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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. 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
Epidural anesthesia is a popular choice for pain control because it does not affect your ability to push during labor. With this procedure, 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. With 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 into the lower back. An epidural block can be used for a Cesarean delivery.
With a spinal block, both contractions and the ability to push are temporarily abolished. With a spinal block, the anesthetic is injected into the subarachnoid space surrounding the spinal cord. A spinal block is usually used when a Cesarean section or an instrumented delivery (e.g. forceps or vacuum extraction) is planned. A spinal usually provides better pain relief than an epidural and may take several hours to wear off, at which time sensory and motor function of the tissues/muscles controlled by the previously blocked nerves will return.
Because many women are not able to urinate immediately following regional anesthesia, a catheter may need to be inserted into the bladder until the spinal or epidural block wears off. A relatively uncommon complication is a headache which begins after the anesthesia wears off. Both types of anesthesia may temporarily reduce blood pressure, although this is more commonly seen with a spinal block.
A spinal block requires less medication and is typically given only one time, while, with an epidural block, a catheter may be inserted into the epidural space for repeated delivery of anesthetic medications as necessary.
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 both spinal and epidural anesthesia.
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 wall of the vagina 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. It does not relieve the pain of labor and is only used at the time of delivery.
Narcotics, or opioids, are drugs that diminish the perception of pain. They may be given intravenously or as an intramuscular injection during labor. They can cause 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 of respiration in 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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Top Pregnancy: Pain Relief Options for Birth Related Articles
Braxton Hicks Contractions
Braxton hicks contractions are also known as false labor pains. Though these irregular uterine contractions may occur in the second trimester, they're more likely to occur during the third trimester of pregnancy. Unlike true labor pains, false labor pains are often irregular, may stop when you walk, rest, or change positions, and the contractions do not get closer together or stronger.
Braxton Hicks vs. True Labor Contractions
Many pregnant women often mistake Braxton Hicks contractions (false labor) for real labor contractions, especially if is your first pregnancy. Braxton Hicks contractions occur in third trimester of pregnancy, however, sometimes can occur in the second trimester. True labor contractions begin around your due date (unless your baby is preterm, in which you will be in preterm labor). So how can you tell the difference? Here are a few similarities and differences between Braxton Hicks contractions and True or real labor contractions.
Braxton Hicks contractions
Braxton Hicks contractions tend to become more frequent toward the end of pregnancy, and are not as painful as real labor contractions; do not occur in regular intervals; do not become longer over time; and may disappear for a period of time and then return.
Frequently one of the early symptoms and signs of true labor is when the contractions begin to occur less than 10 minutes apart.
Real labor contractions occur at regular intervals that become progressively shorter; more painful as labor progresses; are described as a tightening, pounding, or stabbing pain; may feel similar to menstrual cramps; and sometimes Braxton Hicks contractions can be triggered by dehydration, sexual intercourse, increased activity of the mother or baby, touching of the pregnant woman's abdomen, or a distended bladder.
Natural and home remedies to soothe and provide comfort for Braxton Hicks contractions include relaxation exercises like deep breathing or mental relaxation; change positions or take a walk if you have been active and rest; drink a glass of herbal tea or water; eat; or soak in a warm bath for 30 minutes (or less).
Preterm labor signs and symptomsWhen you have reached 37 weeks, and the contractions are more painful and are increasing in frequency you will have abdominal pain or menstrual-like cramping, an increase in pelvic pressure or back pain, and the contractions are more than four contractions an hour.
C-Section (Cesarean Birth)C-section (cesarean birth) is surgery to deliver a baby. C-section options, what to expect before, during, and after the delivery of your baby are important considerations for birth. Reasons for a C-section delivery include multiple births, health problems, problems with the pelvis, placenta, or umbilical cord. Vaginal birth after a C-section (VBAC) is also an important issue to discuss with your doctor if you have had prior C-section deliveries.
Early Signs and Symptoms of LaborEvery woman's experience with labor and delivery is unique for each woman, and thus "Normal" labor varies from woman to woman. Some of the common signs and symptoms of normal labor include the "baby dropping," increase urination, back pain, contractions, and diarrhea.
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 Delivery
Early and later symptoms and signs of labor and delivery are unique to each woman. Early signs of labor are "lightening” and passing the mucous plug.
Later symptoms and signs that labor that labor is are the woman’s water breaking, and when contractions begin.
There are three stages of labor, stage 1 is the longest and occurs when the cervix begins to thin and dilate. During stage 2 of labor the baby passes through the birth canal and remains there until delivery, and stage 3, is when the baby is delivered.
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 bloating.
Second trimester symptoms include backache, weight gain, itching, and possible stretch marks.
Third trimester symptoms are additional weight gain, heartburn, hemorrhoids, 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 Symptoms Am I Pregnant
Pregnancy symptoms can vary from woman to woman, and not all women experience the same symptoms. When women do experience pregnancy symptoms they may include symptoms include missed menstrual period, mood changes, headaches, lower back pain, fatigue, nausea, breast tenderness, and heartburn. Signs and symptoms in late pregnancy include leg swelling and shortness of breath. Options for relief of pregnancy symptoms include exercise, diet, and other lifestyle changes.
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.