Labor Pain Management

Typically when we feel physical pain it means that something is wrong. A notable exception to this rule is the pain that accompanies labor and childbirth. The pain associated with uterine contractions and progressive cervical dilation usually means that labor is progressing and ultimately a baby will be born. Productive pain is how a patient once described labor pain. However pain, whether productive or not, still hurts and needs to be managed. How to do this brings us to one of the long standing debates in obstetrics…should I have my baby naturally or use medications.

Natural childbirth typically refers to labor without the use of pain medications but may have different meanings to individual women and their obstetric providers. Some use the term to differentiate between labor with and without an epidural. Some use the term to mean labor without any medications. The benefits of natural childbirth include a sense of accomplishment and empowerment; some people feel women may bond better with her baby when natural childbirth is utilized. It is easier to move around during labor when drugs or an epidural are not used and usually it is not necessary to be continuously on fetal or maternal monitors. Mothers who don’t use epidurals can get up and move around more easily after the baby is born.

Pain management during labor depends on the stage of labor. For example I remember when I had my third child (without pain medication) my obstetrician just telling me to push and the pain would go away; it did, after 2 pushes and the birth of my son. Until it is time to start pushing the key to managing labor pain is distraction and relaxation. Learning what to expect during the labor process is critical to staying calm and avoiding anxiety that can actually serve to increase pain. Childbirth classes are very useful in this regard….many of us in obstetrics think that all expectant mothers should be required to attend childbirth classes!!!

Focal points, breathing exercises, walking, listening to music, getting in the shower or bath are all techniques to help in the distraction and relaxation process. Each woman may find that different positions, which may change as labor progresses, are more comfortable for her. Rocking, standing, bouncing (we have a special ball for that) are all techniques that women can use.

However, many women want to use medicine to decrease their labor pain. Usually the first medication used is a narcotic that is given through an intravenous line or into a muscle. This does not completely take away the pain of contractions but does cause the mother to relax and takes the "edge" off of contraction pains. Narcotics are not given near the time of delivery as they may affect the baby.

Epidurals do take away most of the pain associated with labor and delivery however they do not guarantee a pain free labor. Although most women experience considerable relief from epidural anesthesia sometimes there are parts of the abdomen that are not adequately anesthetized or other pain sensations may be noted. For women who are not coping well with the pain of labor epidurals can restore their sense of control over the labor process. Women who chose to have epidurals for managing labor pain do need to have intravenous fluids and have their blood pressure and other vital signs measured frequently. The baby also needs to be continuously monitored. Although taking away much of the pain of labor, epidurals make labor last longer, especially when it is time to push.

There is no "right" way to manage labor pain. The goal is to have a healthy baby and hopefully a good experience with labor. The latter will be very individual dependent on the desires, expectations, past experiences, and knowledge of the mother. Pregnant women should discuss their wishes and expectations with their obstetrician or midwife and all are encouraged to take childbirth classes.