers do not tell moms this. Learn to work with your body a little bit so you can get yourself a little further out, because the truth is, the later in labor that you are able to receive that epidural (six centimeters plus) and actively working through labor, if you can wait a little bit longer, your chances for intervention and Cesarean birth will decrease. 

[12:53 ] Risks/side effects of an epidural:

  • Uncomfortable
  • Can lower mom's blood pressure
  • Can cause baby's heart rate to drop
  • You will be given IV fluids and Pitocin
  • You'll have a urinary catheter placed

[16:31] Opioid options for pain management help your entire body feel less pain, but they can make you feel loopy. Opioids are usually given in the earlier stages of labor, so it's less likely that there'll be serious consequences to baby. Overall side effects from opioids, especially for mom, are nausea, vomiting, itchy, dizziness, sedation, decreased gastric motility, loss of protective airway reflexes, and hypoxia due to respiratory depression. Opioids cross the placenta during labor so it can cause some serious issues with the baby breathing if administered much later in labor. Some of the risks include depression, respiratory depression, impaired early breastfeeding, altered neurologic behavior, and decreased ability to regulate body temperature.

  • Demerol
  • Narcan
  • Stadol
  • Fentanyl

[21:34] Nitrous oxide is given at 50% oxygen and 50% nitrous oxide, and it does not offer strong pain relief. It helps mom to relax and it decreases that pain perception. Side effects for mom, dizziness, nausea, vomiting. It's not available at all hospitals so make sure that you call ahead of time and ask if this is something that you are interested in utilizing.

[25:45] What are some natural coping techniques? Massage, counter pressure, practice while you're pregnant and see what feels good. You can use breath work and breathing, birthing balls, leaning over them, rocking your hips, doing figure eights, bouncing on them a little bit, warm compresses, create kind of a home life atmosphere. I always tell moms to bring what's going to make you feel the most comfortable and safe, especially if you're going to a hospital or birth center. Bring essential oils, have relaxing meditation and music. Combs can be really great for pain management and holding onto that and moving it around in your hand or gripping it during contractions. Every 30 minutes, get up and move and drink lots of water.

[28:21] Water is Mother Nature's natural epidural. Take a bath, sit in a tub, utilize a warm shower!

I want you to realize that you have pain management options and understand what happens with each of those and what the benefits/risks are of each. Whether that's medicine that you're utilizing in a medical setting, or unmedicated options that you're using at a hospital. home birth, or birth center, all of those things that we talked about today are all OPTIONS that you have. You get to decide what's going to work best for you. I think it's really important to plan for the birth that you want, the one that's going to light you up, the one that's going to bring you joy. If that is an epidural, that sounds great. If it is an unmedicated birth, that's wonderful. If it's somewhere in between. You get to pick! It's really important that you have all the information in order to be able to make those decisions. 

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