They don't call it labor for nothing. Having a baby is hard work, and part of that work is getting through the pain. But don't panic. There are more ways than ever to manage that pain, and you don't have to choose just one. "The trick is to have as many tools in your bag as possible," says Kim Hildebrand Cardoso, a certified nurse-midwife in Berkeley, California, and a mother of two. "You don't know what's going to work until you're in it, and what helps a woman at one point can change five minutes later." That's why it's important to keep an open mind and do your research. So take a deep breath (good practice for later) and prepare to enter the wide world of pain management.
"The most important thing you can relax during labor is your mind," says Stacey Rees, a certified nurse-midwife at Clementine Midwifery, in Brooklyn, New York. The idea is simple -- when you fear pain, you tense up, which makes the pain worse, which makes you tense up more. Cardoso had back labor for 21 hours with her first baby and says her saving grace was enjoying the time between contractions. "I tried to stay in the moment and not spend the precious pain-free minutes stressing about the pain I just had and what was to come. The result was ecstasy -- I felt like I was on really good mind-altering drugs."
To stay relaxed, it's crucial to pay attention to your breathing, the same way you do when you're lifting weights. Whether you're hee-ing or haa-ing, panting or deep inhaling, as long as you're focusing on your breath and releasing it, you'll find some relief. "I tell women their breath is the path through the contraction," Rees says, "and to just keep following that path until the sensation starts to fade."
And don't feel inhibited about making strange loud noises. Rees recommends strong low-pitched moans rather than high-pitched horror-movie screams, which tend to make the throat tight and tense, but she admits it isn't always possible. "With my second baby, I was able to make those low guttural sounds, somewhere between a Gregorian chant and a large animal near death," Cardoso remembers. "But with my first baby, I just ended up screaming a lot."
Walking, swaying, changing positions, and rolling on a birthing ball can not only ease the pain but can help your labor progress by using the force of gravity to your advantage and encouraging the movement and rotation of the baby down through the pelvic canal. In a hospital setting, being hooked up to fetal monitors, IVs, and pain medicine can limit your walking, but you can still try positions like hands and knees in the bed or standing, squatting, or sitting by the side of the bed. "It really helped to be on my hands and knees, leaning onto my husband's chest," says Andrea Vander Pluym, of Oakland, California, mom to Bastien Brace, 3. "And I liked leaning over in the shower, leaning over the sink, leaning on the stairs -- lots of leaning."
Warm water can work wonders for diminishing labor pain. "It felt absolutely amazing and so soothing to step into this 100 degrees F. water at the birthing center," recalls Cynthia Overgard, of Stamford, Connecticut, mother of Alex, 3. "My doula [a person trained in childbirth support, who assists the mother physically and emotionally] began pouring cups of water over my shoulders -- it was almost spa-like."
Don't underestimate the power of the shower either -- the stream of hot water will not only keep you relaxed but will massage you too. There are no hard-and-fast rules, but some doctors or midwives may caution you against getting in the water in early labor (under 4 centimeters) for fear it'll slow things down.
Massage may be a bit of an understatement when it comes to the kind of pressure most women need for relief during labor. "After the baby was born, my husband complained that his hands hurt so much from pushing on my back," says Kari Bennett, of Gatlinburg, Tennessee, mom to 3-year-old Jorja. "I had to laugh." Even if you don't find that counterpressure reduces the pain, having your partner rub your feet or massage your hands or temples can distract you, relax you, and generally make you feel cared for, which is a major morale boost.
Over the last 10 years, the epidural has changed dramatically, explains William Camann, MD, coauthor of Easy Labor and director of obstetric anesthesia at Brigham and Women's Hospital, in Boston. The medicine is no longer delivered through one hefty shot that leaves you completely numb. Instead, it's given via a slow continuous drip so you can't run out, and you should feel enough pressure to be able to push. In fact, most hospitals now use patient-controlled epidural anesthesia, which keeps the baseline epidural low but allows you to press a button for more if you need it.
Studies show that you're not at a higher risk for having a c-section or a prolonged labor (an epidural adds one hour, on average). Spinal headaches, caused by the leakage of spinal fluid through the tiny hole the needle makes, are now exceedingly rare, occurring in just 1 percent of patients. And you don't need to worry about missing a small window of opportunity to get the epidural, says Benito Alvarez, MD, codirector of obstetrics and gynecology at the Cleveland Clinic. In general, you can get an epidural anytime after starting active labor, and, Dr. Alvarez adds, "it's really only too late if the head is popping out." A few medical conditions could prevent you from getting the epidural, like certain blood clotting disorders, scoliosis or past back surgery, or severe infections like sepsis. But for the vast majority of women, it's fine. All of which adds up to a lot of satisfied patients.
"When I first arrived at the hospital, I was in such pain and so disoriented, everything was like a blur," recalls Erika Scott, of Minneapolis, mother of two. "But a half hour after the epidural, I felt no pain, just pressure -- and more than that I felt totally like myself, really present in the experience."
Spinal and Combined Spinal-Epidural
Epidurals can be very effective, but they take a good 10 to 25 minutes to work. The spinal, which goes into a slightly lower space in your back, works within seconds. But unlike the epidural, which you get continuously, the spinal is a single injection that is effective for about 45 minutes. Eighty to 90 percent of elective c-sections are done with spinals, Dr. Camann says, and sometimes doctors will choose to use a spinal or spinal-epidural combo for women who are very far along in labor and desperate for fast relief.
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Women who don't want an epidural or who can't have one may opt for opioids like Demerol and Stadol, delivered via IV. Unlike spinals and epidurals, IV pain medicine can make you drowsy and nauseated, and it does enter the baby's bloodstream. "IV meds can make the baby groggy, so if we think the delivery will happen within an hour, we try not to use them," Dr. Alvarez says. "And we don't generally give more than a few doses." Getting drowsy may help if you're trying to rest, and some women like IV meds for this reason, but Dr. Alvarez cautions they'll also make you a little loopy.
Originally published in American Baby magazine.
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