Tuesday, March 10, 2015

Pain Relief During Labor

Pain relief.  I know that was the first thing on my mind when I truly felt and knew what a contraction was the first time I was in labor.  I'll just begin by saying that you will NEVER understand what a contraction is like until you feel it for yourself.  No blog, book, person's word will teach you better than your own body. Oh boy.  The first time I felt a true contraction, I was stoked. This is it! Contractions are just like my period cramps! Not bad! How naive... I had just graduated from nursing school and passed my boards and learned a lot of science in regards to labor, but not a lot in the actual experience.  I really wasn't sure what labor was going to be like, so I did not prepare much in regards to pain relief.  I basically decided that I would see what it felt like first and then get an epidural if I really needed some relief.  Tell you what, I was begging for an epidural as soon as the triage nurses decided that I was actually in labor and those two or three hours I didn't have any relief were agony.

Knowing what I know now, I wish I researched all my options very carefully.  Pain relief is definitely possible in multiple ways, most commonly through medication. Let's go over our options, ladies:

I am putting this one first because it is the most common one we all hear of.  Talking about epidurals will probably be the longest response out of all the pain relief options.  Epidurals are a regional anesthetic, which basically numbs you from waist to knees, if not toes too.  You will begin with a 1-2 liter fluid bolus as an epidural will generally lower your blood pressure.  A anesthesiologist or nurse anesthetist will place the epidural.  It is placed in the lumbar region of your spine- about where the curve of your back is.  They will have you either sitting on your bedside, hunching over a bit, or laying sideways in a "fetal" position:

The provider will first numb the skin/tissue in front of your spine with a local anesthetic (Lidocaine) and then proceed to first insert a hollow needle (Tuohy needle) between your vertebrae into the epidural space, the space between your spine and spinal cord that's filled with cerebrospinal fluid (CSF).  Next, they insert a thin tube (catheter) into the Tuohy needle and thread it up a couple of centimeters, remove the Tuohy needle, hook it up to a pump, and begin a continuous infusion of anesthetic (usually some kind of -caine ending medication [lidocaine, bupivacaine, etc.] and a mix of something else like a narcotic).  The catheter is taped down your back and you should be feeling fairly numb by now.

A lot of times they will give you a patient-controlled button to press when you feel like the medication is wearing off and needs a boost.  This is called a patient-controlled analgesia (PCA) pump. Some women find the epidural placement uncomfortable and others may not even notice it since they are too focused on their contraction pain (me).

Pros- complete pain relief, obviously.  There's a reason this is one of the most common pain relief options for labor! Also, the medication does not cross the placenta/blood barrier, so it wouldn't directly affect the baby.  All those reports of epidurals causing groggy babies are lies.  Haterz gonna hate!  Epidurals can sometimes be what your body needs to just relax enough to dilate/efface completely and push the baby out too.

Cons- there's a nasty adverse reaction of dropping your blood pressure too low.  It doesn't happen to everyone, but it can happen and can vary.  For me, it was quite unpleasant as my blood pressure suddenly dropped from its usual 115/80 to 70/50 or less immediately.  This caused me to feel faint and dream like and both my son and I were not getting enough oxygen.  Fortunately again for modern medicine, there are medications the anesthesiologist will be equipped with to reverse these kinds of reactions and the nurses are trained to respond quickly.

So indirectly, yes, an epidural could affect the baby, but most women seem to have a positive experience.  There's also always the possibility that the epidural won't work, won't last, or only affect one side.  From being completely numb, you may or may not have as much ability to push the baby out so you rely a lot more on the nurses and provider telling you when to push.

Visual aid of an epidural placement:

Spinal Block
So similar to an epidural placement, a spinal block will be administered much the same except it is a one-time injection of anesthetic into the CSF instead of a steady flow.  Spinal blocks last only 1-2 hours because of this.  As I mentioned in a previous post, this is more commonly given when having a c-section, but sometimes you may have this as an option. With both a spinal block and epidural, you will definitely get IV fluids, a urine catheter probably, and your blood pressure will be monitored.

Pros- much the same as an epidural. Complete pain relief! Shorter duration (which could be a con I guess if you still need the pain relief) and does not directly affect baby.

Cons- From what I've read, the severe headaches associated with a spinal block (spinal headache) are much less common now, but I guess that's always a risk.  They occur from a little of your CSF leaking from the puncture site and the headache lasts for 24 hours at most typically.  Low blood pressure is also a side effect too.

Narcotics, or also called opioids, can be given intravenously (IV, through a vein) or intramuscularly (IM, into a muscle like your shoulder, leg, or buttocks) and will not numb you completely.  They basically "take the edge off" of the pain.  Some common medications a labor nurse told me they use are fentanyl, stadol, or nubain.

Pros- it lasts a couple of hours and may just decrease enough pain for you to still move around during labor, if that's what you want to be able to do.

Cons- I am not a huge advocate for narcotics just because these do cross the placenta/blood barrier and could directly affect baby.  It's safe enough- narcotics are rated by the FDA as category C, which basically means that there is insufficient data to say it definitely or does not affect your unborn baby and that if needed, your provider can choose to give it to you.  Some babies will be born a little groggy and if too sleepy, they will be given an IV narcotic reversal medication called naloxone, or also called Narcan. Narcotics can also make you a little too sleepy, so take that into consideration.

Other medication
I'm categorizing everything else as other mainly because I highly doubt that you will use anything else besides what's listed.  These are less common, but still options depending on where you deliver:

Nitrous Oxide- I've only seen people outside of the US using this during labor.  It is an inhaled analgesic and makes you relax, a lot like a narcotic, but shouldn't affect baby directly.

Local Anesthetic Injection- I am unaware of this being an option before the baby is born, but I suppose it could be.  A shot of anesthetic, like Lidocaine, will be directly injected into your vaginal walls or perineum, causing numbness.  Usually, it is given when suturing tears or an episiotomy. There is not effect on baby.

Alternative Pain Relief
I will go into unmedicated births in an upcoming post, but I just wanted to list a few different methods people use for pain relief without medication:

  • hypnosis (this is number one and very biased as this is what I used)
  • breathing techniques
  • redirection (focus! you'll be holding a little baby soon!)
  • pressure points- certain acupuncture points can assist with pain relief
  • movement
  • yelling at loved ones and strangers- hey, it could help.
Most of the alternative pain relief options are focused on trying to totally relax your body and reduce the anxiety associated with labor and feelings of pain.  After all, pain is subjective meaning it varies from one person to another- what is excruciating pain to one mom may just be tolerable for another, but whatever it is, it is still very real for that person so that's why we need to treat it with what works for you.

*Thanks to MayoClinic.com for all the helpful pictures and information and Drugs.com for medication references.

1 comment:

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