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Labor and Delivery: Pain control options introduction
Women respond differently to the pain of labor and delivery. Pain control options during labor and delivery are a personal choice, and a birth plan can typically be individualized according to a woman's wishes, but the circumstances of labor and individual medical conditions can sometimes determine what pain relief options are indicated. Available medical pain control options range from pain control medications to nerve blocks and anesthesia. It is helpful to discuss your preferences with your health care professional in advance so that your questions can be fully answered and your wishes can be expressed. Of course, during your labor, your health care professional will assess your progress and determine how you are feeling. It's fine to change your mind about pain relief options even during labor. Consequently, understanding the various options for pain control will help you make an informed decision.
This article describes the most commonly used medical pain relief interventions used for labor and delivery. All of these options have been shown to be safe for both mother and baby.
Regional anesthesia: Spinal and epidural blocks
Spinal and epidural anesthesia are popular choices for pain control because they do not affect your ability to push during labor. In both of these procedures, medications are injected near the nerves of the low back to block pain signals from your lower body, even though you remain awake and labor is usually not significantly slowed. An anesthesiologist typically administers this type of anesthesia. A spinal block involves injection of the medication right around the spinal nerves, while in an epidural block the medicine is injected into the sac that surrounds the spinal cord. Before the medications are injected, a numbing medication is given in the low back. Both these options can also be used for a Cesarean delivery.
Because many women are not able to urinate and others are affected by anesthesia, you may require a urinary catheter with spinal or epidural anesthesia. An uncommon complication is experiencing a headache after the anesthesia wears off. Both types of anesthesia may reduce your blood pressure somewhat, although this is more common with a spinal block.
A spinal block requires less medication and is typically given one time, while a catheter may be inserted into the epidural space for repeated delivery of anesthetic medications.
An epidural block takes about 10 to 20 minutes to work, and because a catheter is inserted into the epidural space, the effects can last as long as needed due to the ability to inject more medication. A spinal block begins working immediately, but its effects last only about 2 ½ hours. It is possible to have a combination of spinal and epidural anesthesia.
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Local injections of a numbing medication may be used to relieve a small area of pain, typically around the vagina, if you require an episiotomy to extend the vaginal opening or if stitches are needed to repair any damage. This type of anesthesia cannot be used to relieve the pain from contractions during labor.
A pudendal block is another type of local anesthesia. It involves injecting a numbing medication into the vaginal wall shortly before delivery to block pain signals from the vagina and area around the vaginal opening. It usually works within 10 minutes and lasts for up to an hour.
Narcotics, or opioids, are drugs that decrease our perception of pain. They may be given intravenously or as an intramuscular injection during labor. They may lead to nausea or sleepiness, and they do not completely eliminate pain. Although narcotics have been shown to be safe in labor, they may cause a temporary depression in breathing for both mother and baby.
Nitrous oxide is an odorless, tasteless, inhaled gas that is given using a hand-held face mask. It is not generally used in labor in the US but is sometimes used in the United Kingdom and Canada. It has little effect on the baby. Nitrous oxide does not eliminate pain but changes the way the pain is perceived.
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Pain Relief Options for Childbirth - Side Effects
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Top Pregnancy: Pain Relief Options for Birth Related Articles
EpisiotomyEpisiotomy is a procedure in which an incision is made between the vagina and anus, in the aid in the delivery of a baby. Complications of episiotomy include bleeding, swelling, local pain, infection, defects in the would closure, and possibly short-term sexual dysfunction.
Labor and DeliveryLabor signs can be very distinct for pregnant women. It is not possible to know what causes labor to start or when exactly it will start, but changes that indicate the beginning of labor include:
- passing of the mucus plug,
- breaking the bag of water, and
- effacement and dilation of the cervix.
Signs and symptoms of pregnancy vary by stage (trimester). The earliest pregnancy symptom is typically a missed period, but others include
breast swelling and tenderness,
- nausea and sometimes vomiting,
- fatigue, and
Second trimester symptoms include
- weight gain,
- itching, and
- possible stretch marks.
Third trimester symptoms are
- additional weight gain,
- swelling of the ankles,
- fingers, and face,
- breast tenderness, and
- trouble sleeping.
Eating a healthy diet, getting a moderate amount of exercise, also are recommended for a healthy pregnancy. Information about the week by week growth of your baby in the womb are provided.
Pregnancy Drug DangersTaking prescription medications or over-the-counter drugs or supplements should be discussed with your doctor. There are some medications that have been found to cause no problems in pregnancy, however, medications such as Accutane for acne, should never be taken during pregnancy.
Pregnancy Induced HypertensionPreeclampsia is related to increased blood pressure and protein in the mother's urine. Preeclampsia typically begins after the 20th week of pregnancy. When preeclampsia causes seizures, it is termed "eclampsia" and is the second leading cause of maternal death of in the US. Preeclampsia is the leading cause of fetal complications. Risk factors for preeclampsia include high blood pressure, obesity, multiple births, and women with preexisting medical conditions such as diabetes, kidney disease, rheumatoid arthritis, lupus, or scleroderma. Pregnancy planning and lifestyle changes may reduce the risk of preeclampsia during pregnancy.
Pregnancy Planning (Preparing for Pregnancy)
Pregnancy planning is an important step in preparation for starting or expanding a family. Planning for a pregnancy includes:
- Taking prenatal vitamins
- Eating healthy for you and your baby
- Disease prevention (for both parents and baby) to prevent birth defects and infections
- Avoiding certain medications that may be harmful to your baby
- How much weight gain is healthy
- Exercise safety and pregnancy
- Travel during pregnancy
Pregnancy: Birthing and Parenting ClassesPreparing for a baby is an important step in parents' lives. Choosing the right birthing class and method (Lamaze, Bradley, etc.) is important for the mother, baby, and father or support giver. Parenting classes are also information for first time parents. Information is provided about diapering, feeding, and bathing your baby as well as the different stages of child development.
Quad Marker Screen TestThe quad marker screen determines if a woman is at higher or lower risk of carrying a baby with a birth defect. This test may only be administered between 15 and 20 weeks of pregnancy. A quad marker screen tests for the presence of:
- unconjugated estriol,
- human chorionic gonadotropin, and
Stages of PregnancySee pictures on the various stages of pregnancy. See and learn what changes a woman's body goes through and view fetal images of how her baby grows during the 1st, 2nd and 3rd trimesters.
Third Trimester Tests During PregnancyTesting is often recommended during the third trimester of pregnancy. These tests are designed to ensure the health and safety of both the child and mother. Common tests during the third trimester of a woman's pregnancy include:
- group B streptococcus screening,
- electronic fetal heart monitoring,
- nonstress test,
- contraction stress test, and
- a biophysical profile.
Women's HealthWomen's health is an important topic area to guide a woman through the stages of her life, as well as knowing the conditions and diseases that may occur. Educating yourself so that the transitions into different phases of life is key to a healthy, happy, and productive life.