Pain Management

Narcotics
The most popular narcotics available for labor and delivery include Demerol and Stadol. The narcotics do not take away the pain completely, but can help dull it for as long as the shot is effective. The shots go in through your IV and must be given in small doses because they can enter the blood stream, and get to your baby through the placenta. One of these shots normally provides relief for 30 minutes to 3 hours. Some women love using these narcotics, while others have complained about them making them feel loopy or sick. There is normally no way to know how it will affect you until you take it. The good thing is since the narcotic does not last a long time, the effects will wear off quickly as well.

Spinal Block/Epidural
The spinal block and epidural are both administered by an anesthesiologist and go into your spinal column through a needle in your back. The pain relief from both of these is normally immediate and can last a while. However, most of the time a woman can no longer move or walk around after being given one of these, so they are restricted to bed and given a catheter to empty their bladder.

With the epidural a woman may still be able to feel the contractions, however she should not feel pain. In some instances though, depending on the dose of epidural given, a woman is unable to feel contractions at all, and find that it is difficult to be able to push their baby out. Many times the doctor will have to turn off the flow of medicine being given to the woman via the epidural line when it comes time to push, in order to get the baby to move down properly. If a woman is going to have a c-section she will be given either a spinal block or an epidural, vs. a narcotic pain relief medication

General Anesthesia
This form of pain relief is rarely used, only generally in case of emergency, or if the baby has to be delivered in a hurry via c-section and there is not time to put in an epidural or spinal block. When a woman is given general anesthesia the mood is generally hurried as the doctors try to get the baby out quickly. The problem with general anesthesia, and the reason they do not use it more often is that the drug can easily get into the babies lungs and affect his ability to breathe, or make him too sleepy to respond properly at birth. The mother also misses witnessing the birth of her baby when she is given this type of pain relief.

There are many choices for pain relief when you go to deliver your baby. Make sure you research all ahead of time and know your options so when the big day comes you are able to make the best choice available for you and your unborn child.

 

If you're like me when I was pregnant, you are probably being bombarded with information. Between reading and getting so much advice about everything from what to feed your baby to which diaper cream to use, you might find that you have more questions than answers. You are also probably wondering about what to expect on the BIG day.

One subject that can generate a lot of opinions is episiotomies. Do you need one? Do you even want one? First of all, let's define the word: An episiotomy is a cut made by a physician in the lower opening of the mother's vagina during delivery in the attempt to ease the passage of the baby through the vagina. Most episiotomy cuts are done straight down into the perineum, the area between the vagina and the anus.

OK, now that you know what it is, I bet you are wondering why doctors perform the episiotomy procedure. Traditionally, episiotomies were done by doctors when forcep delivery was a common practice. A cut enabled the doctor's forceps to fit into the vagina in order to remove the baby.

According to a Centers for Disease Control's 2001 study, forcep deliveries have decreased from a rate of 17.6 percent of all deliveries in 1980 to only four percent of all deliveries in the year 2000. Episiotomy rates, however, have not followed this same trend. Episiotomies have dropped to 32.7 percent of all deliveries versus 64 percent in 1988.

So, I bet you are wondering why doctors would still perform an episiotomy given that forcep deliveries are now done so infrequently.

Most of the reasons for the persistence of this procedure are based on incorrect information. Some doctors believe that an episiotomy will protect the pelvic floor against damage. A 2005 study published in the Journal of the American Medical Association, as well as other recent studies, proves this to be an incorrect assumption. These findings also show no evidence that a cut in the perineum "protects" the pelvic floor muscle.

Another frequently cited reason for doing an episiotomy is the belief that a natural tear repairs more slowly than a doctor-performed cut. This is untrue. A natural tear will actually heal much better than an episiotomy. Tearing is much safer than a cut; and while many people think that an episiotomy is easier to repair than a tear, this is not true, according to a 1987 study by J.M. Thorp and other doctors writing for the publication Obstet Gynecol.

Here's another reason against cutting the skin to allow the baby's head to pass during birth: Think of your skin as a cotton sheet. If you use scissors to create a physical cut, the fabric will rip and tear more easily. The last thing you want, therefore, is for a doctor's cut to your vaginal area to continue to tear with the stress and strain created by the force of a baby being born, thus potentially injuring you or damaging your perineum. Use this analogy to think about how your skin tears, and you may decide that you don't want or need an episiotomy. Always discuss this topic in depth with your caregiver.

As is always the case with many invasive procedures, episiotomies bring several risks to the mother. Infection, bleeding, hematoma, and post-partum pain are merely a few of the risks. Another interesting fact is that some studies have also shown that women who tear naturally during childbirth return sooner to sexual intercourse after giving birth than women who are “cut” by their physicians. (This finding was reported by P.G. Larsson and other doctors in a 1991 edition of Gynecol Obstet.)

Now that you know that routine episiotomies are not always necessary, there are some very rare cases where an episiotomy is necessary. Discuss these reasons with your caregiver so that you are prepared and educated in advance of your baby's birth.

Do you want to know how to avoid an episiotomy? You can prevent the need for an episiotomy in several ways.

First and foremost is to become educated on the topic, including all the pros and cons of the procedure.

In addition, at the time of your delivery, ask your caregiver to instruct you on your pushing at the time of crowning. If a mom has instruction in controlled pushing, the vaginal skin will stretch naturally to accommodate the baby. This goes back to the thought that your body knows what to do.

You might also try the following suggestions:

Discuss the use of episiotomy with your caregiver in order to learn if he or she has done the same homework on the subject that you have.

Perineal massage may help avoid a tear and/or the need for an episiotomy.

Practice Kegel exercises for controlled pushing. This will help to promote a healthy pelvic floor muscle.

Consider having a water birth in order to reduce the stress and strain that necessitates an episiotomy.
No matter what happens on your big day, you must not let this potential need for a physical cut to your body during your baby's birth to create undue stress and emotional anxiety. If education is your best defense, remember this fact: A woman's body is BUILT to give birth.