Tue Jun 17, 2003

If you're like most women, the pain of labor and delivery is one of the things that worries you about having a baby. This is understandable, because for most women, labor is painful.

Even though it is possible to have labor with relatively little pain, your best bet is to be prepared. Take time now to prepare yourself for the idea of pain during labor and delivery and to plan some strategies for coping with it. Alleviating your anxiety about pain is one of the best ways to ensure that you'll be able to deal with it when the time comes.

Pain During Labor and Delivery
Pain during labor is caused primarily by uterine muscle contractions and somewhat by pressure on the cervix. This pain manifests itself as cramping in the abdomen, groin and back, as well as a tired, achy feeling all over. Some women experience pain in their sides or thighs as well.

Other causes of pain during labor include pressure on the bladder and bowels by the baby's head and the stretching of the birth canal and vagina.

Although labor is often thought of as one of the more painful events in human experience, it ranges widely from woman to woman and even from pregnancy to pregnancy. Women experience labor pain differently - for some, it resembles menstrual cramps; for others, severe pressure; and for others, extremely strong waves that feel like diarrheal cramps. In addition, first-time mothers are more likely to give their pain a higher rating than women who've had babies before.

The intensity of labor pain isn't always the determining factor that drives women to seek pain management - often it's the repetitive nature and length of time the pain persists with each contraction.

Preparing for Pain
There are a variety of ways to reduce pain during labor. Some of them are things you can start doing before or during your pregnancy.

Regular and reasonable exercise (unless your health care provider recommends against it) can help strengthen your muscles and prepare your body for the stress of labor. Exercise can also increase your endurance, which will come in handy if you have a long labor. The important thing to remember with any exercise is not to overdo it - and this is especially true if you're pregnant. Talk to your health care provider about what he or she considers to be a safe regimen, given your pre-pregnancy fitness level and the history of your pregnancy.

If you and your partner attend childbirth classes, you'll learn different techniques for handling pain, from visualization to stretches designed to strengthen the muscles that support your uterus. The two most common childbirth philosophies in the United States are the Lamaze technique and the Bradley method.

The Lamaze technique is the most widely used method in the United States. The Lamaze philosophy teaches that birth is a normal, natural, and healthy process and that women should be empowered to approach it with confidence. Lamaze classes educate women about the ways they can decrease their perception of pain, such as through relaxation techniques, breathing exercises, distraction, or massage by a supportive coach. Lamaze approach takes a neutral position toward pain medication, encouraging women to make an informed decision about whether it is right for them.

The Bradley method (also called "Husband-Coached Birth") emphasizes a natural approach to birth and the active participation of the baby's father as birth coach. A major goal of this method is the avoidance of medications unless absolutely necessary. Bradley also focuses on good nutrition and exercise during pregnancy, and relaxation and deep-breathing techniques as a method of coping with labor. Although Bradley advocates a medication-free birth experience, the classes do prepare parents for unexpected complications or situations, like emergency cesarean sections.

Some other ways you can handle pain during labor include:
• Hypnosis
• Meditation
• Distracting yourself by counting or performing an activity that keeps your mind otherwise occupied
• Yoga
• Walking
• Massage or counter-pressure
• Changing position
• Taking a bath or shower

Pain Medications
There are a variety of pain medications that could potentially be used during labor and delivery, depending on the situation. Talk to your health care provider about the risks and benefits of each one.

Analgesics. Pain medications, including the commonly prescribed drug meperidine, can be given intravenously or through a shot that's re-administered as needed. These medicines don't usually slow down labor or interfere with contractions, but can cause side effects in the mother, including drowsiness and nausea. Analgesics may be administered well into labor but several hours before the expected birth.

According to Nancy Fan, MD, an obstetrician/gynecologist, pain medications administered intravenously do not usually pose a problem. But, she cautions, "If pain medications are given intravenously, the baby's going to get those medications." The effect on the baby depends on how much and how close to delivery the drug is given to the mother - some babies show signs of sleepiness immediately after birth. And some women find that the drowsiness and nausea they experience with analgesics makes them less able to deal with the contractions. Talk to your health care provider about the risks and benefits of taking analgesics.

Tranquilizers. These drugs don't relieve pain, but they may help to calm and relax seriously anxious women. Sometimes they are used in conjunction with analgesics. They may be given to women once labor has already started, but may be used earlier in labor for extremely nervous mothers. Again, women's reactions to these drugs vary - some feel a loss of control that is unnerving, whereas others do not. The risks to mother and baby are usually minimal, but again, you should discuss them first with your health care provider.

Regional anesthesia. This is what most women think of when they consider pain medication during labor. Nerve blocks deaden the sensation in specific regions of the body and are used in both vaginal and cesarean section deliveries.