Adriana goes through six different medical options for relieving pain during labor, focusing on the best time to use each one to help you plan your pain management strategy.
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- [Best of Birthful] What is the Purpose of Childbirth Pain?
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- What You Need to Know about Birth Positions
- How to Avoid a “Cascade of Interventions”
- Epidural Risks and Concerns for Mother and Baby, Dr. Sarah Buckley
- Sterile Water Injections for pain relief during labor, Evidence Based Birth
- Sterile water injections for the relief of pain in labour, Cochrane
- Impact of therapeutic rest in early labor on perinatal outcomes: a prospective study, AJOG MFM (PubMed)
- Transcutaneous Electrical Nerve Stimulation (TENS) for pain relief during labor, Evidence Based Birth
- Transcutaneous electrical nerve stimulation (TENS) for pain management in labour, Cochrane
- TENS Unit: The ‘Natural Labor’ Tool No One Is Talking About, Parents
- Using a TENS Machine for Labor Pain: Is It For You? Healthline
- Narcotics for labor pain, March of Dimes
- Medications for Pain Relief During Labor and Delivery, ACOG
- Effects of IV opioids during labor, Evidence Based Birth
- Narcotics for Pain During Childbirth, American Pregnancy Association
- Pro-Con Debate: Nitrous Oxide for Labor Analgesia, BioMed Research International
- The Rise of Laughing Gas in the Delivery Room, New York Times
- Labor and delivery: Pain medications, Mayo Clinic
How to Time Your Pain Relief Options
I’m Adriana Lozada and you’re listening to Birthful. And today just like every other week, we’re going to dive into a perinatal topic that you need to know about. And today it’s going to be about the timing for using medicated pain management options. And truthfully, I find that this is something that doesn’t get talked about much, but can be really important as you plan your options of when to use what. And now I’m going to give you general guidelines, but if you use anything is going to depend, of course, on your specific situation, on how you’re doing, how baby’s doing, your health background, all of that. And even if you are planning to have a non-medicated vaginal birth or just using non-medicated comfort measures, it’s really good to know about the medicated options because they’re there if you happen to need them, then you’ll have the information.
Okay. So the first one that I wanted to talk about is therapeutic rest. And this is something that might be offered when the laboring person is exhausted physically and mentally, and really needs some sleep. So therapeutic rest usually consists of taking some type of pain medication or a sedative or a combination of the two, for example, in my neck of the woods, they offer morphine with Promethazine, also known as Phenergan. And so the morphine helps with the pain and the promethazine helps with nausea and vomiting, but it’s also a little bit of a sedative. It makes you sleepy. So those two things together can help people sleep in between contractions or even sleep through them. One of the benefits of therapeutic rest is that usually they give it to you and you don’t have to stay at the hospital. Although in some protocols, some cases you may have to, but the idea is to give you something that will offer some relief, let you sleep and not have to admit you. Or if you are admitted, once that wears off, you can go home. In terms of the timing for therapeutic rest. We’re talking when you’re having prodromal labor, before labor starts, or in early labor before things get intense, because usually whatever they give you tends to have a long lasting effect. So for example, morphine works about six hours. So the idea is to get you some good, solid rest.
Okay. So let’s now talk about the TENS units and TENS stands for transcutaneous electrical nerve stimulation. If you’ve been to a chiropractor or have had some PT, you’ve probably had these pads put on your back that send electrical stimuli to your nerves to help them contract and relax. That’s the TENS unit. And if you’ve watched the outrageous videos of men supposedly experiencing what labor pains feel like. Yeah, in that case, they’re also using TENS units, but definitely not in the way they were intended. In terms of when to use the TENS unit, it seems that earlier is best because that way you can get into the rhythm of how it works and controlling the intensity. And also in terms of how a TENS unit works and how it helps with pain is that these electrical impulses can change how your body perceives the pain and kind of tricks your brain to focus on that instead of the sensations. Or it might even if it’s at a really intense level, if you put the TENS unit really high, it could even help you produce the feel good hormones of labor, the endorphins, to help mitigate that pain sensation. And even though TENS units are not widely available in hospitals, the reason I included it in this list of medicated options is because you need to have somebody with expertise to help you know where to place them. So usually it’s a good idea to practice with the TENS unit ahead of time, and also go to a chiropractor or a PT or ask your midwife of the placement of the pads. So that then when labor comes, you are set to do it. Another great thing about TENS unit is that you can use it for basically as long as you want, as long as it’s still helping you through the contractions. And if it stops working or you’re sick of it, you can set it aside and then come back to it later if you wanted to.
So moving on, let’s talk about nitrous oxide also known as laughing gas. And the thing about nitrous is that it can be used at any stage of labor, including pushing, or even after you’ve given birth to your baby. If for example, you need manual extraction of the placenta or have a really deep repair. Although at that point, having your baby to focus on may give you just as much or more satisfaction. Nitrous starts working really quickly and can be used repeatedly, but it also leaves your body really quickly. And because of the system of how it works, it’s very labor intensive. You have to tune in to when a contraction is coming and before it arrives, put the mask on your face and then keep it on your face until after you exhale the gas back into the mask for safety of everybody around you, and then take it off your face and then repeat that process for every single contraction. So even though you can use it the whole time, you might get sick of doing that. And so it seems to help more as an option when you’re in active labor, if you do have access, it starts working pretty much right away, and you can use it at any point during labor.
So then let’s talk about narcotics and these are different type of opioids or opioid like medications that take the edge off the pain and make you drowsy enough to sleep between contractions or care less when they happen. They do make you feel out of it. So some people like them and others really hate that feeling. Some of the most common ones used for labor are Nubain or Demerol or Stadol. And in terms of when to get a narcotic, you want to avoid it if it seems that you could your baby before the medication wears off. And this is because the medicine does cross the placenta and makes the baby sleepy as well, or it may slow down their breathing and their heart rate. And so you want that medicine to be out of their systems before they’re born, which is usually a couple of hours after getting the narcotic. If a baby is born what providers tend to call floppy, which means they’re a bit less responsive or lethargic, then that might require that they get another medicine to counter the effects of the narcotic. To be honest, that complication is rare. I’ve only seen it once where a baby was born shortly after the birthing person got Nubain. And the baby’s one minute Apgar score was one out of a possible 10, and then the baby was given Narcan and their five minute Apgar was a seven. So that backup plan in case a narcotic is given too close to the time of birth does work.
Okay. So then let’s talk epidurals. The general rule of thumb about epidurals is that it’s never too late to get it. However, if your baby is about to come out, if you are feeling the fetal ejection reflex or a lot of pressure, it might technically be too late because in order to get it, you need to sit still. At that point, you might not be able to sit still. And also it takes about 15 minutes to place that and about 20 for it to take effect. So you need those 35 minutes of time for it to start working. And also because a side effect of epidurals is that your blood pressure may tank. They often want to give you some bags of fluids before they start the epidural. So that might also add some time to the whole process. Now, is it ever too early to get an epidural? The research seems to say that it doesn’t really matter in terms of birth outcomes when you get an epidural, although many practices suggest that you’re in active labor before you get it. However, there is research that shows that the longer you are receiving fluids during labor, so because of a long induction or a long time using an epidural, this will impact your ability to breastfeed. I have a great episode on breastfeedings and epidural that I would suggest you check out with Dianne Cassidy. So even though having an epidural in place for a long time doesn’t seem to matter in terms of birth outcomes, it might impact other things which might be a good reason for you to wait until you’re in active labor to get it if you’re going to get it at all.
So then to close this off, let’s talk about sterile water injections. And this is a pain option generally used for severe back pain. As the name suggests, it’s about doing some injections of sterile water into your skin, usually in four points in your lower back. Now, sterile water injections work almost immediately and they happen extremely quickly, but getting them can be intensely painful, sort of like a severe wasp sting or four of them, if you will. You can get them whenever you want as many times as you want. But my experience is that people only get them once because they are so intense. The biggest obstacle to getting sterile water injections might be finding a provider that will agree to do them or knows how to do them. Or there might be a protocol in your place of birth that says that they don’t do them anymore. I have seen it come and go. So this is a pain option that may or may not be available. It’s best to ask ahead of time so that you know what you can count on.
You can connect with Birthful on Instagram at Birthful Podcast, and to learn more about Birthful and my birth and postpartum preparation classes go to birthful.com. Let’s get you birth and postpartum ready.
Birthful was created by me, Adriana Lozada, and this episode was produced by LWC Studios: Paulina Velasco, Jen Chien and Kojin Tashiro. Thank you for listening to and sharing Birthful. Be sure to follow us on Apple Podcast, Goodpods, Amazon Music, Spotify, and everywhere you listen, and come back for more ways to inform your intuition.
Lozada, Adriana, host. “Birthful: How to Time Your Pain Relief Options.” Birthful, Birthful., January 26, 2021. Birthful.com.
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