Conquering Labor – Pain Management Options at Huntsville Hospital for Women & Children

The journey to welcoming a baby in the world is not one without obstacles. If you’re working on your birth plan, you may be wondering what options are available to you and how each of them work. We’ve caught up with the pros in the Labor & Delivery Unit at Huntsville Hospital for Women & Children to let you know not only all of your pain management options during labor and delivery, but the pros and cons to each.

Each individual has different goals and needs for their pain management while in labor and it’s important to be able to consider all options when choosing what’s best for you.

Unmedicated or ”Natural” Birth

No medications at all.

Patients that would benefit from this method: Patients that have prepared by attending various types of childbirth classes (i.e. Bradley, hypnobirthing, etc.)

Pros of this Method: You can get up and move around when ready; no medication side effects; controlled by you.

Cons of this Method: If you require assistance at delivery (vacuum/forceps) or have a shoulder dystocia, pain management may be difficult.

Nitrous oxide or ”laughing gas”

The nurse rolls in a mobile unit of mixed nitrous and oxygen; you have a mask that you hold over your mouth and nose and begin taking big, deep breaths before a contraction is starting or at least the second you feel it so that it can peak right when the contraction does. It lowers anxiety and “takes the edge off” more than actual pain relief, but can also be used as a pain management option. May get nauseous or dizzy, but will wear off quickly as soon as you finish taking breaths through the mask. More details

Patients that would benefit from this method: Plenty of patients who were looking for an unmedicated delivery where they didn’t want an epidural, but then decide they need a little something; patients who went unmedicated for delivery but need some type of medication for a repair.

Pros of this Method: non-invasive; wears off quickly and does not affect baby

Cons of this Method: does not take pain completely away so will not be a replacement for an epidural; cannot be used by patients with uncorrected B12 deficiency

Nubain

Nubain is an IV push medication that can be given every 2 hours (cannot be given if patient is on methadone or buprenorphine); takes off the peak contraction pain and can help patient rest; cannot be given too close to delivery time as it can make baby sleepy and may not have good respiratory effort at delivery.

Patients that would benefit from this method: Patients that are trying to hold off for a couple hours before they get an epidural. Often labor, particularly augmented labor, and the pain that comes with that, accelerates at a faster rate than this medication can be readministered, and we often find that patients find repeat doses less effective.

Pros of this Method: Can help you rest, is given via IV that most patients already have in place anyway, wears off in a couple hours.

Cons of this Method: It will not take pain completely away and typically one dose/repeat doses will not sustain patient for entirety of labor.

Epidural

This is perhaps the most known pain management option. An anesthesiologist numbs your back then uses a needle to get a small tube (the size of fishing line-very small!) into your spinal column where a combination of medications keeps you numb from the bottom of your ribs down; lasts as long as the epidural pump is running. You will likely need a urinary catheter of some sort after as most patients cannot void independently.

Patients that would benefit from this method: Patients who are seeking COMPLETE pain relief; patients with normal platelets and white blood cell count; patients that can sit still for procedure.

Pros of this Method: Offers the most complete option of pain relief compared to previous options; can help patient rest.

Cons of this Method: Must have IV in place, get a fluid bolus, wait for lab results to come back, and have consent forms signed….cannot get it without these happening FIRST. Does have more potential for side effects (will sign a consent form reviewing these); have to wait an hour or two after delivery to start trying to walk around again.

Spinal anesthesia

Anesthesiologist numbs your back then uses a small needle to administer a combination of medications into your spinal column. Offers very heavy pain block from bottom of ribs down.

Patients that would benefit from this method: Used during a controlled c-section only, where patient’s lab work is appropriate (per anesthesia) and patient can sit still for procedure.

Pros of this Method: Can be numb at area of c-section and still awake to meet baby.

Cons of this Method: Cannot be offered during labor or in an emergency c-section; takes a couple of hours for leg mobility to return, but may be up to 6 hours before you are up walking; many become nauseous when they first lay back after it’s in.

General anesthesia

A combination of gases that are inhaled in an operating suite so that patient “sleeps” during procedure. A tube must be inserted in your mouth/airway to help you breathe.

Patients that would benefit from this method: Patients undergoing birth or another obstetrical procedure where an epidural or spinal would not be appropriate. Often used during emergencies. Patients who do NOT have a history of malignant hyperthermia.

Pros of this Method: Complete pain relief during procedure

Cons of this Method:  While we can offer IV pain medications in many cases, expect to have pain as soon as you “wake up.” May be able to meet baby in recovery room, but will not be awake at baby’s delivery. Often, throat is sore after.

Peanut balls

A peanut shaped exercise ball that can be used in different ways during various parts of labor to achieve labor progression. This is a great non-invasive pain management option.

Patients that would benefit from this method:  Both epiduralized and non-epiduralized patients can use to help facilitate optimal positions to keep labor moving.

Pros of this Method: Non-invasive

Cons of this Method: Can’t think of any! Just might look a little awkward.

Labor balls

A large, round exercise ball that can be free-moving or placed on a stabilizing disc; allows laborer to rotate hips and change positions to optimize fetal descent and labor progression.

Patients that would benefit from this method: non-epiduralized patients that are not hindered by other medications that put them at a risk for falling

Pros of this Method: Non-invasive; allows laborer to keep moving

Cons of this Method: Could roll out from under you if you’re not careful, so have someone help stabilize when standing up and sitting down

Birthing bar

A bar that attaches to a part of our labor beds and allows patient to get into other positions.

Patients that would benefit from this method:  Primarily non-epiduralized patients that are trying to hang or lean in different ways during contractions; can be used with

patients to different leverage in certain pushing positions.

Pros of this Method: Non-invasive; might give the birthing partner’s back a break if laborer is one who likes to lean and hang on something during a contraction.

Cons of this Method: Can’t think of any!

Non-pharmacological pain management methods to reduce discomfort and swelling after delivery

Invalid ring to sit on to take pressure off of perineum due to swelling, stitches or tear.

Ice packs to perineum for first 24 hours to reduce swelling and pain.

Sitz Bath after 24 hour to reduce swelling and pain in perineum.

Heating pads to abdomen or back to help with cramps or back ache.

Pharmacological Methods to reduce pain after delivery

Narcotic pain meds by mouth as ordered by the OB for both Vaginal Delivery and C/section. Takes the edge off of the pain so you can relax and heal. Patient is able to request pain meds when needed or becoming uncomfortable. Prescription given to patient at discharge. Mom is able to breastfeed if desired.

Non-narcotic pain med by mouth as ordered by the OB for vaginal Delivery and post-operative C/Section pain. Takes the edge off of the pain and helps with abdominal cramping and pain. Many women prefer this to a narcotic because there are no drowsy side effects.

Dermaplast cream to stitches for perineum pain as needed.

Anusolfor can help with hemorrhoid pain as needed.

PCA pump or IV pain meds after C/Section to reduced post-operative pain. PCA has a hand control and the mom can push the button when pain medication needed. There are controls on this so mom can only get the required dose and mom is placed on an O2 sat monitor when on a PCA. IV pain meds can be ordered too for post-operative pain. It is up to the OB and anesthesia to determine pain medications after a c/Section. Moms control the PCA pump medications and has to ask for the IV pain meds when they are needed.  Moms can breastfeed with both medications.

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