Pain management during childbirth

Pain management during childbirth is the treatment or prevention of pain that a woman may experience during labor and delivery. The amount of pain a woman feels during labor depends partly on the size and position of her baby, the size of her pelvis, her emotions, the strength of the contractions, and her outlook.^[1] Tension increases pain during labor.^[2] Virtually all women worry about how they will cope with the pain of labor and delivery. Childbirth is different for each woman and predicting the amount of pain experienced during birth and delivery can not be certain.^[1]

Some women do fine with "natural methods" of pain relief alone. Many women blend "natural methods" with medications and medical interventions that relieve pain. Building a positive outlook on childbirth and managing fear may also help some women cope with the pain. Labor pain is not like pain due to illness or injury. Instead, it is caused by contractions of the uterus that are pushing the baby down and out of the birth canal. In other words, labor pain has a purpose.^[1]

Preparation

Preparation for childbirth can effect the amount of pain experienced during childbirth. It is possible to take a childbirth class, consult with those managing the pregnancy, and writing down questions can assist in getting the information that a woman needs to help manage pain. Simple interaction with friends and family can alleviate concerns.^[1]

Non-pharmacological

Moche - Female Figure in Birthing Position

Many methods help women to relax and make pain more manageable. These can be:

• breathing and relaxation techniques^[1][3]
• warm showers or baths^[1]
• massage^[1][2]
• using heat and cold, such as heat on lower back and cold washcloth on forehead^[1]
• Having the supportive care of a loved one, nurse, or doula^[1] The presence of a doula or female attendant results in a decrease in need for pharmacological pain control.^[4]
• changing positions while in labor (stand, crouch, sit, walk, etc.)^[1]
• using a labor ball^[1]
• listening to music^[1]
• acupuncture^[3]

Water and childbirth

According to the American Office of Women's Health, laboring in a tub of warm water, also called hydrotherapy, helps women feel physically supported, and keeps them warm and relaxed. It is also easier for laboring women to move and find comfortable positions in the water. In waterbirthing, a woman remains in the water for delivery. The American Academy of Pediatrics has expressed concerns about delivering in water because of a lack of studies showing its safety and because of the rare but reported chance of complications.^[1]

Medical and pharmaceutical methods of pain control

Physicians, Nurse Practitioners, Physician Assistants, Nurses and Midwives will typically ask the woman in labor if there is a need of pain relief. Many pain relief options work well when given by a trained and experienced clinician. Clinicians also can use different methods for pain relief at different stages of labor. Still, not all options are available at every hospital and birthing center. Depending on the health history of the mother, the presence of allergies or other concerns, some choices will work better than others.^[1]

There are many methods of relieving pain used for labor. Rare and unpredictable, serious complications sometimes occur. Also, most medicines used to manage pain during labor pass freely into the placenta to the baby. Asking questions about the procedures and medications which may affect the baby are valid questions.^[1]

Epidural and spinal blocks

Further information: Epidural administration

Further information: Spinal anaesthesia

An anesthetic medication is injected into the spine.

An epidural is a procedure that involves placing a tube (catheter) into the lower back, into a small space below the spinal cord. Small doses of medicine can be given through the tube as needed throughout labor. With a spinal block, a small dose of medicine is given as a shot into the spinal fluid in the lower back. Spinal blocks usually are given only once during labor. Epidural and spinal blocks allow most women to be awake and alert with very little pain during labor and childbirth. With an epidural, pain relief starts 10 to 20 minutes after the medicine has been given. The degree of numbness felt can be adjusted. With spinal block, good pain relief starts right away, but it only lasts 1 to 2 hours.^[1]

Although movement is possible, walking may not be if the medication affects motor function. An epidural can lower blood pressure, which can slow your baby's heartbeat. Fluids given through IV are given to lower this risk. Fluids can cause shivering. But women in labor often shiver with or without an epidural. If the covering of the spinal cord is punctured by the catheter, a bad headache may develop. Treatment can help the headache. An epidural can cause a backache that can occur for a few days after labor. An epidural can prolong the first and second stages of labor. If given late in labor or if too much medicine is used, it might be hard to push when the time comes. An epidural increases risk of assisted vaginal delivery.^[1]

Pain management after childbirth

Perineal pain after childbirth has immediate and long-term negative effects for women and their babies. These effects can interfere with breastfeeding and the care of the infant.^[6] The pain from injection sites and possible episiotomy is managed by the frequent assessment of the report of pain from the mother. Pain can come from possible lacerations, incisions, uterine contractions and sore nipples. Appropriate medications are usually administered.^[7] Routine episiotomies have not been found to reduce the level of pain after the birth.^[8]

See also

• Epidural
• Lumbar puncture
• Combined spinal and epidural anaesthesia
• Intrathecal administration

References

External links

• BabyCentre entry on Entonox
• Detailed medical analysis of the drug