Know Your Options for Pain Management

This blog is the third in a series of blogs about Preparing for Childbirth. The first week, we talked about preparing your body and mind for childbirth. The second week, we talked about the way we talk about labor and birth. This week, we will talk about your options for handling the sensations of labor.

We ask all our clients about their plans for pain management. To some, it can seem odd to plan ahead of time what medications you want to use, or not use, during labor. Whether or not you have given birth before, it can be hard to know what to expect. That’s okay! We still recommend you learn what options will be available to you and get your questions answered before you are in labor.

The purpose of this blog post is not to try to convince you to pursue any one kind of birth!

We have no agenda on whether you choose to have an unmedicated birth (one without any medications for discomfort) or a birth with a planned epidural.  

There is no right or wrong way to birth.

As your doulas, what we do want to do is help you find information on your options and acting as a sounding board while you process how you feel.

Some things to think about prior to labor:

First, what kind of birth experience are you looking for? 

Do you want to experience every part of labor and deal with the sensations using medication-free methods? Do you want to labor without medications until a certain point (for example, until you are in active labor or transition) and then use them? Do you want to feel as little pain or other sensation as possible? Your answers will determine the kind of birth experience you are looking for!

What is your motivation?

Why do you want what you want? Did you decide this on your own? Do you feel pressured or like “you ought to” give birth in a particular way? The “why” matters because it may make a difference in how likely you are to follow through during labor.

Do you want to change the language used at your birth?

Check out our blog about the language of birth to learn about this.

Who is most supportive?

Whatever your choices, surround yourself with people who support you in your decision of how to birth your child. A support person’s negativity can be disheartening when you’re pregnant or during labor and birth. Fill your birth space with people who will help you have the birth you want, not stand in your way.

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What are the benefits and drawbacks of both unmedicated and medicated births?

Unmedicated birth

Benefits: 

Drawbacks:

  • You feel everything.
  • It often takes more prenatal preparation to achieve (usually at least one childbirth education class or at least pretty intense self-study).
  • It’s harder to do by yourself. You may need additional support people (including someone like a doula, who cost money).
  • It is harder to rest or socialize because your unmedicated labor often needs your undivided attention.

Medicated birth

Benefits:

  • Less physical discomfort during labor. 
  • Improved comfort may allow you to rest better or socialize more with visitors.

Drawbacks:

  • Depending on the type of pain management you want, most medicated births have to occur in a hospital. Some birth centers do offer things like TENS units or nitrous oxide, but home birth is off the table if you plan to use medication for pain management.
  • Your movement may be restricted (either because you have cords/IV tubing attached to you or because the staff is afraid you might feel dizzy and fall).
  • Your provider may insist you push while you lay on your back, which may feel unnatural. This varies by provider and by medications used.
  • You may lose touch with your body. It’s hard to remember you are in labor if you can’t feel it. For some, this is a significant drawback but for others, this is a fair trade-off.

Learn everything about your options during your pregnancy. There are many comfort measures and medications available to pregnant parents and this is just a brief description of each. This is not an exhaustive list, but these are the most common ones and ones you might run into in your prenatal books or on birth center & hospital tours. My reference for these is Pregnancy, Childbirth, and the Newborn: A Complete Guide by Penny Simkin.

We obviously recommend a birth doula for all births. But especially if you plan to go unmedicated, we cannot recommend strongly enough the benefits of having a doula at your birth. At the very least, both you and your support people need to learn and be familiar with comfort measures prior to labor. They require prenatal work so we highly recommend you begin researching these early in your third trimester. Labor is simply too demanding for most people to manage unmedicated without preparation for it and help during it.


Here we go. All the options:

Labor Mindfulness

How it works:

  • Birth affirmations involve using positive phrases (like “my body was made to give birth”) to help you keep in mind why you are uncomfortable.
  • Hypnobirthing uses mindfulness and Hypnobabies uses clinical hypnosis to help you change your understanding and thus the experience of labor.

Benefits:

  • You can create these prior to labor.
  • Your support people can say these to you during labor or you can say them to yourself.

Side effects/Drawbacks:

  •  Hypnobirthing and Hynobabies require time for prenatal classes during your pregnancy to prepare and cost money.

Massage

How it works: 

  • Massage works by distracting you and soothing tired, achy muscles.
  • Acupressure can reduce labor pain, increase contractions, and increase your satisfaction of your pain relief. This article on acupressure talks about many pressure points, but the main ones to try for labor are Hoku and Spleen 6.

Benefits: 

  • Massage is very effective way to show love, reassurance, and encouragement to the laboring parent.
  • Both massage and acupressure can be performed by either a partner, a doula, or friends.

Side effects/Drawbacks:

  • None, although acupressure should not be used prior to your due date as it can cause preterm contractions.
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Free Movement

How it works:

  • Movement helps your baby to find the best way to pass through your pelvis and allows you to respond in ways that make this most comfortable.

Benefits:

  • These labor positions are free and easy to learn.
  • Partners can help you with the two-person positions, allowing them to be involved.
  • You can continue to use some of these after you use pain medications/get an epidural.

Side effects/Drawbacks:

  • None

Hydrotherapy (aka water!)

How it works: 

  • The warmth and buoyancy of a bath, especially if accompanied by a gentle massage with jets/a showerhead, help your whole body relax. 
  • Using a hot shower or bath is often called a “midwife’s epidural” by birth workers because it can be so effective!

Benefits: 

  • Water is readily available and can help parents refresh and refocus their energy.
  • It can loosen sore muscles.
  • If you take a bath during active labor, it can decrease stress hormones and may speed up labor.

Side effects/Drawbacks:

  • If you take a bath during early labor, it can slow down your contractions. This can help you rest but if your provider wants you “on the clock” you may end up having Pitocin later to speed things back up.
  • You only want to stay in the bath for around 90 minutes so you and your baby don’t get too hot. This is less of a problem with showers.
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Counterpressure/TENS Unit

How it works: 

  • You create a separate, uncomfortable sensation that is controlled by the laboring parent. 
  • Some parents do this spontaneously (think: digging your nails into your palm or gripping something very hard) but you can also plan to do this by using something like a TENS unit or squeezing a hairbrush/labor comb.

Benefits: 

  • You feel in control during your labor. 
  • The extra stimulus can increase the release of endorphins (natural pain reducing hormones) and serves as a distraction from contractions.

Side effects/Drawbacks:

  • Although you can use some household items to do this (like a hairbrush/labor comb), a TENS unit may not be available if you plan to birth at home. The Knoxville Baby+Co. does offer TENS units as an option to their clients.

Nitrous oxide

How it works: 

  • Nitrous oxide is also known as “laughing gas” or “gas and air”.  It is given via a mask held by the laboring parent, who inhales it during every contraction. 
  • The nitrous oxide does cause a release of dopamine and endorphins, which help reduce the pain, but what nitrous oxide really does well helps you not care about the pain as much.

Benefits:

  • You have more control over this method because you choose whether or not to inhale it with each contraction. No medication is given when you aren’t inhaling.
  • Nitrous oxide also reduces anxiety and can give you a slight euphoric feeling.
  • It is cleared from your system very quickly – the half life is only 3 minutes – so you can easily move to another method if it isn’t working for you.
  • Nitrous oxide usually doesn’t require IV fluids, continuous fetal monitoring, or restrictions in your movement. It does NOT slow labor or affect your ability to push.

Side effects/Drawbacks:

  • Side effects may include nausea, dizziness, drowsiness, or hazy memory of events.
  • Nitrous oxide may not be available if you plan to birth at home. The Knoxville Baby+Co. does offer nitrous oxide gas as an option to their clients.

Narcotics (IV or by mouth pain medications)

How it works: 

  • Some well-known ones are morphine, fentanyl, or Stadol.
  • They reduce the transmission of pain messages to the pain receptors in your brain.
  • Many people describe these as “taking the edge off” as opposed to removing the pain entirely.

Benefits

  • These can give you a longer break between contractions and allow you to rest during this time.
  • These are given one time (as opposed to having to deal with it every contraction) and can be given again after a certain amount of time (usually a few hours – depends on the dose/type of medication used).

Side effects/Drawbacks:

  • You still may need coping mechanisms to handle the peak of your contractions.
  • These medications can make you feel sleepy, lethargic, disoriented, or euphoric. Due to this change in mental status, most hospitals require you to remain in your bed after receiving them (so you don’t fall).
  • Most hospitals require you to be on IV fluids.
  • Most hospital require you to have continuous fetal monitoring. These medications make your baby sleepy as well, which can change the fetal monitoring, making it harder for your provider to interpret it.
  • This added sleepiness in babies also means that most providers will not give narcotics if they think you are within 2 hours of birth. Narcotics can cause your baby to breathe slowly or have poor muscle tone, although another medication can be given to reduce these side effects if severe.
  • Medication side effects may include itching, nausea, vomiting, and lowered blood pressure.
  • Narcotics can slow labor.

Epidural

How it works: 

  • The nerves that feel the discomfort of contractions start from the spine and go out to the rest of the body. An epidural is a numbing medication that is injected into the epidural space (a space around the spinal cord).
  • The goal is that the medication in your epidural will either partially or completely numb the sensations of labor.
  • This blog is a good reality check on your expectations of epidurals.

Benefits: 

  • You may have partial or even complete relief of contraction discomfort while still allowing you to participate in your birth. 
  • These results are usually achieved with one epidural placement (despite many horror stories on the internet!).
  • You are not mentally altered as with narcotics.
  • Since you’re more comfortable, you may be better able to rest or socialize with visitors.

Side effects/Drawbacks:

  • Your nerves control muscle movement, so you may not be able to control your legs well while you have it. Due to this, most hospitals say you must remain in your bed when you have an epidural so you don’t fall. You may need help moving around in bed.
  • Most hospitals require you to be on IV fluids before your epidural can be placed and remain on IV fluids after you have one.
  • You will likely need a bladder catheter. This is often placed after your epidural is well established (so you don’t feel it) but it can leave some irritation with urination after it has been removed. This is often mild and improves without intervention.
  • Most hospitals require continuous fetal monitoring if you have an epidural.
  • Epidural side effects include decreased blood pressure, itching, nausea, a longer labor, a longer pushing phase, and fever. You are also at an increased risk of further intervention (such as oxygen use, Pitocin augmentation, vacuum or forceps assisted delivery, or cesarean birth).

There is a lot of information here and it does not replace careful discussion with your healthcare provider!! But we hope this has helped you learn about the most common options for dealing with the sensations of childbirth.

Now comes the hard part: deciding how you want to birth!