Okay ladies. Welcome to week thirty-three. We promised you a newsletter about pain relief and not just the “hee-hee-hoo” kind. This week’s newsletter is for all you girls that just don’t like pain or don’t want to commit to doing things naturally. We are going to tell you about all your options, and when we are done, we expect you to talk them over with your doctor or midwife. She can tell you what is available at your hospital or birthing center, and she can help you decide which options are best for you. Epidurals are probably the most discussed pain relief option. You may be hearing all kinds of things about epidurals and, well, you might be feeling a little apprehensive about having one. We are going to try to put your mind at ease and answer your questions about epidurals and other pain relief options you may have heard about.
What Is Going on with Mom & Baby
Baby is the size of a pineapple!
Baby: Baby’s crown to rump length is around 31 cm (12.2 inches). Your baby weighs about 2100-2250 grams ( 4.6-5 pounds). Your baby is starting to get cramped for space but she is still very active. Your baby is doing a lot of growing right now, preparing for her entrance to the world. Your baby’s lungs are still not mature yet, but she is starting to practice breathing by inhaling amniotic fluid into her developing lungs.
Mom: Remember to keep drinking lots of water to stay hydrated. If you are having problems with hemorrhoids, as many moms do at this stage in pregnancy, you may find soaking in a warm bath helps. Witch hazel pads or over-the-counter medicated wipes may help to ease discomfort and keep the rectal area from getting irritated.
This Week’s Pregnancy Checklist
- Purchase extra batteries for baby’s swing or other gear.
- Purchase diaper care products. Purchase extra nipples for your bottles, bottle brush or bottle liners.
- Verify that your crib is assembled correctly and that there are no safety hazards.
- Write down any questions you have for your next doctor’s visit.
- Take a new belly picture for your scrapbook or journal.
Pain Relief During Labor
There are two different types of drugs that you can choose from to relieve pain during labor. One type of drug is called an analgesic. Analgesics, like Stadol or Demoral, relieve pain but they don’t cause you to lose feeling or not be able to move parts of your body. Anesthesia, on the other hand, blocks all of the feelings in the area where it is administered. This results in you not feeling pain. When you think of anesthesia, you may think about being put to sleep. This type of anesthesia is called general anesthesia, and you will most likely not need this type of pain relief during a typical labor and birth. We are going to give you the basics on analgesics and anesthesia, and we will also try to answer the most common questions moms have about pain relief during labor.
Types of Pain Relief
Analgesics- You may want to use analgesics for your pain relief if you don’t like the idea of not being able to feel parts of your body or want to use something less invasive. Analgesics are generally avoided if you are close to delivering as they can slow down babies breathing and reflexes.
Epidurals- Epidurals are a type of local anesthesia that causes you to lose feeling in the lower half of your body. An epidural is a very effective pain relief option for labor; however, it is more invasive and requires you to have a needle inserted into a small area of your lower back called the epidural space. It may take up to twenty minutes for your epidural to take effect, and you may still feel your contractions even after getting your epidural. There are some side effects and risks, including the potential to cause low blood pressure and spinal headaches. Serious complications are rare.
Spinal block- A spinal block is similar to an epidural and also requires a needle to be inserted in the lower back. It is inserted into the spinal fluid rather than epidural space. A spinal block works quicker than an epidural but only lasts for an hour or two. It is often used for c-sections, as it works very quickly. It is generally only used once during labor so it is best to use when mom is very close to delivering.
- Walking Epidural (combined spinal-epidural block)- A walking epidural is a combination of spinal and epidural block. Medicine is injected into both the spinal fluid and the epidural space. To explain this simply, the spinal fluid is a little deeper than the epidural space. The spinal needle is inserted through the epidural needle so that medication can be delivered to both areas. The reason this is called a walking epidural is because moms can move around around with this type of epidural (although most hospitals will not allow you to walk around), and if the spinal medication loses effect, more medication can be inserted through the epidural space.
- General anesthesia- General anesthesia makes you lose consciousness. This is not ordinarily used during a vaginal birth but may be used in emergency situations or sometimes for cesarean births.
Frequently Asked Questions about Pain Relief and Childbirth
Are pain medications and epidurals dangerous to mom or baby?
During your pregnancy, you have been told to avoid taking narcotics and other medications to protect baby, so you may be wondering if pain medications are avoided during pregnancy, why wouldn’t they be dangerous during birth? Pain medications cross the placenta during labor and do enter your baby’s blood stream. There are potential side effects that you should be aware of including respiratory depression, central nervous system depression, and problems regulating body temperature. It is best to avoid taking narcotic medications close to when your baby will be born to avoid these possible side effects. Epidurals are given to over half of all moms giving birth in a hospital, and they are considered very safe. There are some potentially dangerous side effects, however, including a possible sudden drop in blood pressure, spinal headache, or permanent nerve damage in the area where the epidural is placed. Talk with your doctor or midwife about the risks involved.
How soon can I get something for pain?
Analgesics are often given in the earlier stages of labor. In most cases, you will be given an analgesic as soon as you ask for it. Epidurals are generally not given until you are 3 to 4 cm dilated and you are in active labor, meaning that you are having strong contractions 3-4 minutes apart. It used to be suggested that epidurals given too early in labor would lead to stalled labor and increase the chances of needing a cesarean. New studies have shown that this is not true. There is no reason that you have to wait until later into your labor to have an epidural, but many women prefer to try to go as long as they can handle it before getting an epidural.
I have heard that epidurals sometimes don’t work, is this true?
Epidurals work well for most women but, sometimes the medication doesn’t get into the epidural space properly and they do not get effective pain relief. Talk to the anesthesiologist if you are still having a lot of pain after twenty minutes, and he can normally do something to remedy this without having to reinsert the needle. Epidurals do not always take away all the pain. You may still feel contractions, pressure or even some pain.
Can I wait too long to get medication or an epidural?
Analgesics are not given right before delivery. If you wait until you are close to delivery to request them, you will most likely be told that you can not have them, because they can slow down your baby’s breathing and reflexes. Epidurals, on the other hand, can be given close to delivery, but keep in mind that they take up to twenty minutes to take effect. If you wait until very close to delivery, it may not start to work in time to be of any use.