Your Delivery at Covenant

Whether you’re planning on a more natural approach to childbirth or you want a traditional childbirth experience, including pain medications, labor and delivery is a process. And even with medication, you will likely experience sensations that are new or uncomfortable. Even if you’ve had babies before, you may have a different experience or symptoms this time around. Fortunately, there are things you can do to make the most out of your labor and delivery.

Childbirth is one of the most natural events in the human experience. And though there are things women can do to make childbirth more comfortable, which of those things work vary from woman to woman. If you decide you don’t want to take medication, that’s fine. And if you do want to, that’s fine too. There’s no shame in either decision. You have to do what you believe is best for you and your baby. And with the help of your health care team and your partner, you should be able to come up with a plan to help you have the best labor and delivery you can.

There are many ways to help you stay comfortable and relaxed during labor.

Non-medicated ways to stay comfortable

There are many non-pharmacologic ways to stay comfortable during labor. They may help provide comfort and relieve stress both at home and in the hospital. They are great for both natural childbirth and traditional childbirth because they can help you feel confident, relaxed and in control of the process.

Breathing techniques - There are different types of breathing and breathing patterns that can help you direct your mind away from the discomforts of labor.

Visualization - helps you focus on an object or task, such as breathing, to help you through the pain and discomfort of labor and to encourage your body to relax and do what it’s supposed to do.

Guided imagery - is a technique used to help you form mental pictures and transport yourself mentally to another place. This can help you relax cope with the difficulties of labor.

Positioning and movement - Many women find changing positions and moving around during labor helps relieve discomfort and may help speed labor along. Rocking in a rocking chair, sitting on a "birthing ball," walking and swaying may be helpful to relieve discomfort. Your health care provider can help you find comfortable positions that are also safe for you and your baby.

Massage - This may include massage or light stroking to relieve tension. Effleurage is a type of self-massage that some women find very helpful.

Heat or cold therapy - This type of therapy uses the therapeutic benefits of heat and/or cold to help relax tensed or painful areas of the body. Many women find that a warmed towel or cold pack (or both intermittently) can be helpful.

Hydrotherapy - Some labor and delivery rooms have hydrotherapy tubs. Hydrotherapy can be helpful in easing pain and aiding in relaxation during labor. A shower during labor may also be effective.

Medications for Pain Relief

There are many pharmacologic ways to stay comfortable during labor. Some can be used with other comfort measures. Remember, there is no correct choice about what you use to cope with labor. You decide what options are right for you.

Analgesics are given either by a shot or through an intravenous (IV) line. These medications are often used in early labor to help you rest with less pain. Side effects include drowsiness, nausea, and trouble concentrating. If the medication is given too close to delivery, it may make your baby drowsy. Talk with your care team about timing of pain medication during labor.

Epidural or Intrathecal Anesthesia is a procedure done by a doctor who specializes in anesthesia or a certified nurse anesthetist. Pain medicine is injected into the small of the back. This medicine affects the nerves of the spinal cord to block the pain that comes with labor and delivery.

Epidural – A catheter is placed just outside of the spinal canal to allow for continuous medicine to be given throughout labor. Pain relief starts within 20 minutes. This is placed when the patient is in active labor, after her cervix has dilated 3-4 centimeters. A bag of pain medicine will be placed on a medicine pump and the medicine will continue to flow into the epidural space until delivery.

Intrathecal – The medicine is given by a smaller needle directly into the spinal canal. It works within five minutes. It will relieve your pain without affecting your ability to move your legs. Since this medicine is not given continuously, it will last 4-6 hours. Another injection is possible if you need further pain relief.

How the Epidural/Intrathecal Anesthetic Is Given

• A nurse will help you sit in the right position. This is important for good placement.
• The skin on your back will be cleansed with an anti-bacterial agent.
• You will feel a stinging sensation as the skin is numbed.
• You will feel pressure as the epidural needle is inserted.
• A tiny tube called a catheter will be placed through the needle and the needle taken out (epidural).
• The catheter is left in place and is used to give the medicine (epidural).

After You Receive the Epidural/Intrathecal Anesthetic, You Will

• Need to stay in bed (epidural) or need assistance to ambulate (intrathecal).
• Receive fluids to keep your blood pressure within the normal range.
• Possibly need assistance to empty your bladder.
• Be watched for an increase in temperature which can be mistaken for infection.
• Have continual fetal monitoring.

Side Effects and Risks

• Minor side effects, such as itching or nausea, can be treated with IV medicine.
• Your blood pressure may drop. This can affect the baby’s heart rate. IV fluids are given before the epidural is started to prevent this common side effect. If it happens, it is treated with extra IV fluids and IV medicines if necessary. Nausea usually happens with a drop in blood pressure.
• Occasionally the numbness from the anesthetic may spread to your chest wall. The loss of this feeling may make you feel short of breath. We carefully monitor the oxygen level in your blood. If needed, we will give you extra oxygen to assist you with your breathing through a mask or tube.
• Your labor may last longer, especially the “pushing” stage, but it will be more comfortable.
• One in one hundred women develop a head- ache after a labor epidural. These headaches can vary from a very mild headache to the worst headache you can imagine. Often the headache goes away on its own. It may be necessary to do another procedure called a “blood patch” to stop the headache. During this procedure, we draw your blood and inject it into the epidural space to “patch” the cause of your headache.

Benefits

• Although your labor will not be entirely painless, it should be much more comfortable.
• Induction of labor with the administration of IV Pitocin and other medicines can cause significant discomfort to the mother. A labor epidural is an effective means to assist with the discomfort associated with the induction of labor.
• Epidural anesthesia is a very helpful method of pain relief during labor. Many mothers have expressed satisfaction with this technique. It is safe for both mother and baby.
• An effective labor epidural often permits you to rest and gather energy necessary for delivery.

The Covenant HealthCare Anesthesia Department is proud of the service we provide. We are available to discuss with you any questions or concerns you may have with your decision regarding labor pain relief. Please ask your care team to assist you in contacting us. The ultimate decision concerning your choices for anesthesia/analgesia in labor and delivery are for you to make after thoroughly looking at your options and discussing them with your OB Provider.