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Preparing for Childbirth

For most women, birth is normal, natural, and healthy. Some women try to avoid using any drugs during labor and delivery, though many find that some pain relief medications are necessary. Everyone has a different response to stressful and/or painful situations. You need to understand the range of options available to make your labor and delivery more comfortable.

Your caregivers want you to assist you in making informed decisions so they will work with you on a care plan that most suits your lifestyle, beliefs and ability to tolerate pain. In order to prepare, we recommend that you learn as much as possible about what birth is like in the hospital/birth center you chose. Childbirth education classes will help you and your partner understand what happens during birth as well as learn ways to help your labor, including pain control options.

Here are some of the most common options in coping with, and relieving pain during childbirth.

  • Spinal Anesthesia

    Spinal anesthesia involves a one-time injection into the spinal column to numb the lower body region. This procedure is less preferred in vaginal births because it interferes with the ability to push; it is more commonly used during cesarean sections. As with the epidural, spinal anesthesia blocks nerve impulses, which may cause a drop in your blood pressure and may decrease the fetal heart rate. Continuous monitoring of baby and mother are observed as a precaution.

  • IV Narcotics/Analgesics

    Many women choose to take the "edge" off their pain, or dull it with intravenous narcotics. Ones most commonly used are Nubain and Stadol which have a short duration of action, meaning their effects don’t last too long. These medications cause sedation and drowsiness. If given early in labor, they may decrease the strength and frequency of contractions. While there are always some risks with medications, these pain relievers are used regularly in laboring women with remarkable safety.

  • Lamaze technique

    This is a widely used method of childbirth preparation. It advocates avoidance of unnecessary medical intervention with a mind over matter approach to overcome the pain associated with various stages of labor. This method teaches breathing exercises, overview of pain relief, visualization, massage, and verbal coaching to gain control over contractions.

  • Bradley Method

    This method’s focuses on overcoming pain naturally, rather than controlling it. Partner-assisted coaching is involved, which teaches open-mouthed abdominal breathing, and visualization. There is little emphasis on medical pain relief measures.

  • Epidural anesthesia

    An epidural is regional anesthesia, meaning it blocks a specific region of nerves. It is given through a small catheter (tube) placed in your lower back that reaches a space just outside the spinal cord, called the epidural space. Pain relief occurs along with a complete numbing of the pelvis and lower extremities within 5-20 minutes. It may be given during active labor and adjusted based on your needs. As a safety precaution, IV fluids will be given throughout the time the epidural is in place.

    Although very safe and effective, an epidural blocks nerve impulses, which may cause a drop in your blood pressure and may decrease the fetal heart rate. You and your baby will be monitored closely to be sure vital signs are stable. Since an epidural numbs from the waist down, you will feel a decreased urge to push, but you still will have the ability to push.

    If you are considering an epidural, ask your clinician about the best time for your epidural to be started. If given too early, an epidural can slow labor.

  • Nerve blocks

    Nerve blocks are local anesthetics (numbing drugs) injected into specific areas to help alleviate pain. Typically, their effects last for less than 2 hours. The following are descriptions of the nerve blocks that can be used during labor:

    Paracervical

    Local anesthesia is injected into the cervix. It is used most often during the active and transitional periods of labor. If you have a paracervical block, your baby’s heart rate and response will be closely monitored.

    Pudendal

    Local anesthesia is injected through the vagina into the tissue surrounding the pudendal nerve. This numbs the vagina, rectum and perineum (area in between), and is used just before delivery. This block is typically well-tolerated by the baby.

  • Fetal Monitoring

    Fetal monitoring is used to measure the fetal heart rate and uterine contractions during labor. It may be used intermittently or continuously to give your health care providers an indication of how your labor is progressing and, how the fetus is handling labor. The monitor has two parts; one measures the strength and the duration of contractions, while the other measures the fetal heart rate. 

    After your membranes are ruptured, your provider may recommend internal fetal monitoring of the baby. This involves insertion of a small fetal electrode into the skin on the fetus’ head. The electrode provides a better reading of the fetal heart pattern than the external monitor does. Typically internal monitoring is used when your provider feels that closer observation of the fetus is necessary.

    If you have questions about having fetal monitoring in labor, talk to you health care provider during a pre-natal visit; ask how he or she typically uses fetal monitoring in labor.

  • Alternative therapies

    There are a variety of methods that promote comfort. Whatever your preference, you may want to consider these additional comfort measures in planning your labor and birth.

    While every measure may not be offered in every medical setting, the following therapies are more readily available and generally accepted. If there is a specific one that you want to practice, call and ask your childbirth educator or staff at the delivery center if it is available, or if you need to bring in supplies on your own.

    Heat

    Heat helps to relax tense and sore muscles while increasing the blood flow to this area. Suggestions include: warm or hot towels (dry or moist), or a heating pad to provide heat to a specific region.

    Cold

    Applying ice or cool packs may provide a numbing effect to areas of discomfort by reducing the blood flow and swelling.

    Aroma

    Therapeutic and tension-relieving qualities of certain scents are well recognized. Pleasant experiences stimulate the “good feeling” part of the brain which may result in a release of hormones called endorphins (act as the body’s natural pain relievers). In labor, scents that work well are chamomile, sandalwood, vanilla and lavender.

    Music

    Some women find music relaxing, while others may find it distracting. If you relax with music or a favorite radio program, be sure to have a CD, tape or radio with you during labor.

    Water therapy

    Some birthing facilities offer showers or tubs for use during labor.  These may be used to help relieve muscle aches and tension.

    Birthing Balls/Balance Balls

    Balance balls may be used in labor to help reduce labor pains by placing it under the areas where the most pain is felt. The ball allows for a natural rocking motion, keeping the baby in alignment with the pelvis, and may improve the progress of labor.

    Tennis balls for back massage

    These come in handy for back labor when deep pressure applied to the lower back area brings relief. Place the tennis balls in a long tube sock so you can rest them on the lower back and direct their pressure to wherever you need it.

  • Prepared childbirth

    There are a variety of prepared childbirth education options to prepare mom and her coach for the new arrival. Courses usually begin in the second trimester. Below are some tips to help you choose a program that is right for you:

    • Look for a program that supports birth as normal, natural and healthy, and empowers you to make informed choices.
    • Look for instruction that provides class discussion, “skills” practice (e.g. breathing, positioning and relaxation) and comfort measures.
    • Small classes of 6-10 couples with a maximum of 12 couples are ideal. This allows the instructor to take time to answer questions and give you personalized attention.
    • Check on the instructor’s qualifications, including certification from a nationally recognized certification program such as Lamaze or ICEA (International Childbirth Education Association).

    Prepared childbirth classes usually are available at the facility where you will be delivering. Often tours of their birthing units, sibling classes and infant CPR (cardiopulmonary resuscitation) also are offered. Additionally, your clinician may be able to provide alternative choices of local childbirth educators who may have specific training in a birthing method that best fits your needs.

    If your pregnancy is at high risk and your activity is limited, you can benefit from prepared childbirth education, too. Call the childbirth education programs you are interested in, many will help accommodate your special needs.

    Most programs review combined approaches to labor management and pain control. Every option, natural or medical, is reviewed. During labor, you have a choice to use some techniques or all of them. Other programs such as Bradley and Lamaze have a more distinct philosophy guiding their programs.

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