The Laboring Woman's Options for Pain Relief

I don’t usually use the P word (pain) when I discuss labor. I prefer the physiological descriptors like “intense pressure,” “tightening,” “intense stretching,” etc. However, it’s hard to have a discussion about a laboring woman’s options for relief without using the word pain. So for this article, I’m going to let it slide for ease of reading. This article is by no means exhaustive on these interventions, but for a mama trying to get a general idea of her options, this is a good place to start.

Every woman has different needs and thresholds for pain. Therefore the kinds of pain relief used depends on the woman in labor. For example, is Pitocin being used on her? How much?If too much is administered before mom’s body can adapt, it may become harder for mom’s body to keep up with the birth waves and she may suddenly struggle to cope. How’s mom’s blood pressure? Oxygen levels for mom and baby? If mom or baby’s wellbeing seem to be at risk during the intensity of labor, an epidural may be of use to help mom relax and lower her blood pressure as well as get the baby out faster in an emergency situation. Those emergency situations are not the norm however, and since each pain relief intervention has its negative side-effects, they should be considered with informed hesitation at very least.

Natural Coping Tools & Techniques-
These are drug-free coping tools & techniques as well as laboring positions that reduce pain and are optimal for mom and baby’s health when drugs are not medically necessary. You can read my full article on that here.

Cannabis-
A controversial subject in modern days, medical Cannabis is undeniably known for its calming properties that ease nausea and reduce pain. The most effective and positive labors for mom and baby occur when the mother is as uninhibited as possible and feels able to follow her body’s deepest instincts without hesitation. Cannabis may provide just that avenue for a laboring mom. If you want to learn more on the subject, I encourage you to do your own research and come to your own conclusions. Here’s an article by Sensi Seed that discusses the modern and historical use of cannabis in childbirth. Because of the current legality status, cannabis will not be an option for women birthing in hospitals or birth centers of most states. However for mothers birthing at home or in states where cannabis is legally administered, it may be a viable option to consider.

Nitrous Oxide-
Nitrous Oxide is not considered a true analgesic because it’s doesn’t significantly lower the pain score according to scientific standards. Also called “laughing gas,” nitrous helps mom cope through the intensity of labor. More popular in Western Europe & Australia, only natural leaning hospitals and birth centers usually offer it in America–though its popularity is growing. To administer the gas, the mom inhales & exhales through a mask. It’s important that she breathe out through the mask as to not contaminate the room. You don’t want your midwife to start feeling the effects. Biologically speaking, it’s closer to a dissociative analgesic, in that you still feel the birth waves (aka contractions), you just don’t seem to care as much. What’s nice is the sense of control for momma because she can hold the mask and decide when to breathe it in and when she’s had enough. To use most effectively, you’ll want to breathe in the nitrous 45 sec before contractions so that you feel the dissociative effects at the peak of the birth wave. The nitrous does cross the placenta, however is does not interfere with the natural flow of oxytocin, nor does it affect infant alertness or breastfeeding during the early bonding period between mom and baby. Nitrous oxide is relatively insoluble in the body so it’s effects are fast on when you breathe it in, and then fast off once you stop breathing it. Some women have reported feeling light headed and no longer present in the moment, which they did not enjoy. Again, the good thing is that it’s easy enough to stop breathing it if you don’t like it. While nitrous oxide still allows mom to be ambulatory (move around), she may not be allowed to move on her own while breathing it in as she could get dizzy and fall.

Narcotics-
Narcotics are central nervous system depressants administered through IV (through a vein), intramuscular (into muscle tissue), or subcutaneous (under the skin). The narcotics attach to pain receptors and block the pain by not allowing those receptors to transmit messages to the brain. The effects of a standard dosage last anywhere from 2-4 hrs. The extreme and rare downside is that narcotics could also shut down the central nervous system completely and mom could stop breathing if they are overdosed. The good thing about narcotics in labor is that while they decrease the pain, they don’t take away mom’s mobility completely (though it may be limited because of the IV and dizziness). The downside of narcotics that concerns moms most often are the effects on the baby. Electronic fetal monitoring show that heart rate patterns differ from normal after the narcotic is administered, as do their brain wave tracings, and respiratory movements. Depending on the brand, dosage, and when its administered during labor, babies born with narcotics in their system sometimes require temporary assistance to stimulate breathing. They may also be a bit groggy and less motivated to nurse or bond through eye contact. Narcotics given during labor have been detected in babies’ bloodstreams up to eight weeks after birth. If you want a narcotic that you can’t overdose on, you’ll want to ask for an option that is mixed agonist AND antagonist. Basically they have a ceiling effect, which means that over a certain dosage, they won’t increase their potency no matter how much you administer. Some examples are Butorphanol and Nalbuphine.

— Fentanyl is a more commonly used narcotic these days. One benefit is that it doesn’t last as long (only 1hr), but it still takes the edge off and blocks pain messages from being sent. Remifentanil is another option. It is ultra short lasting, though the pain score still decreases, so it’s a true analgesic.
— Smokers, drinkers, and pain pill poppers require larger doses of narcotics to feel the same effects because their bodies are more used to metabolizing.
— Morphine rest is the administration of the narcotic Morphine in early labor to help mom sleep if she is over exhausted and wants to rest so that she’ll have the energy to finish her labor when it gets intense. Sometimes that little break can help mom complete a vaginal delivery during a super long labor.
— Naloxone is a drug designed to rapidly reverse the effects of any narcotic in the case of overdose. Evzio is an auto-injection device that makes it easy to inject naloxone quickly into the outer thigh. Narcan is a pre-filled nasal spray that is sprays naloxone into one nostril while patients lay on their back.

Epidurals-
Here is a great article on the 7 common types of epidural by Dr. Sears. “Epi” means around and “dura” refers to the sac that contains spinal chord fluid and nerves. An epidural doesn’t penetrate the sac itself. Instead, a large volume of medicine spreads in all directions and numbs up each nerve root. Pain messages are still being sent from the body but they are blocked right before they hit the spinal chord so they can’t be sent to the brain. Epidurals are administered in the lower back by first cleaning the area with an antiseptic solution, then repeated numbing shots are given using local anesthetic little by little along the track from the skin through to the spine. Done successfully, this should numb the entire path before the epidural is administered. After that, a small tube called a catheter is threaded through the needle. Once the catheter is in place, the needle is removed and the catheter is taped down to the back, leaving it to administer the medication as desired. Epidurals have been shown to increase the pushing stage of labor up to 15-20 min.

— Lying in one position can sometimes cause labor to slow down or stop. But since most hospitals also administer Pitocin when epidurals are given, contractions are generally kept at 2-3 min apart, with no noticeable difference in the length of the pushing stage.
— Some studies also suggest that baby has increased risk for respiratory depression, poor fetal positioning, and fetal heart rate variability. For these reasons additional interventions may be needed such as forceps, episiotomy, or cesarean.
— Epidurals may cause your blood pressure to suddenly drop. For this reason, your blood pressure will be routinely checked to help ensure an adequate blood flow to your baby. If there is a sudden drop in blood pressure, you may need to be treated with IV fluids, medications, and oxygen.
— Some studies suggest that babies might have trouble “latching on” to nurse after birth.
— You might experience shivering, ringing of the ears, backache, soreness at the injection site, nausea, or difficulty urinating (which could result in the placement of a urinary catheter).
— In the rare case of a dura sac puncture resulting in loss of spinal fluid and spinal headache, an epidural blood patch can be administered. Blood is taken from the arm and put into the back essentially plugging the hole in the dura sac until the sac can heal on its own. It can be administered after the first 24 hrs and works pretty much right away.
— In other rare instances, permanent nerve damage may result in the area where the catheter was inserted.

Spinal block-
Spinal blocks are used generally just for surgery. The needle goes a few mL deeper than an epidural and penetrates the dura sac, injecting a smaller quantity of local anesthetic and potentially some narcotic. Spinal blocks kick in faster than epidurals and are most common for c-sections. Less drugs need to be administered because it penetrates the dura sac and numbs the spinal chord itself, not just the nerve root. Spinal block needles have a blunt tip that push through the fibers of the dura sac instead of puncturing them. This allows the fibers to bounce back shut once the needle is removed, releasing very little if any spinal fluid. All of the same risks of the epidural apply to the spinal block as well.

Walking epidural aka CSE-
A combined spinal/epidural, called a CSE provides both the immediate pain relief of the initial spinal block anesthesia and longer acting pain relief of an epidural with fine tuning. After the medication is administered to the spinal chord, the anesthesiologist will pull the needle back into the epidural space, thread a catheter through the needle, then withdraw the needle and leave the catheter in place, only administering more medication as requested. This allows for partial relief while enabling mom to still move around with assistance. Some hospitals even allow you to have a button option that you can control to get an extra boost of the medicine when you want it. Safety features only allow you to administer a certain amount at a time so there’s no fear of overdose. It takes about 10 minutes for the medicine to work once you administer the button.

General Anesthesia-
General anesthesia usually uses a combination of intravenous drugs and inhaled gasses (anesthetics) to make mom completely unconscious during the medical procedure. Usually only used in emergency c-section situations, an anesthetized brain doesn’t respond to pain signals or reflexes. An anesthesiologist will stay near to monitor your body’s vital functions and manage your breathing. A breathing tube may be inserted into the windpipe to maintain proper breathing during surgery.

Leave a Reply

Your email address will not be published. Required fields are marked *

Comment *