/ by Dee Polito
One of the most important discussions between a midwife and a woman planning for the birth of her baby has to do with the pain of labor. A woman wants to be prepared for birth and confident that it will be a safe experience. She also wants to be reassured that she will be able to cope with labor.
This leads us to talk about the different options we have as midwives to help a woman give birth to her baby in a safe and satisfying way. Midwives are trained to address all of the choices for pain management during labor. During prenatal visits with the midwife, these options can be discussed in detail, including the risks, benefits and any side effects of each.
How to look at pain
There are two ways to look at pain: Pain can be viewed as, “Something is wrong,” or as our body’s way of saying, “This needs attention.” Pain can be seen as a normal process – especially when it comes to labor. Uterine contractions need to be strong, regular and frequent, and the experience can be intense. This intensity is completely normal, and the pain does not indicate anything is wrong. Midwives approach the discussion of pain management during labor first by asking how a woman intends to cope with the intensity. This is how we begin planning for pain management during labor and birth.
Some of the methods we recommend for pain management don’t have an effect on the process of labor or on the baby. These methods include frequent position changes, freedom of movement, massage or distraction. In fact, these actions can actually promote or enhance the process of labor.
We often recommend sitting on a ”birth ball,” which is just like an exercise ball, during labor to open the pelvis as a comfortable alternative to being in bed. Other more technical actions may include hypnosis, which requires training and practice, or acupuncture, which requires a trained professional to administer.
One of the most helpful ways to manage the intensity of labor is to have a doula by your side. A doula is a trained companion who provides continuous one-on-one care as well as education and physical and emotional support during birth.
Another effective method of non-medical pain relief during labor is the use of hydrotherapy, which involves standing in the shower or being immersed into a pool or tub of water. Hydrotherapy can be very soothing and relaxing. This not only helps a mother manage the discomfort but also reduces her stress and anxiety. We use the tub frequently for mothers who are at low risk for complications and do not require constant fetal monitoring.
We also have more medical methods of pain management for labor and birth. Each of the medical forms of addressing pain during labor require more attention to how the baby is tolerating the medicine as well as side effects that can affect the progress of labor and/or the baby.
Nitrous oxide, which is the same laughing gas used by dentists, can be inhaled through a mask during a contraction. It can reduce the perception of pain and create a sense of pleasure and relaxation.
Narcotics can be administered through an IV to reduce pain temporarily and promote rest and sleep.
With the assistance of the anesthesiologist, spinal or epidural anesthesia can be used to provide effective pain relief. Medications are injected into the lower back outside of the spinal canal to cause some loss of feeling and numbness in the lower part of the body while allowing the laboring mother to be awake and alert. Epidural anesthesia is common, and more than 60 percent of women use this form of pain management during labor.