Pain Management

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.

2. 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 c-section.

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.

-Be 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.

-Try the “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.

-Stay 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.

-It 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.

-Consider 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.

-Read some 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:
http://transitiontoparenthood.com/ttp/foreducators/handouts/beliefs.pdf

Pain Medication Preference Scale:
http://dolphin.upenn.edu/~doulas/documents/PMPS.pdf

This is a good article about alternative pain management techniques AND info on the actual pain medications:
http://askdrsears.com/html/1/T010800.asp#T012000

To find a doula near you, here is a link:
http://dona.org/FindingADoula.html

Birth Plan Maker
http://www.birthnaturally.org/HospitalPlan.htm
http://www.babycenter.com/calculators/birthplan/

Pros and cons of birth plans
http://pregnancytoday.com/reference/articles/birthplanarticle.htm

More reasons to write up a birth plan:
http://birthplan.com/plan-why.htm

Common interventions and risks/ benefits:
http://www.lamaze.com/birth/choices/articles/0,,167805_240720-2,00.html#npo

Tips to have an easier first birth [or second, third…]..:
http://sheknows.com/about/look/609.htm

15 tips to have an empowering birth:
http://sheknows.com/about/look/102.htm

Accept that contractions aren't your enemy. Keep this acronym in mind.
PAIN
P- 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)

Someone recently posted their birth story and said something very true:
"Labor isn't actually about the pain. It's about really hard work."