Non-Medical Strategies For Dealing With Labor Pain
Massage Techniques for Childbirth
Medical Strategies For Dealing With Labor Pain
The following information was taken from Epidurals for Labor Pain by Henci Goer. To read the complete article click on this link Epidurals for labor pain
PROS
- It abolishes pain. It is the only pain relief method that can do this. That being said, epidurals fail to take only on one side, or leave “windows” in about five to ten percent of cases (6,11,29). Note: Having a continuous delivery system provides more even pain relief than having the anesthesiologist come in to inject more medication into the catheter at intervals or when pain returns.
- It abolishes pain without affecting consciousness. Epidurals leave you awake and aware. Narcotics leave you feeling fuzzy-headed, drowsy, or a little drunk.
- It allows you to rest or sleep. This can be a benefit in long or difficult labors.
- It may help a labor where progress in dilation has stopped in the active phase. Usually, epidurals slow labor down. Occasionally though, they help labors that have gotten “stuck” probably by inducing profound relaxation. An epidural is certainly worth trying before going to a cesarean
CONS
- Delay in obtaining relief -- It can easily take an hour between the time you request an epidural to the time it takes effect … and that’s if the anesthesiologist is readily available.
- Changes the psychological experience of labor -- It converts labor and birth from a natural, normal experience in which you are an active agent to one in which the equipment (I.V., Pitocin pump, epidural pump, electronic fetal monitor, blood pressure cuff, etc.) takes center stage.
- Requires an I.V. and continuous electronic fetal monitoring -- It also frequently requires Pitocin and bladder catheterization. These procedures have their own potential adverse effects.
- Slows labor -- This leads to more vaginal instrumental deliveries and episiotomies and it can lead to more cesareans, especially if the epidural is given early (28). These procedures also can harm mother or baby.
- Fever -- Fever becomes more likely the longer the epidural is in place (28). In one study, 15 percent of women who had epidurals ran fevers versus one percent of women who didn’t have them (16). Among women who had epidurals, seven percent of women with epidurals whose labors lasted six or fewer hours ran fevers rising to more than one-third of women whose labors lasted over eighteen hours. Because fever is a symptom of infection, babies of mothers who run fevers will likely be subjected to a septic work-up, (multiple blood tests and a spinal tap) kept in the nursery for observation and possibly given preventative I.V. antibiotics until cultures come back negative.
- Low blood pressure -- This is the most common potentially serious complication of epidurals. To give you an idea of how common, a recent study reported that one woman in five experienced low blood pressure (hypotension) with two per hundred requiring drug treatment to correct it (22). Hypotension (28) can be particularly dangerous in cases where the baby is already at risk such as when the mother has high blood pressure (pregnancy induced hypertension or preeclampsia), the baby is already experiencing fetal distress, or the baby is premature.
- Fetal distress -- About one in ten babies will experience an episode of seriously abnormal heart rate as a result of an epidural (11,26,27). Note: Some doctors have argued that epidurals protect babies from fetal distress. By eliminating pain, epidurals lower maternal adrenalin levels, which theoretically reduces the risk of fetal distress. However, no trial in which women were randomly assigned to an epidural or not has found that epidurals benefit babies and as you can see here, several studies have found that epidurals can cause the problem they are supposed to prevent.
- Life-threatening complications -- About 1 in 3,000 to 1 in 4,000 women will experience a complication (dangerously low blood pressure, respiratory or cardiac arrest, severe allergic reaction, convulsion) that will require emergency treatment to save them and their baby’s lives (8,25).
- Temporary problems after the birth -- These can include severe headache, urinary incontinence, muscle weakness or abnormal sensation, or a painful bruise (8,21,24,25). All are rare.
- Possible effects on newborn behavior -- We know that epidural anesthetics and narcotics get into the baby’s circulation, but we have little data on what effects they might have (18). The few studies that evaluate the newborn use a relatively crude test intended only to detect drug effects on muscle tone. It would miss subtle deficits that would be picked up on tests of behavioral competencies. Even so, the crude test found a difference with one type of narcotic-epidural a day after birth, compared with another type and a plain epidural (18). Of course, all mothers in that study had some type of epidural. We don’t know how the babies might have compared with babies whose mothers had no drugs. In any case, by increasing the likelihood of having Pitocin, instrumental delivery, cesarean delivery, and of keeping babies in the nursery for treatment or observation, epidurals also almost certainly have indirect effects on mothers, babies, and their early interactions.
- When it's used: It's best suited for pain relief during delivery — not labor — because it's usually only given once and the effects don't last long. It's most often used when the mother is too tired to push. A spinal block is frequently used for a cesarean birth, or if forceps or vacuum extraction are necessary.
- How it's given: A spinal block is administered as a single injection into your spinal fluid while you're lying on your side. A thin needle is inserted in the same location of your back as the epidural. Once the spinal anesthetic is injected, the onset of numbness is quite rapid.
- Pros:
- It works more quickly than an epidural.
- A much smaller dose is needed than for an epidural.
- Cons:
- You may experience a drop in blood pressure and some difficulty with urination.
- As your blood pressure drops, oxygen flow to your baby decreases.
- You may experience a spinal headache.
- You'll need to lie flat on your back for four to eight hours after delivery.
- Pudendal block
- The anesthetic--a numbing
medication, such as lidocaine or marcaine--is injected through the wall
of the vagina into the pudendal nerve on each side to relieve pain at the vaginal opening as the
baby comes out. It works well and is extremely safe.
- IV Medications
- IV, or narcotic, pain relief may be given up to 7 centimeters dilation. The most common medications are Stadol, Nubain, Fentanyl, and Demerol. Narcotics offer pain relief and do not interfere with a woman’s ability to push during labor. Unlike an epidural, a narcotic does not “numb” the pain but instead it helps to take the “edge” off. Narcotics help to reduce anxiety and improve the ability to cope with painful contractions.
- Potential maternal side effects include: Nausea Constipation
- Vomiting Loss of protective airway reflexes
- Itching Hypoxia due to respiratory depression
-
- Sedation
- Narcotics cross the placenta and will therefore have an effect on your baby. The most common infant side effect is depressed respiration. The baby may need help to initiate breathing, or may need to be intubated.
- Potential side effects for baby include: Central Nervous System depression Altered neurological behavior
- Respiratory depression Decreased ability to regulate body temperature
- Impaired early breastfeeding
- Types of narcotic pain relief
- Demerol is a popular choice for pain relief during labor. Demerol alters how you recognize the pain you are experiencing by binding to the receptors found in your central nervous system.
- PROS
- Can be given by injection into the muscle, given intravenously or by a Patient Controlled Analgesia (PCA) pump
- Demerol also starts working in less than 5 minutes
- CONS
- Demerol can cause drowsiness, nausea, vomiting, respiratory depression, and maternal hypertension (low blood pressure).
- If injected within five hours of delivery, Demerol has been found to cause breathing difficulties in babies.
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- Stadol has been found to relieve pain when given in the first stage of labor. This narcotic is also considered more potent than morphine and Demerol. It is usually given intravenously in small doses, usually 1 to 2 mg.
- PROS
- Starts working in less then five minutes
- Minimal fetal effects
- Minimal nausea
- CONS
- Is a powerful sedative which may make mom feel 'spacey' or drunk.
- Stadol can cause the mother to have respiratory depression and a dysphoric reaction (a state of feeling unwell and unhappy).
- Fentanyl is a synthetic narcotic similar to Morphine or Demerol and provides moderate to mild sedation.
- PROS
- Begins working quickly, (but only lasts usually 20-30 minutes)
- Minimal sedation
- Minimal fetal effects
- According to Danforth’s Obstetrics and Gynecology 9th edition, baby’s born to mothers who used Fentanyl to relieve pain
- during labor were less likely to need Narcan (medication to help with breathing) then babies born to mothers who used Demerol
- during childbirth
- CONS
- Maternal and newborn nausea
- Nubain is a synthetic ( man made) analgesic, which is helpful for moderate to severe pain.
- PROS
- Begins working in 2 - 3 minutes and lasts 3 - 6 hours
- CONS
- Sedation
- Nausea
- Clammy skin
- Dizziness
- Decreased respiratory rate in both mother and baby
For these reasons, having medication to counteract the narcotic may be necessary for your baby. Naloxone is a medication that when given in small doses can reverse the respiratory depression that narcotics cause without creating more problems. This drug may be given intravenously, or through an endotracheal tube (small opening in the throat) to your baby. The effects of Naloxone can be seen within a few minutes and can last as long as 2 hours.