• Pain Management During Childbirth: What Are Your Options?

    PD Fitness and Wellbeing 67027 Childbirth is often thought of as one of the most painful events that we humans experience. In reality, the degree of pain can vary widely from woman to woman, and even from pregnancy to pregnancy.
    Preparing yourself for the type of pain you will experience during labor and delivery can help alleviate some of the worry and anxiety you may be feeling. Planning strategies for pain relief in advance of labor will also help ensure you are able to deal with pain when the time arrives.

    The Causes of Labor and Delivery Pain

    Most women begin labor around the 40th week of pregnancy. Signs associated with the beginnings of labor include uterine contractions, water breaking (amniotic fluid leaking through the vagina).
    Uterine contractions are the primary cause of pain during labor. In addition, the baby’s movement out of the uterus can cause pain through stretching of the vagina and pressure to the cervix, bladder, and bowels.
    Labor pain is often manifested as cramping in the abdomen, groin, and back. Many women complain of a tired, achy feeling throughout their entire body. Some women may also experience pain in their sides and thighs.

    Managing Pain During Childbirth

    While you cannot prevent pain during labor and delivery, the following strategies can prepare you for this pain, so you are better able to handle it:

    Exercise During Pregnancy

    Getting regular exercise during your pregnancy can strengthen your muscles and increase your endurance to prepare your body for the stress of labor. If your doctor says it is okay for you to exercise, aim to get 30 minutes of moderate cardiovascular activity (eg, walking, stationary biking, swimming) and strength training exercises on most days of the week.

    Take Childbirth Classes

    In childbirth classes, you will learn pain management techniques, such as visualization and stretches. The two most popular birthing philosophies in the United States are the Lamaze technique and the Bradley method.
    In the Lamaze technique, relaxation strategies, breathing exercises, distraction, and massage are taught as ways to manage pain during childbirth. The attitude toward pain relief medicines is generally neutral, encouraging women to make an informed decision about whether medicines are right for them.
    The Bradley method emphasizes a “natural” childbirth, in which pain medicines are avoided unless absolutely necessary. Instead, women are encouraged to rely on the baby’s father, who is the birth coach, to help the mother relax and use deep-breathing techniques.

    Use a Doula

    A doula (pronounced doo-lah) is a woman trained to give continuous emotional support during labor to help manage pain. Some hospitals and birth centers provide doulas, and some women hire them privately. A study, published in the Journal of the American Medical Association , found that the presence of a doula during childbirth significantly reduced the rate of cesarean section deliveries and use of epidural anesthesia .

    Use Other Nonmedicine Strategies

    Other ways of managing pain include: undergoing hypnosis, doing yoga , walking, having a massage , changing positions, taking a bath or shower, and engaging in other distractions (eg, counting or other activities). A study in Pain Research and Management found that breathing techniques and nurse-administered massage significantly reduced the perception of pain during labor. Acupuncture may also provide some benefit.

    Use Pain-relief medicines

    Spinal and epidural anesthesia are commonly used to manage labor pain. In epidural anesthesia, pain medicines that numb nerves are given through a catheter placed in the epidural space near the spinal cord. In spinal anesthesia, the medicines are injected into the spinal fluid.
    In most women, these medicines almost completely relieve labor pain, but do not numb the entire body. This allows the mother to use her abdominal and leg muscle strength to push and deliver the baby when it is time. In addition, the epidural catheter can be used to give extra medicines in the event a cesarean section becomes necessary.
    Pain medicines can also be administered through an intravenous (IV) catheter or through an injection into the muscle. But since these medicines can cross into the baby’s bloodstream and cause his heart rate to decrease, epidural anesthesia is often preferred.

    Plan Ahead

    However you choose to manage childbirth pain, be sure to discuss all of your options with your doctor well before you go into labor. Having a pain-relief plan in place will not only make labor and delivery less stressful, it will also relieve your anxiety during your pregnancy. Remember to be flexible since you will not know how childbirth pain will affect you until you are in labor.

    RESOURCES

    American Pregnancy Association http://www.americanpregnancy.org/

    March of Dimes http://www.marchofdimes.com/

    CANADIAN RESOURCES

    The Canadian Women's Health Network http://www.cwhn.ca/en/

    The Society of Obstetricians and Gynaecologists of Canada http://www.sogc.org/index%5Fe.asp

    References

    Childbirth. National Women’s Health Information Center website. Available at: http://www.womenshealth.gov/Pregnancy/ . Accessed August 26, 2005.

    Dealing with pain during childbirth. Kids Health, Nemours website. Available at: http://kidshealth.org/parent/pregnancy%5Fcenter/childbirth/childbirth%5Fpain.html# . Updated February 2008. Accessed June 14, 2011.

    Kennel J, Klaus M, McGrath S, et al. Continuous emotional support during labor in a US hospital: a randomized controlled trial. JAMA. 1991;265:2197-2201.

    Labor pain: what to expect and ways to relieve pain. American Family Physician. 2003;68.

    Torpy JM, Lynm C, Glass RM. Birth labor. JAMA. 2002;288:1432.

    Tortp JM, Lynm C, Glass RM. Childbirth. JAMA. 2005;293:2180.

    Yildirim G, Sahin NH. The effect of breathing and skin stimulation techniques on labour pain perception of Turkish women. Pain Res Manag. 2004;9:183-187.

    4/29/2011 DynaMed's Systematic Literature Surveillance DynaMed's Systematic Literature Surveillance : Hjelmstedt A, Shenoy ST, Stener-Victorin E, Lekander M, Bhat M, Balakumaran L, Waldenström U. Acupressure to reduce labor pain: a randomized controlled trial. Acta Obstet Gynecol Scand. 2010;89(11):1453-1459.

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