Pain Management During Childbirth: What Are Your Options?
Childbirth is often thought of as one of the most painful events that we humans experience. In reality, the degree of pain can vary widely from woman to woman, and even from pregnancy to pregnancy.
Preparing yourself for the type of pain you will experience during labor and delivery can help alleviate some of the worry and anxiety you may be feeling. Planning strategies for pain relief in advance of labor will also help ensure you are able to deal with pain when the time arrives.
The Causes of Labor and Delivery Pain
Most women begin labor around the 40th week of pregnancy. Signs associated with the beginnings of labor include uterine contractions, water breaking (amniotic fluid leaking through the mother’s vagina), back pain, and slight vaginal bleeding.
Uterine contractions are the primary cause of pain during labor. In addition, the baby’s movement out of the uterus can cause pain through stretching of the vagina and pressure to the cervix, bladder, and bowels.
Labor pain is often manifested as cramping in the abdomen, groin, and back. Many women complain of a tired, achy feeling throughout their entire body. Some women may also experience pain in their sides and thighs.
Managing Pain During Childbirth
While you cannot prevent pain during labor and delivery, the following strategies can prepare you for this pain, so you are better able to handle it:
Exercise During Pregnancy
Getting regular exercise during your pregnancy can strengthen your muscles and increase your endurance to prepare your body for the stress of labor. If your healthcare provider clears you to exercise, aim to get 30 minutes of moderate cardiovascular activity (eg, walking, stationary biking, swimming) and muscle strengthening exercises on most days of the week.
Take Childbirth Classes
In childbirth classes, you will learn pain management techniques such as visualization and stretches. The two most popular birthing philosophies in the United States are the Lamaze technique and the Bradley method.
In the Lamaze technique, relaxation strategies, breathing exercises, distraction, and massage are taught as ways to manage pain during childbirth. The attitude toward pain relief medications is generally neutral, encouraging women to make an informed decision about whether medications are right for them.
The Bradley method emphasizes a “natural” childbirth, in which pain medications are avoided unless absolutely necessary. Instead, women are encouraged to rely on the baby’s father, who is the birth coach, to help the mother relax and use deep-breathing techniques.
Use a Doula
A doula (pronounced doo-lah) is a woman trained to give continuous emotional support during labor to help manage pain. Some hospitals and birth centers provide doulas, and some women hire them privately. A study, published in the Journal of the American Medical Association , found that the presence of a doula during childbirth significantly reduced the rate of ]]>cesarean section]]> deliveries and use of epidural anesthesia.
Use Other Nonmedication Strategies
Other ways of managing pain include hypnosis, yoga, walking, massage, changing position, taking a bath or shower, and distractions (eg, counting, other activities). A study in the Winter 2004 issue of Pain Research and Management found that breathing techniques and nurse-administered massage significantly reduced the perception of pain during labor.
Use Pain-relief Medications
Spinal and epidural anesthesia are commonly used to manage labor pain. In epidural anesthesia, pain medications that numb nerves that cause pain are given through a catheter placed in the epidural space near the spinal cord. In spinal anesthesia, the medications are injected into the spinal fluid.
In most women, these medications almost completely relieve labor pain, but do not numb the entire body. This allows the mother to use her abdominal and leg muscle strength to push and deliver the baby when it is time. In addition, the epidural catheter can be used to give extra medications in the event a cesarean section becomes necessary.
Pain medications can also be administered through an intravenous (IV) catheter or through an injection into the muscle. But since these medications can cross into the baby’s bloodstream and cause his or her heart rate to decrease, epidural anesthesia is often preferred.
Sometimes, nitrous oxide (laughing gas) is used during labor to relieve pain.
However you choose to manage childbirth pain, be sure to discuss all of your options with your healthcare provider well before you go into labor. Having a pain-relief plan in place will not only make labor and delivery less stressful, it will also relieve your anxiety during your pregnancy. Remember to be flexible, since you will not know how childbirth pain will affect you until you are in labor.
American Pregnancy Association
March of Dimes
The Canadian Women's Health Network
The Society of Obstetricians and Gynaecologists of Canada
Childbirth. National Women’s Health Information Center website. Available at: http://www.womenshealth.gov/Pregnancy/ . Accessed August 26, 2005.
Dealing with pain during childbirth. Nemours Foundation website. Available at: http://kidshealth.org/parent/pregnancy_newborn/pregnancy/childbirth_pain.html . Accessed August 26, 2005.
Kennel J, Klaus M, McGrath S, et al. Continuous emotional support during labor in a US hospital: a randomized controlled trial. JAMA. 1991;265:2197-2201.
Labor pain: what to expect and ways to relieve pain. American Family Physician. 2003;68.
Torpy JM, Lynm C, Glass RM. Birth labor. JAMA. 2002;288:1432.
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Last reviewed June 2009 by ]]>Ganson Purcell Jr., MD, FACOG, FACPE]]>
Please be aware that this information is provided to supplement the care provided by your physician. It is neither intended nor implied to be a substitute for professional medical advice. CALL YOUR HEALTHCARE PROVIDER IMMEDIATELY IF YOU THINK YOU MAY HAVE A MEDICAL EMERGENCY. Always seek the advice of your physician or other qualified health provider prior to starting any new treatment or with any questions you may have regarding a medical condition.
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