Pain relief in Labour

There is probably no area of obstetrics that generates more anxiety and more controversy than the subject of pain relief. That's not surprising when you consider the reputation childbirth has for being so painful. The truth of the matter is that the reputation is well deserved. The good news is that there are many ways available to cope with or ease the pain. These methods can be divided into three basic types: psychological, narcotic, and conduction anesthesia (epidural and spinal anesthesia).

You should learn all you can about each of these types and determine your preferences. But do not make any firm decisions before labor begins. It is impossible to know beforehand what your labor will be like. Committing yourself to one particular type of pain relief, and no other, is a setup for disappointment. You may find that you need something quite different than your original preference, and you should never feel disappointed, or reproach yourself, if you change your mind in the face of actual experience.

Psychological methods of pain relief have come to be known as "natural childbirth." They were formulated in the 1950s as part of a larger effort to wrest control of childbirth from the medical establishment and give it back to women. Natural childbirth depends, in large part, on becoming knowledgeable about the entire process of giving birth. If you know what to expect, you are less likely to be frightened by this incredible process. Assuming that increased fear leads to increased pain, knowledge and preparation become your first line of defense.

Psychological methods of pain control involve focusing and relaxation exercises specifically tailored to each stage of labor. Most of these exercises involve specific types and patterns of breathing that are designed to focus your concentration on mastering the pain. Many women find that what they learn during natural childbirth preparation is all that they need to negotiate the long hours of labor. The advantages of natural childbirth include absence of side effects from pain relieving medications and no slowing down of the labor process.

Unfortunately, to promote natural childbirth, some of its supporters have claimed that using the breathing techniques makes childbirth, at best, painless or, at worst, only slightly uncomfortable. Neither scenario is true. For the vast majority of women, childbirth is extremely painful. Although the breathing exercises will help you to maintain control in the face of the pain, they will not relieve pain; after all, they are just prescribed breathing patterns.

Many women who are determined to use natural childbirth techniques often become frightened as labor progresses. The pain is so much greater than they have been led to expect and they fear that something is wrong, either with the labor or with themselves. Nothing could be further from the truth. Part of being knowledgeable about the process of childbirth is understanding how painful it is likely to be.

At a minimum, you should be sure to take a childbirth preparation course (offered by most hospitals and birthing centers) in order to prepare for labor and to familiarize yourself with the techniques of natural childbirth. However, if you decide that you need a bit more than natural childbirth breathing exercises to manage the pain, short-acting narcotics are often the first choice. These medications, such as Nubain and Numorphan, are related to stronger narcotics, such as morphine or codeine, which you might be given after surgery or a dental procedure. They differ in that they are much shorter-acting; they will be out of your bloodstream within an hour or two. That way, they are unlikely to be present in the baby's bloodstream at the time of birth.

Short-acting narcotics are given by injection, either into a muscle (like the buttock) or through an intravenous line. They do not take away the pain; they just "take the edge off." Some women find that this is the boost that they need to help them continue with the breathing exercises.

Because of some disadvantages that are associated with short-acting narcotics, it is preferable to avoid narcotics if the delivery is anticipated to occur within the next hour. Given too early in labor (that is, before 4 cm. dilation has been reached), they may slow down the progress of the labor. Narcotics cross the placenta and enter the baby's bloodstream, which has minimal effects before the baby is born. However, if the baby is born shortly after their administration, it could result is a sedated baby that is reluctant to breathe on its own. The effects of the short-acting narcotics on the baby can be reversed by administering an injection of naloxone.

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Before Labour begins

Has the baby dropped yet? Friends and complete strangers are asking the same question. What are they talking about? How will you know the answer to this question? As the end of pregnancy draws near, the fetus is likely to take a position that will be favorable for the coming journey. Over 95 percent of all fetuses will be facing head down, with their chins tucked on their chests. Some babies, particularly those of first-time mothers, will literally drop into the pelvic opening. The cervix may not have dilated, and the fetus is still totally within the uterus, but the fetal head is now nestled within the pelvic opening instead of above it. Doctors and midwives refer to this process as engagement.

Engagement is also known as lightening, probably because it provides relief from some common pregnancy symptoms. When your baby drops, pressure on your stomach and diaphragm drops, too. You will probably have less heartburn and shortness of breath. Of course, these symptoms may merely be exchanged for new ones. You may feel increased pelvic pressure, and some women complain that it's hard to walk because it feels like the baby's head is between their legs. However, it's important to remember that many women have no change in their symptoms and never even notice when the fetal head engages. In any event, it is quite possible that the baby will not drop until labor begins.

There are other signs that the time for labor may be drawing near. For example, the mucous plug, which has kept the inside of the uterus sealed off from the vagina, falls out as the cervix begins to soften and thin in preparation for labor. The mucous plug may fall out hours or even days before labor begins. Sometimes the membranes of the amniotic sac rupture (this is called "breaking your water") minutes or hours before labor begins. If your membranes rupture, you should call your practitioner. Some doctors and midwives prefer that you come in for examination right away. Others will advise you to wait at home to see if labor begins spontaneously.

Some women exhibit other physical symptoms that signal labor is approaching, including diarrhea, low-back ache, or abdominal cramping. There are many who believe that impending labor causes psychological changes as well. Some women are seized with the nesting instinct in the hours and days before labor begins: They are suddenly consumed with the urge to clean and arrange things, when just a few days before they were too exhausted to move.

Can you do anything deliberately to start your own labor? Well, there are a lot of old (and new) wives' tales that you can consider. Some women insist that spicy food started their labors, and others claim it was because they dosed themselves with castor oil. Then there are those who swear by sex, reasoning that even if it doesn't work, at least they'll have a good time. Unfortunately, it's not likely that any of these home remedies are effective. Labor starts when the baby is ready-and not one second before.

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Baby's Day Out

Introduction

Some people always bring along a travel guide when they go on a trip. They pore over the maps, study the local customs, and try to learn a bit of the native language. This additional knowledge makes their trip both more comfortable and more enjoyable.

You can think of Baby's day out information guide as your travel guide on your journey through the process of birth. Although the distance is short just a few inches from inside your uterus to the outside world and into your arms-the trip you take with your baby is indeed a new and wondrous journey. Like a travel guide, this session offers you detailed maps, an introduction to the local customs, and a smattering of the native tongue. In this session, the color illustrations are your maps; you will learn about the local customs and procedures that are related to your visits to the hospital; and you will be able to add terms like amniocentesis and placenta to your vocabulary.

Read this session before you visit with your practitioner. Take it with you to your doctor's or midwife's office and use the illustrations to enhance his or her explanations. In fact, your doctor might find the illustrations a helpful aid in answering your questions. Remember this session when you go to the hospital or birthing center so that the new place won't seem strange or frightening. Use this information to help you make the decisions you need to make to help ensure the kind of birth experience that you hope to have.

Like a traditional travel guide, the goal of this information is to help you feel less foreign and more familiar with new surroundings and the new experiences of pregnancy, labor, and delivery. You should know what the amniocentesis procedure will be like before you have one done. If your baby is breech, you should understand what that means and not become alarmed by the term. When you walk into the hospital birthing room, you should recognize the various pieces of equipment and what they are used for. Above all, you should feel neither frightened nor threatened by the new environment and experiences.

And, just as a travel guide cannot tell you exactly what you should see or do to have the best possible trip, this piece of information cannot tell you what you must do to have the best possible birth experience. That's because, like a trip itinerary, what's great for one person may be disappointing for another. Your journey toward becoming a parent is a deeply personal one. Use this information to understand your options and explore your preferences. Do you wish to minimize intervention during labor and delivery, or do the high-tech tools and equipment of the modern hospital provide you with a sense of security during an anxiety-provoking time? Use this information guide to decide what a good birth experience means to you. Then, don't hesitate to share your preferences with your obstetrician or midwife. Your practitioner will not know what you want unless you discuss it beforehand.

Unlike a traditional travel guide, this one intends that everyone wind up at exactly the same place: with a healthy baby and a healthy mother. Most of the time, no special effort is required to reach this outcome. Unfortunately, no one cannot predict which labors might be difficult or which babies might not easily withstand the strain. Above all, be flexible. It might turn out that your baby needs more intervention than you would have wished. That can be a disappointment, but may be less of one if you keep in mind that your deepest wish is for a healthy child.

This information section covers the following four territories: Pregnancy, Labor and Delivery, Common Obstetrical Procedures, and The Newborn. While the organization within each section is chronological, it is not necessary to read the chapters in a sequential order.

This info guide does not contain every possible situation encountered in pregnancy, nor is every possible obstetrical procedure described. Because mastering the practice of obstetrics takes many years of study and experience, no single book could encompass the entire subject.

The information is not intended to substitute for consultation with your own obstetrician or midwife. You can compare reading this information to working with an experienced travel agent in planning a lengthy and extensive excursion. Each pregnancy, labor, and delivery is unique, just as each baby is unique. Only someone familiar with every detail of your situation is qualified to make recommendations about your obstetrical management. However, this info-guide will provide you with detailed explanations of the most commonly encountered issues and obstetrical practices, which will allow you to participate as a full partner in any decision making that may be required.

The ultimate goal of a travel guide is to make your trip as easy and as enjoyable as it can be. This information guide shares this goal. Giving birth to a new life is nothing short of a miracle. Enjoy your part in this miracle to the fullest and celebrate your role in creating and nurturing the new life within you. Prepare to bring your child forth to share in the excitement of your world and the security of your love.

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