Pain Management

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Epidural does NOT = no pain

Thursday, August 27th, 2009

Did you know the rate of drugged babies at birth in the U.S. is about 98%?  So that leaves 2% to natural births.  Definitely the minority.

A lot of pro epidural people think natural childbirth participants are crazy.  They think and feel that childbirth was painful enough with the medication, why would anyone want to do it without?

Well, maybe we should ask these questions first of the medicated delivery:

  • When were the drugs administered (after you’ve labored almost to 10cm)?
  • Was the administration of the medication painful (after all, it is injected with a very long needle into a very sensitive area)?
  • Did you feel the drugs decreased your ability to function (feel the urge for pushing, urination, no sensation in your legs, etc.)?
  • Did you feel out of it (the medication causes sleepiness)?
  • Were you conscious enough after delivery to breastfeed and bond with your baby (emotional disconnect causes pain as well)?
  • Did you take any classes or receive training for birth, whether it be natural or not (preparation reduces fear which reduces pain)?

So pain is really a subjective thing and perhaps in labor, more of the “pain” that epidural users report is due to some of the items mentioned above and not just to the act of childbirth.

I am not saying natural childbirth is for everyone as we all have our own pain tolerance but let’s at least investigate our options, explore why it is better for us and our babies and perhaps at least try to labor before signing up for the epidural at our first office visit.

Posted in Labor & Delivery, Medical Consumerism, Medical Procedures, Natural Childbirth, Pain Management | 2 Responses »
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Male midwife bashing

Monday, July 27th, 2009

Denis Walsh, a male midwife in England, has been receiving a lot of bad press in the blogosphere about an article that has not even been published yet.  The paper in question, “Epidural Culture” is only in peer review for the Royal College of Midwives’s journal, Evidence Based Midwifery.

Some of the statements he has made are, “A large number of women want to avoid pain.  Some just don’t fancy the pain [of childbirth].  More women should be prepared to withstand pain,” he [said].  ”Pain in labour is a purposeful, useful thing, which has quite a number of benefits, such as preparing a mother for the responsibility of nurturing a newborn baby.” The rest of the piece goes on to state epidurals carry serious risks, impede bonding and interfere with birth as a rite of passage.

Many women bloggers are up in arms saying a man cannot chime in on such a subject.  They’ve said there is one thing worse than a painful labor and that is listening to someone who will never know the pain of labor describing it as a “rite of passage”.  A lot of people think that concept goes back to biblical references regarding the pain of childbirth as a symptom of our sin (look for a future post regarding the misconception of translating the word “travail”).

I applaud Mr. Walsh’s comments.  I do not think his gender has any part in the scientific and factual information that he is presenting.  His experience as a midwife is not diminished just because he has not experienced the pain of childbirth himself.  After all, there are female midwives out there who have never given birth as well.

I believe any good birth support professional will never judge a woman for the choices she makes for her own body and her baby but we all want to make sure we are making the information accessible to all consumers of obstetrics so informed decisions can be made.

Posted in Childbirth Professionals, In the News, Medical Consumerism, Natural Childbirth, Pain Management | No Responses »
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How do you spell relief? R-E-L-A-X-A-T-I-O-N

Friday, May 15th, 2009

Ok, so everyone wants to know: how do you get through the pain of natural childbirth?  We’ve already been through the why and the what, so let’s deal with the how.

Well, sometimes, it is an accident.  Meaning, a woman may not have planned or prepared for an unmedicated delivery but due to timing or other reasons, she had her baby without using drugs.  For those who’ve intended to go natural know that being prepared with ways to deal with the pain helped immensely to get through labor.  These can be very personal methods as every woman does not experience pain in the same manner, every labor is different and some ways that work with some women may just not offer relief to another woman.

In my natural childbirth class, the key to pain management is relaxation.  Physical, mental and emotional relaxation.  Physical relaxation deals with the ability to relax the muscles in your body in labor, mental relaxation has to do with what you are thinking about in labor and emotional relaxation has to do with how you feel about what is happening to you in labor.

Relaxation is something that actually needs to be learned for a lot of people.  Studies have shown that to make something a habit, you need to do it 12 times (that’s why The Bradley Method® of Natural Childbirth classes are a 12 week series).  As coming from a professional environment working in engineering, I was not one to relax easily.  I carried my stress in my upper back and shoulders.  I was go, go, go until I dropped.  So I definitely valued learning how to relax through the childbirth classes me and my husband took.  In fact, when we were students, we found early on that him telling me “relax” actually did the exact opposite.  Now he uses that phrase at times to get under my skin.  Isn’t learning great?

Physical relaxation starts with letting go of all your muscle tension.  You need to be in a comfortable position (usually side-lying for the pregnant woman) where all limbs are supported and nothing is bearing on anything else or getting pinched.  Pillows can be your best friend when trying to support your belly and breasts and they are very comfortable when placed between your legs to better align your hips.  My husband bought me a body pillow after my first birth and now he regrets it since I don’t find him as cushiony.  You should also have your eyes closed to block out any visual distractions.  A partner comes in real handy at this point to rub and massage away any stress in your body.  Once you have help getting to the physically relaxed state, it is important to remain in it throughout the duration of your labor: during contractions and in between.  That does not mean you are to be bedridden but ensure any position you are in does not reintroduce any physical tension, especially during a contraction.  A sign of complete physical relaxation is the “duh” look which indicates even the face and jaw are relaxed which is the hardest and last thing to loosen up.  I always focused on my hands and feet staying unclenched because that meant everything in between had to be relaxed as well.  Of course, during a contraction, it is difficult to not tense up and remain physically relaxed but that’s where the powers of distraction come in and mental and emotional relaxation tools can be utilized.

Mental relaxation encompasses finding things to think about and concentrate on that are relaxing to the mother.  This could be as simple as music, white noise, a poem or book read by your partner, prayer or thoughts and images of your baby.  Your partner can relive vacations you took together using a soft voice and talking about all the wonderful sights, sounds and smells to take you right back to that place.  Remember, a contraction isn’t more than two minutes so you don’t need a whole lot of verbiage but it might want to be rehearsed and practiced to get the correct tone and meter.  Sometimes this banter can be difficult on husbands to do since there may be others present at birth and they may feel uncomfortable or silly which is why relaxation should be practiced between the mom and coach.

Emotional relaxation can be achieved by positive thoughts and preparedness.  When a woman has educated herself in regards to labor and delivery, she won’t have too many surprises and can be relaxed with knowing what’s happening at each step and what it means for the baby and mother.  Fear is the biggest tensor for people and tension brings pain.  Pain brings more fear and then you are in a vicious circle.  A coach can help the laboring woman with emotional relaxation by using words of encouragement.  Supportive, reassuring and calming phrases go a long way in keeping the mother emotionally relaxed.

Even though relaxation in my opinion the best and most used method to manage pain during labor, there are a lot of other great things to do too.  Water is a wonderful pain reducer.  Being immersed in water reduces the intensity of contractions since it helps to equalize pressure.  Think about when you float on a lake or a pool, you feel so light and free from all tension (hey, that’s a good imagery for dad’s to use with mom in labor).   You will find me saying often: “Calgon, take me away” and retreating to a bubble bath to help ease my back pains and relax from a rough day .  Moaning or low groanings are great for when contractions get more intense.  We women make a lot of different noises during natural labor, screaming perhaps included as well, but don’t knock it until you try it and when you are in this stage of labor, you never care what you look like or sound like.  Counter-pressure is a blessing for back labor (contraction pains are felt in the low back due to baby’s posterior position – it’s back of head is facing mother’s back).  Being properly hydrated and nourished helps reduce pain.  Emptying your bladder helps as well.  “Walking it off” is another great one.  The list can go on and on.

The key to getting through a natural birth is knowing what works for you and having a lot of different tools in your toolbox.  And in the advice of any teacher/coach/parent, etc.: practice, practice, practice.

Posted in Natural Childbirth, Pain Management | 2 Responses »
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Just breathe

Thursday, May 7th, 2009

In…and out…in…and out.  Relaxing, isn’t it?  Now try: hee-hee-hoo-hoo-hee-hee-hoo-hoo.  BLECH!  Which way would you rather breathe during labor?  How about the one that does not require learning or practice since you already do it naturally and the one that you don’t have to count or concentrate on?

I only bring this up because there still does exist that childbirth preparatory class that is known for a certain way to breathe/pant during labor.  I was even asked by relatives or friends during my pregnancy when I said I was going to a childbirth class, “oh, are you going to ____ class – are they teaching you hee-hee-hoo-hoo?”.  It was just so synonymous with birthing back in the day that many assume it is still taught.  In actuality, if you went to their website they state that breathing is no longer the hallmark of their organization.  Good for them, figuring that one out. 

Even though I do not teach altered breathing techniques, there are times in labor when you need to use breathing effectively and be aware how it can help in your labor and delivery.

In general, natural abdominal breathing is the best way to breathe during first stage labor in childbirth.  It can be through your nose or mouth or both, whatever you do normally.  It is self regulating by your body.  It uses less energy than other breathing techniques and it lowers blood pressure.  It uses the full capacity of your lungs and avoids hyperventilation which can reduce the oxygen supply to your baby.  It is conducive to relaxation which is a great pain relieving method.  I used to even listen to my own breathing to help me fall asleep on those last toss and turn weeks of pregnancy.  However, listening to my husband’s breathing (snoring) only seemed to awake and annoy me.  Humph.

For second stage labor, most people have heard the take-a-deep-breath-and-hold-it-and-push-to-the-count-of-ten mantra.  Holding your breath during a push can be used as a means of pain relief.  It also traps a cushion of air and increases intra-abdominal pressure which helps the uterus move forward and keeps the baby aligned.  Nonetheless, you do not “need” to hold your breath and if you can’t make it to the ten count, by all means, take another breath.  No biggee.  You can even exhale slowly through grunting or moaning if you choose.  You do not need to take three breaths for every contraction, either.  You find what is comfortable for you. 

During second stage labor, there may be a medical situation where you should not push.  Do not hold your breath at this time as that adds to the pushing that your body is already doing.  Raising your chin off your chest ensures you are not pushing and singing and talking can distract you from holding your breath or trying to pant it out which again reduces the oxygen supply to your baby at the point when he might be needing it the most.

The husband or birth partner can be an aid to the mother in making sure her breathing is natural and normal.  Healthy, abdominal breathing can exaggeratedly be seen in the rise and fall of the pregnant woman’s belly.  If there is fear or tension, the mother may resort to chest breathing and the husband or birth partner should redirect and distract the mother with relaxation techniques or any other pain relieving methods.

During reading this, you probably breathed in and out 12 times a minute (by the way, if you were an infant, it’d be 44 times).  Did ya notice?  Did it distract you?  No, because it’s just what you do, it’s natural and normal.

Breathe away, my friend.

Posted in Labor & Delivery, Natural Childbirth, Pain Management | No Responses »
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No pain, no gain?

Thursday, April 30th, 2009

I wish I could tell you that natural childbirth will be pain free. I cannot make that promise.  I can tell you though that childbirth pain is manageable.  I also know that even with pain relieving medication, women still declare their labors were painful.  So the only thing a medicated birth did for those women was take away feeling their birth.  Don’t even get me started on the pain and discomfort of inserting a long needle into your spine!

Pain associated with childbirth does have purpose and not all pain is bad.

You can experience “good” pain like associated with working hard.  Working with your contractions and understanding your body’s reaction makes labor effective.  Therefore, some pain = tremendous gain.  You can also experience “unnecessary” pain from doing something wrong like fighting against a contraction instead of letting go and letting your body do it’s thing.  This comes about from lack of knowledge.  Very rarely in childbirth will you feel “injury” pain which indicates something is wrong and requires medical attention.

There are many ways of handling pain.  Think about the last time you stubbed your toe.  Didn’t shouting out, hopping around and rubbing it help alleviate that initial pain?  I recently cut an almond sliced size of meat off the tip of my finger using a mandolin in the kitchen (stupid, I know: I now have Kevlar gloves).  My way of dealing with that pain was to apply pressure to the tip while running it under cold water and doing a sort of marching dance with my feet with my eyes closed and chanting how stupid I was.  It worked.  In my book, any method that helps you get through something without hurting others, then by all means, just do it (you knew a Nike reference would come in sooner or later).  Who cares what you look like, sound like or act like. 

Here, I talk about ways of handling pain through relaxation and a few other ways but a lot of getting through childbirth pain unmedicated is in educating yourself and being prepared physically and mentally.

Posted in Pain Management | 1 Response »
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