What to expect when you're expecting (120 page)

The needle is removed, leaving a fine, flexible catheter tube in place. The
tube is taped to your back so you can move from side to side. Three to five minutes following the initial dose, the nerves of the uterus begin to numb. Usually after 10 minutes, you’ll begin to feel the full effect (hopefully, sweet relief). The medication numbs the nerves in the entire lower part of the body, making it hard to feel any contractions at all (and that’s the point).

Your blood pressure will be checked frequently to make sure it’s not dropping too low. IV fluids and lying on your side will help counteract a drop in blood pressure.

Because an epidural is sometimes associated with slowing of the fetal heartbeat, continuous fetal monitoring is usually required as well. Though such fetal monitoring limits your movements somewhat, it allows your practitioner to monitor the baby’s heartbeat and allows you to “see” the frequency and intensity of your contractions (because, ideally, you won’t be feeling them).

Happily, there are few side effects with an epidural, though some women might experience numbness on one side of the body only (as opposed to complete pain relief). Epidurals also might not offer complete pain control if you’re experiencing back labor (when the fetus is in a posterior position, with its head pressing against your back).

Combined spinal epidural (aka “walking epidural”).
The combined spinal epidural delivers the same amount of pain relief as a traditional epidural does, but it uses a smaller amount of medication to reach that goal. Not all anesthesiologists or hospitals offer this type of epidural (ask your practitioner if it’ll be available to you). The anesthesiologist will start you off with a shot of analgesic directly into the spinal fluid to help relieve some pain, but because the medication is delivered only in the spinal fluid, you’ll still feel and be able to use the muscles in your legs (which is why it’s called a walking epidural). When you feel you need more pain relief, more medication is placed into the epidural space (through a catheter that was inserted at the same time the spinal medication was administered). Though you’ll be able to move your legs, they’ll probably feel weak, so it’ll be unlikely you’ll actually want to walk around.

Pushing Without the Pain

Does pushing have to be a pain? Not always. In fact, many women find they can push very effectively with an epidural, relying on their coach or a nurse to tell them when a contraction is coming on so they can get busy pushing. But if pain-free pushing isn’t getting you (or your baby) anywhere—with the lack of sensation hampering your efforts—the epidural can be stopped so you can feel the contractions. The medication can then be easily restarted after delivery to numb the repair of a tear.

Spinal block (for cesarean delivery) or saddle block (for instrument-assisted vaginal delivery).
These regional blocks, which are rarely used these days, are generally administered in a single dose just prior to delivery (in other words, if you didn’t have an epidural during labor but want pain relief for the delivery, you’ll get the fast-acting spinal block). Like the epidural, these blocks are administered with you sitting up or lying on your side while an anesthetic is injected into the fluid surrounding the spinal cord.
The side effects of spinal and saddle blocks are the same as for an epidural (a possible drop in blood pressure).

Pudendal block.
Occasionally used to relieve early second-stage pain, a pudendal block is usually reserved for the vaginal delivery itself. Administered through a needle inserted into the vaginal area, the medication reduces pain in the region but not uterine discomfort. It’s useful when forceps or vacuum extraction is used, and its effect can last through episiotomy (if needed) and repair of an episiotomy or tear.

General anesthesia.
General anesthesia is rarely used for deliveries these days and only used in specific cases for emergency surgical births. An anesthesiologist in an operating/delivery room injects drugs into your IV that put you to sleep. You’ll be awake during the preparations and unconscious for however long it takes to complete the delivery (usually a matter of minutes). When you come to, you may be groggy, disoriented, and restless. You may also have a cough and sore throat (due to the tube that’s routinely inserted through the mouth into the throat) and experience nausea and vomiting.

The major downside to general anesthesia (besides the fact that mom has to miss the birth) is that it sedates the baby along with the mother. The medical team will minimize those sedative effects by administering the anesthesia as close to the actual birth as possible. That way the baby can be delivered before the anesthetic has reached him or her in amounts large enough to have an effect. The doctor might also tilt you to your side or give you oxygen to get more oxygen to the baby, minimizing the drug’s temporary effect.

Demerol.
Demerol is one of the most frequently used obstetrical analgesics. This shot (sometimes given in the buttocks) or IV-administered drug is used to dull the pain and relax the mother so she is better able to cope with contractions. It can be repeated every two to four hours, as needed. But not all women like the drowsy feeling Demerol imparts, and some find they are actually less able to cope with labor pains while under the effects of Demerol.

There may be some side effects (depending on a woman’s sensitivity), including nausea, vomiting, and a drop in blood pressure. The effect Demerol will have on the newborn depends on the total dose and how close to delivery it has been administered. If it has been given too close to delivery, the baby may be sleepy and unable to suck; less frequently, respiration may be depressed and supplemental oxygen may be required. Any effects on the newborn are generally short-term and, if necessary, can be treated.

Demerol is not generally administered until labor is well established and false labor has been ruled out, but no later than two to three hours before delivery is expected.

Tranquilizers.
These drugs (such as Phenergan and Vistaril) are used to calm and relax an extremely anxious mom-to-be so that she can participate more fully in childbirth. Tranquilizers can also enhance the effectiveness of analgesics such as Demerol. Like analgesics, tranquilizers are usually administered once labor is well established, and well before delivery. But they are occasionally used in early labor if a mother’s anxiety is slowing down the progress of her labor. Reactions to the effects of tranquilizers vary. Some women welcome the gentle drowsiness; others find it interferes with their control and with their memory of this memorable experience. Dosage definitely makes a difference. A small
dose may serve to relieve anxiety without impairing alertness. A larger dose may cause slurring of speech and dozing between contraction peaks, making it difficult to use prepared childbirth techniques. Though the risks to a fetus or newborn from tranquilizers are minimal, most practitioners prefer to stay away from tranquilizers unless they’re really necessary. If you think you might be extremely anxious during labor, you may want to try learning about some nondrug relaxation techniques now (such as meditation, massage, hypnosis; see below), so you won’t end up needing this kind of medication.

Not every woman wants traditional pain medication, but most still want their labor to be as comfortable as possible. And that’s where complementary and alternative medicine (CAM) therapies can come in. These days, it’s not just CAM practitioners who are touting the benefits of these techniques. More and more traditional physicians are hopping on board the CAM bandwagon, too. Many recommend CAM techniques to their patients—either as an alternative to pain medication or as a relaxing supplement to it. Even if you’re sure there’s an epidural with your name on it waiting at the hospital, you may want to explore the world of CAM, too. (And to explore it well before your due date, since many of the techniques take practice—or even classes—to perfect, and most take plenty of planning.) But remember to seek out CAM practitioners who are licensed and certified, not to mention ones who have plenty of experience with pregnancy, labor, and delivery.

Just Breathe

Hoping to skip the meds but can’t—or don’t want to—CAM? Lamaze (or other kinds of natural childbirth techniques) can be very effective in managing the pain of contractions. See
page 279
for more.

Acupuncture and acupressure.
Scientific studies now back up what the Chinese have known for thousands of years: Acupuncture and acupressure are effective forms of pain relief. Researchers have found that acupuncture, through the use of needles inserted in specific locations, triggers the release of several brain chemicals, including endorphins, which block pain signals, relieving labor pain (and maybe even helping boost labor progress). Acupressure works on the same principle as acupuncture, except that instead of poking you with needles, your practitioner will use finger pressure to stimulate the points. Acupressure on the center of the ball of the foot is said to help back labor. If you’re planning to use either during labor, let your prenatal practitioner know that your CAM practitioner will be with you through labor.

Reflexology.
Reflexologists believe that the internal organs can be accessed through points on the feet. By massaging the feet during childbirth, a reflexologist can relax the uterus and stimulate the pituitary gland, apparently reducing the pain of childbirth and even shortening the duration of labor. Some of the pressure points are so powerful that you should avoid stimulating them unless you
are
in labor.

Physical therapy.
From massage and hot compresses to ice packs and intense
counterpressure on your sore spots, physical therapy during labor can ease a lot of the pain you’re feeling. Massage at the hands of a caring coach or doula or a skilled health professional can bring relaxing relief and can help diminish pain.

Hydrotherapy.
There’s nothing like a warm bath—especially one with jets kneading your sore spots and particularly if you’re in labor. Settle into a jetted tub (or merely a soaking tub) for a session of hydrotherapy during your labor to reduce pain and relax you. Many hospitals and birthing centers now provide such tubs to labor—or even deliver—in.

Hypnobirthing.
Though hypnosis won’t mask your pain, numb your nerves, or quell contractions, it can get you so deeply relaxed (some women describe it as becoming like a floppy rag doll) that you are totally unaware of any discomfort. Hypnosis doesn’t work for everyone; you have to be highly suggestible (some clues are having a long attention span, a rich imagination, and if you enjoy—or don’t mind—being alone). Still, more and more women these days are seeking the help of a medically certified hypnotherapist (you’ll want to shy away from someone without such credentials) to train them to get through labor by self-hypnosis; sometimes, you can have a hypnotherapist with you during the process. It’s not something you can just start when that first contraction hits; you’ll have to practice quite a bit during pregnancy to be able to achieve total relaxation, even with a certified therapist at your side (and while you’re practicing, you can use hypnosis to get relief from pregnancy aches, pains, and stress, too). One big benefit of hypnobirthing is that while you’re completely relaxed, you’re also completely awake and aware of every moment of your baby’s birth. There are also no physical effects on the baby (or on you).