We are all well aware that labor and delivery cause pain. Despite this expectation, it’s hard to know what it will feel like and what you may need to cope until you are in the thick of it. Because of this, it’s helpful to think about what pain management techniques, both non-pharmacologic and pharmacologic, are available to you before you are actually in labor.
The early phase of labor, from the onset of contractions to about 5-6 centimeters of dilation, can last hours to days. During this stage, most obstetric providers recommend care at home with use of conservative measures like warm baths, heating pad use, stretching and movement. When labor becomes more intense and dilation begins occurring more quickly, this is typically when you would make your way to the hospital to prepare for birth.
Non pharmacologic techniques remain an option for you once you are in the hospital. Our nurses are well versed in the use of birthing balls, movement and position changes to support labor progress and pain management, and counter pressure techniques. Some of the labor rooms at WakeMed also have tubs for hydrotherapy.
Certain breath work and mind body techniques can also be quite effective. Many birthing classes will provide instructions on these methods, and there are specific programs like Lamaze and Hypnobirthing that can provide additional guidance.
Continuous labor support has been shown to improve birth outcomes, including pain. So be it your partner, a family member or friend, a doula, or a combination of these figures – having supportive people by your side during labor and delivery is highly important.
The use of medication through your IV can provide short term pain relief. At WakeMed we typically use the opioid medication fentanyl for labor pain management for patients who desire this method. Fentanyl is a strong medication, so to ensure mom and baby are safe, we typically monitor mom and baby continuously when fentanyl is being used, and try to avoid dosing close to the time of delivery, as opioids can depress an infants respiratory drive (which can lead to need for breathing support after birth). Inhaled nitrous oxide is another short acting option. This is a safe pain management method available at WakeMed for patients to self administer during labor.
Epidural is the most common method of labor pain management in the United States, and a popular choice amongst our patients. Epidurals deliver anesthetic and opioid medications to the fluid surrounding the nerves that supply the lower body. This provides excellent pain relief in the area where you need it, with less systemic absorption that could affect your baby. Epidural placement involves an anesthesiologist introducing a small plastic catheter into your lower back through a needle, through which medication can be delivered to the nerves continuously over time. So you can really have the epidural placed at any point in your labor process (provided you can sit still for the placement), without fear that the pain relief will “wear off.”
Hodnett ED, Gates S, Hofmeyr GJ, Sakala C. Continuous support for women during childbirth. Cochrane Database of Systematic Reviews 2013, Issue 7. Art. No.: CD003766. DOI: 10.1002/14651858.CD003766.pub5. Accessed 11 June 2023.