The pain of childbirth is said to be one of the toughest to bear. While you may bravely decide during pregnancy not to opt for labor pain relief, you may find on that day that the pain isn’t what you imagined. Or you may reach the end of your tether if labor becomes prolonged or complicated.
Each person has a different pain threshold, and while some women manage very well without any pain relief, others should keep an open mind about how much pain they can take. Your choice should preferably be made before you go into the delivery room, because by the time you are getting contractions that are closer apart, it may already be too late.
Here are some common pain relief options, as well as their pros and cons.
Gas and drugs
Entonox — a mixture of the anesthetic gas nitrous oxide and oxygen — can be helpful to ease the pain during the first stage of labor. It is usually inhaled by the patient. You may also be given systemic painkillers, but these may not completely eliminate the pain. Another option is a tranquilizer to reduce anxiety and calm your nerves. These drugs may be delivered into your blood stream through an IV line or injected into a muscle. They may make you feel sleepy, but probably won’t knock you out like general anesthesia.
Pros:
- They help you relax and cope better with the pain.
- Gas or drugs are easier to deliver than an epidural or spinal block.
- Studies show that women who use systemic painkillers are less likely to need forceps or vacuum delivery compared to women who choose an epidural.
Cons:
- In labor, systemic painkillers may be given in doses too small to offer effective pain relief.
- These drugs can have unpleasant side effects such as drowsiness or disorientation, as well as nausea and itching. Side effects may be profound to the extent that you may have to stay in bed for a while or will not be able to remember your labor clearly afterwards.
- Systemic painkillers can affect baby’s heart rate and cause confusion when the nurse is trying to interpret the fetal heart rate monitor.
- These drugs may cross the placenta and affect the baby, e.g. by causing breathing difficulties.
- Systemic painkillers can affect baby’s alertness and make breastfeeding more difficult for him.
Epidural
An epidural is a popular choice of pain relief because, while it continuously blocks pain from the lower part of your body, it leaves you fully conscious and aware of how your labor is progressing. For the medicine to be inserted, you will have to lie curled on your side on the edge of the bed while an anesthetist injects the medicine carefully into your epidural space (a part of the spine). A catheter is then drawn through so that the medicine can be delivered as needed. You will be able to lie down after that without discomfort.
Pros:
- An epidural offers very effective pain relief that can be used throughout your labor.
- The anesthetist will be able to control how much of the medication is needed at different times during your labor. This will be helpful because as baby progresses down the birth canal, you may need more relief or you may feel pain in a different area.
- Unlike drugs, only a tiny amount of the medication might reach baby.
- An epidural that is already in place can also serve as anesthesia if you suddenly require a C-section.
Cons:
- It can make you lose sensation in your legs and you may not be allowed to walk about.
- The loss of sensation in your lower body may make pushing harder. This is called a weakened bearing-down reflex. The epidural will usually be lowered when it is time to push but it takes time for the effect of the medicine to wear off.
- Having an epidural is associated with a higher tendency for forceps delivery or vacuum extraction. This can heighten your risk of getting injuries.
- An epidural is also associated with higher risk of having a ‘face-up’ baby, leading to a C-section.
- An epidural can cause side effects like facial itching and nausea.
- An epidural makes it harder to feel when you have the urge to pee. You may therefore, need to be catheterized.
Spinal block
Like an epidural, a spinal block also helps eliminate pain from your waist down. But unlike an epidural, it is delivered directly into the spinal fluid and not a space around your spine. It is also a one-time injection and not a continuous delivery of medication. Relief is therefore, very quick, but lasts only a few hours.
Pros:
- You can be pain-free in minutes.
- Only a tiny amount of medication reaches your baby.
Cons:
The disadvantages of a spinal block are quite similar to that of an epidural. In addition, a spinal block can cause an uncomfortable tingling sensation in the legs that may last several days.
You may also choose a combined spinal block cum epidural that only requires one back injection. This allows you to walk around for the first hour after the spinal block kicks in, and then gives you continuous relief once the epidural starts to take effect and the spinal block wears off.
However, there are conditions that prevent certain women from having an epidural or spinal block. These include having an abnormally low blood pressure, a history of taking blood-thinning medication, a skin infection in the back where the needle will enter, or a previous allergic reaction to local anesthesia.
Non-medical comfort options
If drugs don’t seem right for you, there are also psychological means of stemming pain. There is a possibility that you will want both medical and psychological relief when the pain gets more intense.
Popular non-medical ways to ease pain include:
- A warm bath. This can be instrumental in easing pain during the earlier stages. Warm water has both a calming and pain-relieving effect. Use a handheld showerhead and ask hubby to help direct it where it hurts most.
- Heat and/ or cold. You may want to use alternate heating or cooling pads according to how you feel. A heating pad can work wonders on a hurting lower abdomen while a cold pack can help ease a sore back.
- Choose your environment. Some hospitals will allow you to create a delivery environment that you are more comfortable with, such as by changing the temperature, having more pillows, switching on your favorite music or even using aromatherapy.
- Mom’s presence. You may feel that having your mom or an older loved one by your side will be more comforting and reassuring than just hubby alone. Check with your doctor whether the hospital has guidelines on the number of people who can accompany you into the delivery room.
- Using mental pictures. Picturing a favorite place, such as where you had your honeymoon or where you grew up, helps create a sense of relaxation and security that can also ease pain. Or you may find it motivating to have a mental picture of baby moving down the birth canal as you push.
- Breathing. Look around your neighborhood for antenatal classes that can teach you effective ways to breathe during labor.
- Varying your position. Some women swear that switching to a vertical position is less painful during labor. Squatting, leaning forwards or sitting on a beach ball-sized birthing ball with someone stroking your back may be very helpful for pushing too. Again, check with your doctor if the hospital can offer guidelines on birthing positions.
- TENS machine. This is an obstetric pulsar machine that works by influencing the pain messages from your body to your brain, hence reducing the pain. The machine can also stimulate the production of endorphins, your body’s own pain-relieving hormones.
Prioritize comfort and safety
You may decide that you don’t want any pain relief and want to be fully involved in the birthing process. While this is to be lauded, there is also nothing wrong with wanting to relieve labor pain. Asking for pain relief does not mean you are less brave. Neither does it make you a bad mom. Every woman is different and has her own needs. So go ahead and ask if you feel that you want to enjoy giving birth, but without the intense discomfort. Do ensure that you discuss your options well with your doctor to reduce any risk of harmful side effects.
