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Thread: Pain Relief
December 13th, 2012 06:08 PM #21
For pain relief while labouring I used entonox (gas). It made me feel quite floaty and my face felt numb after a while. I hardly said 5 or 6 sentences during labour, but do remember saying how weird the gas made me feel. Mostly it just helped me focus on breathing during contractions. It must've done enough for pain since I remember that I didn't even think of requesting further pain relief (eg. epidural).
Aside from the pain of contractions I had terribly sore hips, but only when trying to move about/change positions. I got into the tub fine, but almost couldn't get out as it really hurt me to lift my leg high enough to get it over the edge. I also found it incredibly painful whenever I had to change positions or roll over. I'd heard of people having contraction pain all through their hips but not when trying to move about between contractions.
My labour ended in an emergency c-section after 2 hours of pushing, and it took them two goes to get the epidural in. I only felt the needle when the local anaesthetic was being administered (both times).Leo Sebastian l Ronan Alexander
December 13th, 2012 06:32 PM #23
Again, you can talk to your doctor about episiotomy. I think for the most part, there has been a decrease in routine episiotomies. You can request that it only be done if necessary and that they ask you first, provided it's not a true get-the-baby-out-asap emergency. If the baby's coming fast, they may ask you to ease up on pushing a little to allow for stretching instead of barreling through.
December 13th, 2012 08:37 PM #25
Dantea, so happy to have helped.
Kungfualex is quite correct-- episiotomies are no longer routine. It was hypothesized in the past that a controlled cut which could be quickly repaired after labor would be better than uncontrolled, unpredictable tearing. Makes sense, but turned out not to be true. As long as your lacerations are properly identified and immediately repaired, there is no benefit to having an episiotomy. However, if you need one: as long as your episiotomy is cut correctly (i.e. a 'mediolateral' episiotomy), there is almost no risk of damage to adjacent structures or any other problems.
Soft tissue is NOT the problem in obstructed childbirth. Soft tissue will simply tear, with enough force. If the baby is obstructed and not getting out, that's entirely due to your bones and ligaments. Therefore cutting an episiotomy is rarely going to help speed things along significantly. [In the past, before c-sections, the mother's pubic bones were broken as a last-ditch effort to save her life in the case of true cephalopelvic disproportion. Very rarely worked, and in the pre-antibiotic era you didn't live long with a broken pelvis].
IVs: the best IVs are farther up in your arm, generally in the antecubital vein (the vein in the crook of your elbow-- not the bony side of the elbow, the inner surface contiguous with the palms of your hands). The vein is bigger and it hurts less; the IV is less likely to be dislodged or infiltrate or need to be replaced. The need for the IV is two-fold: 1) you might be receiving medications, like penicillin for Group B Strep or pitocin to augment your labor and 2) epidurals can induce low blood pressure, by causing the veins to dilate and blood to pool. IV fluids support the blood pressure to an adequate level. I admit, I rather hated this (I have very low BP, roughly 90/60, and knew I would get a few liters of fluid once I had an epidural and the resultant hypotension). It makes you puffy but you pee off the extra fluid within a few days. I considered it an extremely miniscule price to pay for adequate analgesia and the ability to concentrate on the work at hand.
The catheter: a urinary catheter is also required as a) you're not going to be up and walking, as I mentioned, for fear of falling and b) the sensation of needing to empty your bladder, like all other sensations, will be dull to absent with the epidural in place and infusing. You don't want a huge distended bladder both because of the risk of urinary tract infection, as well as the problem of the massive bladder smooshing the uterus and preventing the uterus from shrinking down once the baby is delivered. A boggy, distended uterus leads to a postpartum hemorrhage since the uterine muscle can't clamp down to control the bleeding. The placenta has thousands of 'spiral arteries' which take blood from the mother into the baby via the umbilical vein. Those arteries need to close off as soon as the placenta detaches, otherwise the mother's blood will continue to pour through them. This is by far the most common cause of postpartum hemorrhage (happens in 10% of vaginal births). To be clear-- the strongest risk factors for a boggy, atonic uterus are multiple gestations and a multiparous woman, not a distended bladder. But since the problem is completely fixed via insertion of a catheter, it is absolutely required, not up for negotiation, once the epidural is placed. It doesn't hurt much at all, it's lubricated, and you can get it *after* the epidural when you have dramatically decreased sensation.
Re: eating and drinking in labor: the only reason not to eat/drink in labor is if you need to be intubated (have a breathing tube inserted to place you on a ventilator) in order to receive general anesthesia for an emergency c-section or emergency hysterectomy. Pregnant women have very bad airways and are very prone, more so than the average bear, to aspiration (throwing up when unconscious and sucking the vomit into their lungs). This is an extremely serious problem that would require an ICU stay and close monitoring if it should occur. **However,** if you have an epidural, you will NOT need to be intubated under any circumstances, no matter how dire. Therefore it is completely safe, and encouraged, to eat and drink. It keeps your energy up, etc.
Pushing feels good in one sense, but the final descent and actual birth of the baby are by far the most painful parts of childbirth. Unmedicated contractions feel somewhat like charley horses across your entire abdomen (at the end), but the actual exit of the baby from the pelvis and the descent through the vagina are intensely painful.
Lastly, pushing while laying on your back: in most hospitals, you can push however you want (though many obstetricians and midwives will want the actual delivery of the baby to be supine, so as to allow them to monitor & control descent to protect your soft tissue, check for a nuchal cord, manage malpresentation, etc). Hospitals have positional aids like birth balls and squat bars. Any position besides standing upright is an option after you receive an epidural. However, think of this:childbirth is an intensely physical workout. You burn nearly 500 calories an hour during the second stage of labor. It's physically quite exhausting. Every position, except lying supine on your back, requires some effort and energy expenditure to maintain. When you are working that hard, the position which requires the minimal effort often feels best!Blade, MD
XY: Antoine Raphael (3.1.2012)
XX: Cassia Viviane Noor (11.30.2013)
December 13th, 2012 08:51 PM #27
Thanks again Blade!
I always wanted a water birth, but that's not available to me here. Instead, I'd like to labor squatting or sitting up depending on what available at my hospital. It's the best positions from what I understand as it allows gravity to help you. In the book published by my doctor that he gave me at my visit, it says that if I need a labor chair or squat bar to tell someone, so I assume I'll be allowed to do that.Mother, Hellenic Pagan Priestess, and Resident Greek name expert ^_^ Call me Dantea or Remy
Kith nor Kin -- http://kithnorkin.blogspot.com/ Chapter 28 is up
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Persephone Elysia Willow -- June 5th 2013
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December 13th, 2012 08:55 PM #29
Of course, but personally I found it very tiring to squat, even using the bar. I can't squat now, un-pregnant and not doing something intensely physical, for much more than 5 minutes. In labor I grew to hate it very quickly.
Gravity is actually less important-- by far-- than the strength of your uterine contractions. It certainly helps-- far better than standing on your head -- but the baby's head is engaged in the pelvis already, usually a couple of weeks before you're full-term. It's already in -3 position, maybe even -2. Only your cervix opening and the propulsive force of your uterus can really help him come out.Blade, MD
XY: Antoine Raphael (3.1.2012)
XX: Cassia Viviane Noor (11.30.2013)