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Thread: Pain Relief
December 13th, 2012 10:56 AM #1
Now that I'm approaching a halfway point in this pregnancy, I'm starting to think about Labor and Delivery (never to early to think about your birth plan IMO) and I'm very worried about the pain. I like to think I have a pretty high pain tolerance, but I'm sure labor will be above that. I can't take an epidural. I have an extreme phobia of needles to the point that just getting a regular shot has me hyperventilating and I bit a nurse one time who tried to hold me still for a tetanus shot. I know there are other ways to help relax you and to help with pain relief, but it's hard to find good information on them. I'd love it if there was something I could do that wouldn't require a shot, but I don't know if there's anything out there. And if I can't avoid a shot, what about just avoiding a shot in my spine?
My mother had a natural birth with my sister that I was in the room for and she claims it wasn't that bad, but that was about a 48 hour labor with me, so I can't feel like that means much :P
I do have 2 tattoos, which in my opinion didn't hurt all that badly, and I've been told to use the same breathing method to relax myself during labor as during the tattoos. Is this even going to work the same? I've also heard that laughing gas can be used. That would be great for me as laughing gas gives me a calm, numb sort of feeling all over.
Other than my own questions, what did you all do to help with your pain?
December 13th, 2012 11:27 AM #3Senior Member
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I hate needles too, but the epidural wasn't nearly as bad or scary as I thought it would be. They give you an initial shot to numb the area and that was all I felt, and it was only for a split second.
December 13th, 2012 11:55 AM #5
I plan on having a c-section with epidural.
My sister has a HUGE needle phobia (But also has tattoos?! I don't understand that?! lol) and she had the epidural and was fine with it. She just asked them not to let her see the needle beforehand!Hi! I'm Hayley
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December 13th, 2012 11:58 AM #7
Laboring in water has been called "nature's epidural". My understanding is that many hospitals have tubs available to labor in, just don't want you to push the baby out in them. It's worth looking into.
I'd also strongly recommend taking a birth class. Mine covered relaxation and pain relief techniques, both that you can do and that your partner or doula can help with. They also went over the risks and benefits of various medical interventions, the epidural included, and explained what it entailed. Some of the recommendations were massage and changing positions frequently, finding what's most comfortable for you at the time.
My birth class instructors also said to keep in mind that it's not continuous pain, it comes and goes with your contractions. For me, knowing there's short breaks in-between is very comforting.
Some people are going to give you a hard time for having a needle phobia when you've got tattoos, but I have almost half my body covered and still am prone to faint when they draw my blood. I just wanted to throw it in there that I get that it's different.
December 13th, 2012 01:22 PM #9Senior Member
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- Apr 2011
I am not a fan of shots but I am even less a fan of pain. Seriously. I actually have pallid syncope where I can pass out when in extreme pain. Needless to say I was TERRIFIED by the idea of giving birth. When lots of people here in Sweden were telling me to relax and not to worry about it, that my body would know what to do, I found that reading and understanding more about what was going to happen was the only way to calm myself down. I read a book called The Doula Guide to Birth: Secrets every pregnant woman should know by Lowe and Zimmerman. It had chapters about Lamaze, different pain medication options etc as well as pain relieving labor techniques. I found it a helpful tool to manage my fear.
My birth plan was to have a walking epidural. This was my doctor's recommendation for anyone having twins but especially someone with such a strong aversion to pain. However by the time I got to the hospital the most painful position was lying down and they told me that I would have to remain like that an additional hour and a half if I wanted the epidural. I decided that I could do without it. I did have nitrous oxide gas though but I think it depends on where you live. Some of my friends had never heard of that option. I am not sure how much it helped (and I had temporary(?) nerve damage in my hand from griping the mask too hard) but it did give me some feeling of control over what was going on, whether that was real or imagined.
As a side note we spend a lot of time in the labor and delivery ward before the births because I was having problems with strong early contractions. One time while we were there, a midwife came in to the room we were waiting in (a normal delivery room) and asked if we would mind going back out to the waiting room so that she could show the room to a woman who was absolutely terrified of delivering. They wanted her to see what it was like to try to help her manage her fears. (Apparently birth classes used to tour the labor and delivery ward here in Sweden until recently.) I don't know if it is possible where you live, but I think familiarity with the locale (as well as the staff- yes we were there that much! 9 times before delivery) really helped us too!
Good luck!Mama to twin boys Oliver Graham and Luke Axel
December 13th, 2012 02:03 PM #11
From what I've heard, the nitrous oxide gas is not used very much in the U.S. It's more epidural and narcotics if going the medicated route. I'm not sure where the OP lives, but location, both by country and facility, will influence the standard procedures offered.
December 13th, 2012 02:13 PM #13
I gave birth naturally (although aided with Pitocin -or rather, its equivalent here in Canada) and it wasn't so bad, mainly because of the breaks in between & because I had read descriptions of the pain and how long each stage of labour is supposed to take, and for me, it didn't last as long as average and wasn't as painful. I kept waiting & expecting it to get worse, and it never did. The "ring of fire" was not very fiery imo, and suddenly they put a baby on my chest and said "here he is!" I was shocked!
But, not everyone has such an experience. A few of my friends decided not to have epidurals and laboured naturally until they couldn't do it any more. At that point, the idea of the pain from the epidural didn't sound so bad... and from there, they were able to proceed with a vaginal birth.Mommy to John Alexander & 3 furbabies; Maggie the dog, Rex & Bella the wannabe lions
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December 13th, 2012 03:20 PM #15
Dantea, it's good to go into labor as relaxed, knowledgeable and comfortable as possible. Reading, studying, watching birth videos, taking childbirth classes and learning relaxation techniques are all valuable adjuncts to pain relief. Fear and anxiety will heighten the perception of pain.
However, you should not at all expect these sorts of methods to control the pain of labor and especially delivery. The pain is very intense and you should not feel like a weakling or an inferior mother or like you don't earn a merit badge if you request pharmacological pain relief. I have delivered babies with and without pain relief (including in places like Haiti or East Africa, where it was the mother's 10th+ child) and can assure you that every woman, everywhere experiences intense pain with labor and delivery. You can obviously survive it and you can obviously give birth without pain relief, but it adds a needless element of suffering and tribulation to the birth experience.
In the US you have three options:
1) narcotics. These are short-acting (either nubain or fentanyl) and are given via IV. They act systemically (meaning, they're absorbed all over the body and work like any other narcotic, such as oxycodone or morphine). As such they DO cross the placenta and they DO get absorbed by the baby. Since they're short-acting they last about 15 min, so no lasting effect is seen in the baby unless you get a shot immediately before pushing him out. Babies with narcotics on board are often a little stunned and have a decreased respiratory drive; however, these effects are very temporary. Lastly, narcotics "take the edge off," making the pain bearable; they do not erase the pain. For these two reasons-- inadequacy of relief and systemic effects affecting the baby- narcotics are very rarely used as sole agents. Usually they are given while the anesthesiologist is being called for an epidural, or for women who desired a natural birth, declined an epidural when she was still able to receive one, and during pushing is finding the pain too much to bear.
2) regional anesthesia: epidural or spinal anesthetic. Epidurals are far more common than spinals. An epidural is placed OUTSIDE of the sac surrounding your spinal cord (the dura). It cannot cause any neurological damage as the needle, and the anesthetic, are never in contact with the cord itself. The space around the cord remains pristine and sterile, so the risk of meningitis is also zero. Instead the local anesthetic (the same stuff you get when you're numbed up for stitches, or dental work) diffuses around the spinal roots which innervate your body at specific levels. An epidural should provide a near-complete SENSORY block (meaning you're numb from a certain level on down) but should not be so strong as to provide a MOTOR block (i.e. you should be able to move your legs, get into different pushing positions, etc). Most importantly-- the medication LITERALLY CANNOT be absorbed systemically. It is contained by the most fundamental laws of chemistry to stay in the epidural space. It cannot get out. It cannot enter your bloodstream. It is LITERALLY IMPOSSIBLE for it to affect your baby in any way whatsoever. I mean that-- there is not even a "theoretical risk" or a "one in a million chance." It is just as possible to affect your baby as it is for you to throw a ball and see it go up, not down. The rate of the epidural can be adjusted by the anesthesiologist to provide near-perfect pain relief without clumsy motor problems.
A spinal anesthetic IS placed right next to the spinal cord itself. It does go through the dura. The risk of something like meningitis or neurological damage is very low (procedure is done sterilely, the needle is not large and is withdrawn immediately), but definitely possible. The main benefit is that it acts immediately-- complete and total pain relief within 1 minute. Sometimes facilities offer something called a CSE: Combined Spinal-Epidural. A shot of local anesthetic is delivered to the spine, so the mother experiences relief immediately. An epidural is actually left in place, not a spinal, so subsequent pain relief is that of an epidural.
3) General Anesthesia: this is only performed during absolute emergencies when there is no time for an epidural or other regional anesthesia. You are unconscious and paralyzed. The anesthetics are systemic and do pass on to the baby, so there is a careful ballet between obstetrician and anesthesiologist: as soon as the medication is administered into the vein, the OB makes the first cut. A good OB can have the baby out in under a minute, usually 30s in an emergency. The mother has perfect pain relief and the baby is out before the medication has time to cross the placenta.
- Laughing gas, or nitrous oxide, is not routinely offered in the US. If you've had it at the dentist, you know why. It's an amnestic (makes you lose all memory of events), it alters the mother's level of consciousness and behavior, and as such makes it impossible to coordinate pushing, changing positions, etc. The mother too will have a very distorted, altered memory of the birth itself, which is obviously not desirable.
How an epidural is placed:
You are either seated or laying on one side (usually seated). You curl up your spine & hunch your back like a cat. The anesthesiologist is sterile and his/her equipment and medications are all sterile, so you cannot move, turn around, or touch anything. Everything is behind you so you will not see what's happening, but they talk to you to let you know each step.
1) a shot of skin-numbing local anesthetic is given, in a tiny wheal. This is similar to receiving stitches. That's the last think you should feel.
2) the larger, hollow, epidural needle is placed through the numbed skin into the tissue of your mid-back. The anesthesiologist will feel a 'pop' as the needle passes through the ligaments that support your spine and help with erect posture; that is their landmark. The needle does not pass through the dura [the sac surrounding the spinal cord] and never comes into contact with the spinal cord.
3) the actual epidural catheter-- a thin, floppy piece of plastic that looks like your iPod headphones-- is threaded through the hollow needle.
4) the needle is withdrawn. You now have just a floppy piece of plastic that is in no way sharp, cannot poke you or migrate anywhere, sitting in the space surrounding your spinal cord.
5) Anesthetic is infused. You begin to feel the effects after about 5 minutes, and it's complete in roughly 20. The catheter is taped in place sterilely and securely.
You can move around, lay on it, whatever you want. It can't hurt you and you can't do any damage with it.
Since there is so very little downside, you can see why it's the preferred method of labor analgesia. You as the mother are fully awake and alert. You are able to move and to get into different pushing positions (though most places hold off on actually walking for fear of falling). The sensory block is near complete; from personal experience you can still feel your contractions just fine, but they're more like Braxton-Hicks tightening sensations than painful. You can relax and focus on the birth, and your experience thereof, without unncessary suffering. Even the actual delivery is relatively painless, and the subsequent suturing/repair of lacerations is equally painless.
You can request epidural analgesia at any point in the first stage of labor, though most women don't need it until their water has broken, the contractions are intensifying, and/or they're experiencing transition once they reach 7-8cm. Once you start pushing most anesthesiologists are reluctant or refuse to place one, since it's very hard to hold off on pushing and hold still once you're getting going.
Placing one when you're calm, still managing the pain well, and there are no looming concerns about your or your baby's wellbeing is optimal. Again, for most women, that's about 6-7cm dilated.Resident surgeon on the nameberry scene,
Expecting a small human 12/7/13.
XY: Antoine Raphael (3.2012)
December 13th, 2012 03:30 PM #17Senior Member
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- Aug 2009
You would jump at the chance of an epidural if you had a bowel obstruction while 35 weeks pregnant and spent one week in ICU without drugs to dull the pain (it was an horrendous experience for me).
December 13th, 2012 03:36 PM #19
oh no, Rollo! So sorry! Did it open up or did you need surgery?Resident surgeon on the nameberry scene,
Expecting a small human 12/7/13.
XY: Antoine Raphael (3.2012)