Babies Tale

The pain of labor is quite different from other kinds of pain. It is the pain of your body doing a hard and laborious job, not the pain of being in any way harmed. However, labor is normally painful to some degree. Many people have tried to gloss around this or give the impression that, properly prepared and armed with breathing exercises and the right attitude, you will not feel pain. This means many women are taken by surprise and believe they have failed when they do experience intense pain in labor and feel they need some relief from it.

We know fear and tension can create additional pain in labor and make it intolerable. If you tense all your muscles and fight the contractions, you make it much more difficult for your body to do its job. You need to think, therefore, in terms of helping your body through the contractions. This thinking is behind the various breathing and preparation techniques that are taught to women in prenatal classes during pregnancy. By accepting the pain and dealing with it, many women find they do not need painkilling drugs, which might also interfere with their being in control. For others experiencing a long and difficult labor, painkilling drugs may provide much-needed relief.

Breathing Techniques

Slow, deep breathing will help you relax between, and at the beginning and end of, contractions. At the height of a contraction, it may help to breathe quickly and lightly, taking air into the top part of your lungs only. (Do that for just a short while.) During the transition between the first and second stages, when you may feel a desire to push out the baby, your doctor or midwife may ask you to wait till she is sure the cervix is fully dilated. At that point, short, rapid, panting breaths may help you overcome the desire to push.

Pain-Relieving Drugs

A number of pain-relieving drugs are available to women in labor. They are particularly useful if you are experiencing a very long labor, if the baby is presenting the wrong way (see below) or if you are becoming exhausted. These drugs, however, can pass into the baby’s bloodstream and affect the baby, or may affect the progress of the labor. Many women find it useful to wait a little between the moments they first feel that they may want pain relief and deciding to accept it. In the meantime, they may find labor is progressing so well that they are nearly ready for the baby to be born. If progress is slow, however, or there is some problem, they can always decide to accept some pain relief.

Meperidine Hydrochloride

This drug, most commonly known by its trade name Demerols’, provides pain relief. It reduces anxiety and thus pain; however, not all women find it is an effective form of pain relief. Some find it makes them feel heavy and out of control without helping the pain much. Demerol crosses the placenta and can affect the baby, making it drowsy at birth, especially if the drug is given close to delivery. (It should be given at least two hours before the baby is born; this means it cannot always be given at the point in the labor when the woman needs it most.) Some babies even need resuscitation after the birth. Many are sleepy and slow at breastfeeding. This medication can also make the mother feel sick.

Epidural Anesthesia

An epidural consists of a local anesthetic that completely numbs the abdomen and legs, thus removing all sensation of contractions. If an epidural is timed just right, it can be allowed to wear off for the second stage so that you can feel and push with each contraction, thus helping the baby out. It seems to have little or no effect on the baby. The main potential problem is that, because some women cannot feel anything, they cannot participate in the second stage of labor, which is likely to be prolonged. The baby is more likely to be delivered with forceps. However, the correlation may be due to the fact women who are having difficult labors anyway are likely to ask for epidural anesthesia.

An epidural is injected into the epidural space in the spine, between the vertebrae and the membrane enclosing the spinal cord. You will be asked to lie on your left side and to draw up your legs to make as tight a ball as possible. This position makes it easier for the anesthetist to put the needle into the epidural space. You will be given a local anesthetic so you do not feel the tube being inserted. After that, the anesthetic is put in. It feels like a cold fluid running down your legs. The catheter is left in your back so the epidural can be “refreshed;” you will also normally have a catheter put in to empty your bladder because you will not be able to control this yourself. An intravenous drip is usually set up too, in case your blood pressure falls suddenly, which can happen with an epidural.

For some women, an epidural is the answer to a difficult labor:

“1 had been in labor for hours, with strong contractions, but I wasn’t dilating much. I became exhausted and thought I couldn’t take any more. They offered me an epidural, and I accepted reluctantly. I have to say the effect was wonderful. Within a few minutes, I was sitting up and talking to the nurses and felt like I could cope again.”

Epidurals can cause problems. About 20% of the time, the epidural does not take and provides inadequate pain relief, sometimes along one side only. Occasionally-in about one in 100 cases-the needle punctures the membrane enclosing the spinal cord. This means you are more heavily anesthetized and may suffer headaches lasting up to a week after the birth. Very rarely, in about one in 100,000 cases, permanent damage can result.

“1 hated it. First the anesthetist had trouble getting it in. In fact, a little piece of plastic tubing broke off and is still floating around somewhere in my spine. Then I had all these tubes and drips set up, and I couldn’t get up and walk for hours after the birth. I didn’t feel or see the baby born at all because I could feel nothing. I had no idea it would be like that. And, because I couldn’t push, he was delivered by forceps-so now I have all the pain of an episiotomy, which I could have done without.”

Women having an epidural should be aware that they are often beginning a chain of medical intervention they might otherwise have done without. On the other hand, if the labor is likely to be difficult, it means you are spared a lot of pain and are already anesthetized if the baby has to be delivered by forceps. And if you should need an emergency Cesarean, the epidural will enable you to be awake and avoid a general anesthetic when your baby is born.

Pudendal Block

This painkilling injection can be made into the vaginal wall with a special needle. With it, you will feel no pain at all from the delivery, and is especially useful when forceps are used. It may be used in conjunction with Demerol.

Local anesthetics are also given if an episiotomy is necessary and for any stitching done on the perineum afterward.

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