Preparing For Labor
Pain Management (med's, unmedicated and questions to ask.
This thread should tackle all your pain med questions. If it
doesn't feel free and ask for clarification or extra resources.
This is a simple breakdown of the logistics, risks
and benefits of common labor drugs. The specifics come from the book they gave at my hospital birth class called, "Prepared
Childbirth: The Family Way" by Amis and Green. The commentary is from me based on what I have read in books as well as from
moms on the boards and irl.
Demerol, Stadol, Nubain
through injection or I.V. (though some are now being administered through the epidural catheter).
*The effects last about
*Given to "take the edge off"; takes away the perception of the pain but not the actual pain.
prior to epidural though some women use these drugs independently of the epidural.
Side Effects/ Risks to Mom:
difficulty maintaining control over the contractions
Hypotension (drop in blood pressure)
Many moms who use these drugs say that it made them feel "drunk." Not a pleasant feeling. Some report that
these drugs allowed them to get a bit of rest. A majority of women don’t like the way these drugs make them feel.
Effects/ Risks to Baby:
Respiratory depression (baby not able to breath)
Decreased sucking ability
effects that mom experiences- groggy, sleepy
***These effects are most pronounced if given too close to delivery (less
than 3 hours)
There are drugs available to help baby breath at birth. These drugs may interfere with your efforts to
breastfeed as baby's sucking ability is not as good and baby may be sleepy.
Side Effects/ Risks to Labor:
slow down labor
Relaxation in labor is a good thing but these drugs may relax mom too much.
*Administered through a catheter that has been placed in the epidural
space. The drug is injected intermittently throughout labor.
*Proceedure begins with a shot of Lydocaine at the site where
the epidural is to be placed. This has been described as feeling like a bee sting. This drug should numb the mom for the duration
of the proceedure.
* At least one pint of I.V. fluids should be administered before the epidural is received because mom's
blood pressure may drop if this isn't done.
*The epidural may provide complete or partial relief.
*It takes about 15
minutes to be fully effective. It also takes about 30 minutes to administer.
*Numbs your legs and lower half of the body.
catheter may be used to help empty your bladder.
Some women describe the sensation of totally numb legs as unnerving.
There are times when several attempts need to be made in order to get the medicine to work (sometimes it only takes on one
side or doesn't provide adequate relief). Some epidurals take too much and cause numbness up to the neck. . A properly placed
epidural should work as expected though.
An improperly timed epidural can also cause a few problems. Given too soon
(before 4-5 cm) then it is more likely to slow down or stall out labor. This increases the need for further interventions
(like pitocin). Some studies support the idea that an epidural given prior to 5 cm can triple the risk of a c-section. A newer
study says that may not be the case BUT the study has faults and is for *lite* (walking) epidurals...big difference. Given
too late and it may not be effective in time.
Side Effects/ Risks to Mom:
Rare- spinal headache, pain at site of injection, difficulty breathing or seizures
other drugs the epidural should allow mom to remain awake and alert.
Side Effects/ Risks to Baby:
in mom can cause baby's heartrate to fall
Hypotonia (decreased muscle tone)
Subtle behavioral alterations
moms say that their baby was not alert after the birth when an epidural was involved. Some have more difficulty with breastfeeding.
Effects/ Risks to Labor:
Can slow down or stop labor; pitocin may be needed
Continuous monitoring is necessary (this
method of monitoring has been shown to cause a higher false positive rate indicating fetal distress so some unnecessary c-sections
may be performed)
Can diminish urge to push thus necessitating forceps or vacuum
Can impair normal descent and rotation
Epidurals often come with other interventions. Some of them could negatively affect your birth and increase
your risk of a c-section or assisted delivery. Pitocin can cause contractions that are too strong for baby and may increase
their risk of distress. Laboring in bed makes it difficult for baby to descend into the pelvis correctly. Pushing is more
difficult if mom has no sensation. This can lead to a prolonged pushing stage.
Epidurals- Risks and Benefits:
Walking epidurals are lighter versions of the traditional epidural. There is still a catheter in place so more
meds can be added. It should leave you with more feeling and sensation. This is usually a positive thing because if you retain
some control of your legs then you have the ability to labor and deliver in vastly better positions than if the lower half
of your body is numb. It should take away the pain but you may still have pressure.
Odds are you won't be walking
with it due to liability concerns. Epidurals can lower your blood pressure which can make you dizzy. That increases the chances
of falling. You may not have enough feeling to walk unassisted. But, if you have good support, especially an attentive nurse,
you should be able to take short walks to the bathroom or around the room. A walking epidural can minimize the odds of getting
a urinary catheter because you should be able to feel when you need to pee. You may also be able to get to the bathroom when
the urge comes. Urinary catheters shouldn't be painful at insertion if you are numb but they can be uncomfortable. Also, they
increase the risk of an infection and can make urination more painful in the days after the birth.
I would go with
a walking epidural if I were going for pain meds.
Questions to ask before
you are in labor, or at least before you get pain meds.
-What kind of narcotics do you have standing orders for? Demerol?
Stadol? Nubain? Fentanyl? What is the standard dose? Can I request a smaller dose or another drug? Why do you like this drug
over the other ones?
**This is a great link that actually describes the differences between the different drugs. Some moms
have more nausea, disorientation and dizziness with some vs others so it is important to educate yourself now:
-At what point in labor can I have narcotics? (Usually you can get them earlier than an epidural). After a
certain point will I be able to get a narcotic? (Some can affect baby's ability to breath so if you are close to delivery
they may not be willing to administer one of the drugs).
-What other interventions come with an IV drug? Continuous
monitoring? IV fluids? Restrictions on movement? Restrictions on eating and drinking? Is pitocin a likely intervention (if
labor stalls or slows as a result of the meds this could be a possibility)?
-Can I request *not* to have narcotics
and go straight for an epidural? (Some Dr.s like to see if they can help you without the epidural so they will always recommend
the narcotics first. But because some moms really feel miserable and out of it from these drugs it might be best to actually
skip to something that will take the pain away not just take away your perception of it).
-What is the "window"
for an epidural? Do I have to wait till I am 4-5cm and in active labor? (Some studies have found that if given prior to
active labor or before 4-5cm the risk of a c-section goes up dramatically as a result of possible other interventions and
maternal fever). Is there a point where I won't be able to get an epidural? (every practice is different so don't assume
anything from the birth of friends or family! Some moms get epidurals at 9-10cm while others are told "no" at 8cm).
I have access to the newer anesthesia options like the CSE or "walking epidural"? (The walking epidural has quite a few
benefits over the coventional epidural so it would be the way to go! It is a lighter dose of the standard epidural so it should
-What interventions are common with an epidural? (see above for a list of possibilities)
might an epidural affect my ability to push? Will the meds be turned down or off so that I can push more effectively? Am I
doomed to pushing on my back with legs in stirrups if I chose an epidural or will you help me push in more biogically sound
positions that can help speed up this phase as well as minimize damage to my perieneum? Am I more likely to have forceps or
vacuum extraction if I chose an epidural?
-What percentage of your patients recieve some form of pain medication?
non drug options do you encourage your patients to try first or for the whole labor? Walking? Water? Position change? Minimizing
medically unnecessary interventions (like breaking the water, non medically necessary inductions or augmentations, continuous
monitoring...)? Do you support a mom who wants to have an unmedicated birth?
-What are the risks and benefits to
-Are there any reasons why I would not be able to recieve either IV pain meds or an epidural? What are
Standard Questions to ask about all interventions and pain
1) Is this an emergency or do we have time to talk?
2) What are the benefits of doing this?
3) What are the
risks of doing this?
4) If we do this, what other procedures or treatments might we need as a result?
5) What else
can we try first or instead?
6) What would happen if we waited before doing this?
7) What would happen if we didn’t
do this at all?
I wrote up an epidural poll and an IV pain meds poll. This is their content as well as the links you can follow to hear
what real moms have to say about their experiences with those pain meds.
The actual epidural process and experience:
-What kind of eidural did you get- traditional, CSE, epi lite,
(and not an epidural but used) a spinal/ intrathecal? (If you don't know then you probably got the traditional one)
did you recieve your epidural in labor?
-Did you have any other pain meds (stadol, nubain, fentanyl...)? When did you
-Did you have an IV? Where did they put it and did it hurt? How many tries did it take?
when you requested the epidural till you had it in place and working- how long had passed? If you had to wait a while, why?
did the epidural process feel like? What did they do? How long did it take?
-Did the epidural hurt going in?
long did it take to work?
-Did it give you 100% coverage or were you one of the 15% that has "hot spots?"
you had hot spots, were they able tofix them?
-Did your epidural take too much- numb you too far?
-DId it take
in time before you had to deliver?
-What was the worst part of the epidural process?
-What was the best part?
you glad that you recieved an epidural?
Let's here about how it affected mom and, maybe, baby:
you have any of the following:
Drop in blood pressure
Pain at site
Any other complication
Malpresentation (come out at a difficult angle)
at birth (note: if you had IV pain meds, they are a much more likely culprit)
Poor muscle strength and tone at birth
since it is important to know the side effects of an epidural (mainly from other interventions), I want to know if you had
any of the following:
-Continuous Fetal Monitoring (Internal or external)
-Continuous blood pressure monitoring
(breaking the water)
-Lack of mobility
-Urinary Catheter (if so, when was it inserted in labor? before or after
the epidural was complete? when did they take it out? did it hurt?)
-Assisted delivery with vacuum or forceps
(if so, why? fetal distress, just to move things along, or some other reason)
-Pushing stage of 3+ hours
IV Pain med poll
Not all IV pain meds are created equal. Stadol, Nubain, Demerol, Fentanyl, Morphine...these are the most common drugs
used in labor. Some will have more negative side effects than others. What was/ were your experience(s) with them?
moms I have discussed these meds with IRL or on the boards tend to describe this scenario...
They didn't really take
the pain away. I could sleep between the contractions. I would wake up mid contraction then go back to sleep.
moms say that they were enough to take the edge off. Just perfect.
Others say they weren't worth it.
read whole poll before replying***
Which experience did you have?
-Did they take the edge off with no negative
-Did they take the edge off with some negative side effects?
-Were the side effects not worth
the relief that the meds offered?
I'm getting a bit ahead of myself.
-What drug did you recieve?
they give you a full dose, a partial dose (like a half or quarter), or you don't know?
-When did you recieve it? How
far along was your labor?
-Did you progress quickly after recieving it?
-Did you also recieve an epidural or
-If you did recieve an epidural or spinal, how does the IV drug compare? In hindsight would you have preferred
just skipping to the epidural or spinal? Or did you recieve both at the right point in your labor?
-Did you recieve
more than one dose of the IV med? Was it the same drug both times?
There are negative side effects, risks, to the
IV pain meds. Answer yes or no to the following for mom and baby:
Mom, did you have any of the following:
difficulty maintaining control over the contractions
-Hypotension (drop in blood pressure)
-Respiratory depression (baby not able to
breath, especially if given close to delivery))
-Decreased sucking ability or impaired breastfeeding
effects that mom experiences- groggy, sleepy (These effects are most pronounced if given too close to delivery (less than
-Difficulty maintaing body temperature
-Alteretd neurological behavior
Overall, how do you feel about
IV pain meds for labor? Will you use them again for future births?
Any other thougts, comments...please share.
if you have experience with these, please add your experiences to my polls!!
It never hurts to have some tricks up your sleeve just
in case. At the very least these coping strategies can help you through early labor since most car providers won't administer
epidurals till you have made at least some progress (some do it at 4-5cm, others earlier so you should ask). IV drugs can
be given in early labor but they don't usually take the pain away.
There are some times when you plan for an epidural
or pain meds but it doesn't end up working out. Here are some possible scenarios:
1. You progress too quickly. If you are
7+cm they may decide that they aren't going to do an epidural. One, it might not be effective before the baby is born. Two,
it could impair your pushing ability which would up the odds of an assisted delivery or a long pushing phase. Three, the staff
may decide that other moms should have the anesthesiologist's services more. Though most care providers set a certain cut
off point it isn't a hard and fast rule. There are some moms who have demanded an epidural at 9+cm and gotten one. You have
to weigh out the risks and benefits as well as the pros and cons for yourself. Pushing usually isn't at all like labor.
I mentioned before that you could progress too slowly. It depends on your careprovider's philosophy as to when you can get
an epidural. There have been some studies that show that given before active labor (4-5cm) the rate of c-sections triples.
This is usually because epidurals can trigger a series of other interventions that can cause problems. These include laboring
in bed (you lack the aid of gravity and the weight of your uterus could cut down baby's O2 supply), pitocin to speed up a
slow or stalled labor which can happen with the epidural, and continuous monitoring (the American College of OB/Gyns [the
major OB policy making body in the US] admits that continuous monitoring can give false results and prompt a potentially unnecessary
3. There could be a health reason why you can't have an epidural. One reason would be if your platelet count
was low. Blood infection, use of blood thinners, hemmoraging, low blood pressure are some potential medical reasons why they
might say "no."
4. Sometimes the epidural doesn't provide full relief. Some moms experience "hot spots" (happens about
15% of the time); where they still have full sensation. Other times it can be patchy in coverage. Often these can be fixed
but sometimes they can't.
You never know what will happen when the time comes so I urge you to have a back up plan.
It can't hurt and you can use some of the coping strategies in early labor no matter what.
sure that you are on the same page as your careprovider with your hopes and plans. They can make or break the experience.
-Learn about the routine policies where you are giving birth. If you don't agree with them (like I didn't agree with
a routine IV), talk to your careprovider. They can make standing orders that support your hopes.
-Write a birth plan
and make sure that you, your partner and your care providers are all on the same page. Have contingency plans too. Think about
how you would want an induction to go if one became necessary. Same thing for a c-section. Newborn care is an important thing
that you shouldn't ignore. I'll give you some links to info on birth plans and tools to help you write one.
“20 Minute Rule.” Once you decide that you want pain medication, try something new for 20 minutes first and then
reasses how you are doing. Walk, try a new position, use water, a birthing ball, a heating pad anything that you haven’t
tried yet or recently. You might find that after 20 minutes you have progressed more and/or you feel up to continuing just
a bit more. Remember that for most moms they don’t get the feeling thatthey can’t do it anymore till they are
almost about to start pushing.
-Ask for an internal exam before accepting pain meds. You might find that you are already
7+cm and that you can get through just a bit more. Transition is often the most intense part of labor but usually the shortest
too. Some moms have transitions that last 20 minutes or less!
-Hire a doula! A doula can be an absolutely tremendous
asset to the birth. While my dh and I were very well prepred (lots of classes and reading), it was still great to have someone
in the room who was a professional labor support person. She was full of good tips and ideas to help me stay comfortable.
She also helped dh help me feel better by giving him more ideas. She was there exclusively for our physical and emotional
needs. Money well spent, imo.
-Know about interventions and use them wisely. Know what strings come attached to the
various interventions. For example, if you consent to having your water broken do you also inadvertently consent to laboring
in bed with a continuous monitor (whether it be internal or external)? Just know what chain of events can get set into motion
by your choices. In general, unnecessary interventions can make your birth harder. Use them sparingly and wisely.
out of bed- unless you are able to master the Bradley Method of full relaxation. Change positions frequently to help the baby
come down in the best possible position. Walking, position change, water, using a birthing ball, rocking in a chair, "slow
dancing" with your partner...these are all great ideas to help you stay comfortable and manage the contractions.
might sound silly but vocalizing (aka, moaning) feels great! Saying, "oww, oww, oww!!" just makes you tense up all over. Moaning
forces you to relax your shoulders, face, and chest.
-Deep breathing makes more sense than patterned breathing for
most moms. It helps you to relax rather than try and distract yourself. Tension can really hinder labor progress and make
the contractions harder to manage.
-Bring a heating pad with you. It can really help if you have back labor.
making up flash cards of all of the pain relief tricks you learn so that you can refer to them when you are in labor. It can
be hard to remember all of them and there might just be one that perfectly suits your needs.
-Labor at home as long
as possible, or as long as you feel comfortable. You avoid feeling like a watched pot waiting to boil. You can also probably
relax better at home.
-Consider returning home if you go in to be checked and are less than 4-5cm.
good birth books by authors like Dr. Sears, Henci Goer and Ina May Gaskin. Consider picking up a copy of "Natural Childbirth
the Bradley Way" by Susan McCutcheon. I found it to be a very empowering read (very biased on interventions but lots of great
info on the emotionns of labor).
-Sit down with your partner before you go into labor and individually do these to
assessments. Sit down and compare your answers. Birth Beliefs’ Questionare:
Pain Medication Preference Scale:
This is a good article about alternative pain management techniques AND info on the actual
To find a doula near you, here is a link:
Birth Plan Maker
Pros and cons of birth plans
More reasons to write up a birth plan:
Common interventions and risks/ benefits:
Tips to have an easier first birth [or second, third…]..:
15 tips to have an empowering birth:
Accept that contractions aren't your enemy. Keep this acronym in mind.
Contractions are Purposeful. Every contraction works to help you efface, dilate, move the baby down into the pelvis
or change your cervix from posterior to anterior.
A- Labor contractions are Anticipated. You learn in
labor the rhythym of your contractions so you can gear up for the next one. You also can practice coping strategies before
the baby comes.
I- It is Intermittent. You will ot spend all of labor having contractions. There will
be a break between them. Use that break to the best of your advantage.
N- Labor pain is Normal. It is
there because your body is working really hard to deliver the baby.
(I got this from the workbook they gave us in our
hospital sponsored birth class. the book is calles "Prepared Childbirth the Family Way" by Amis and Green)
recently posted their birth story and said something very true:
"Labor isn't actually about the pain. It's about really