pain management during labor + birth

One of the biggest concerns on every pregnant person’s mind is how they will cope with the sensations and pain of childbirth. Before we get into the available pain management options, let’s do some math. Suppose your surges (contractions) are following the 4-1-1 rule, happening every four minutes and each one lasts one minute. If you do the math, this means you will only be actively contracting for fifteen minutes. Even less actually, since surges peak about halfway through. So in one hour, you will have 45 minutes of rest! A future post will focus on enjoying that 45 minutes of rest. For now, let’s explore the options available for pain management. 

Many of the techniques listed below are also highlighted on Evidence Based Birth. Check out their Pain Management Series for a deeper look at the research on pain management in labor. 

NON-MEDICATION

We’ll start with some non-medication-based techniques that you can use no matter where you choose to birth. They work equally well at home, a birth center, or the hospital.

1. Hydrotherapy. There is just something so relaxing about water. Sinking into a warm bath during labor can relieve some pressure caused by gravity. If used in early labor, there is a chance it can slow down your contractions. It can be very effective to take a hands and knees position in a tub and have someone pour water over your back and shoulders. Standing or sitting in the shower with warm water pounding your back can also be very relaxing. 

2. Touch. There are many ways to make touch work for you during labor. Cuddling with your partner can bring on a flood of pain-relieving oxytocin. Lower back massage can distract you as well as relieve pressure in your pelvis. There are several acupressure points that can aid in pain relief as well as start labor or keep it progressing. Squeezing a fine-toothed comb can redirect your focus away from the intensity of surges. Also consider visiting an acupuncturist during the early stages of labor. 

3. Movement. Rhythmic, upright movements can be a great help during labor. Walking helps keep your baby engaged in the pelvis. You may find yourself naturally swaying or making figure-eights with your hips. This also encourages your baby to stay in the proper position. Dancing, either slowly with your partner or alone to more upbeat music, can help distract you from the intense sensations. Slow dancing has the added benefit of releasing oxytocin.  

4. Relaxation. Aromatherapy and music can enhance your birth experience by creating a calming, familiar environment. Focusing on specific breathing patterns can help distract you, relax you, and keep up a steady supply of oxygen to you and your baby. You might also consider a HypnoBirthing or Mindful Birthing class.

MEDICATION 

Now we’ll move on to medication-based pain management that will most likely only be available in a hospital setting. It’s also important to talk with your midwife or OB-GYN beforehand about the possible side-effects of these medications for you and your baby. 

1. Epidural anesthesia. The classic epidural is administered via spinal injection and results in loss of feeling from abdomen to feet and is usually given before 8cm dilation. It can provide welcome relief during a long labor and give you the opportunity to sleep. You can also opt for a “light” epidural, also known as a walking epidural. A lower concentration is used resulting in loss of pain in the abdomen, but retaining sensation and movement of your legs. 

2. Combined spinal-epidural. Administered via spinal injection, the spinal-epidural combines epidural narcotics and spinal block narcotics. It provides pain relief while retaining the ability to stand and walk with assistance. 

3. Single dose narcotics. Given via IV or injection, narcotics can relieve pain and allow you some much-needed relaxation. They are usually only given until 7cm dilation. You can get multiple doses, but each consecutive dose is a little less effective. 

4. Nitrous oxide. Inhaled through a breathing mask, nitrous oxide can provide some loss of sensation below your chest and help you relax or even sleep. Ask ahead of time if this is available at your birth place - not all hospitals and birth centers have this as an option. 

OTHERS

There were a few more techniques that didn’t seem to quite fit in either of the above categories. They aren’t medication-based, but they do require extra equipment.

1. TENS unit. You can purchase a transcutaneous electrical nerve stimulation (TENS) unit yourself online for around $30. The unit is usually applied on the lower back on either side of the spine. It stimulates your nervous system to either block pain signals to your brain or stimulate your body to release endorphins depending on the intensity. 

2. Sterile water injections. This is exactly what it sounds like. Using a short needle and disposable syringe, sterile water is injected under the skin on your lower back. This provides pain relief in a matter of minutes and they can be given at any time during labor. Check ahead of time to see if this is an option.

It is best to discuss your options with your midwife or OB-GYN well before labor begins, as availability varies by location. Even if you are birthing at home or at a birth center, it isn’t a bad idea to educate yourself on the medication options in the event of a transfer to the hospital. If you would like to talk more about these options, please send me a message!