Pain Management in Labor
I talk to my clients often about how I like to reframe pain in labor. It’s much different than pain we feel at almost any other time (aside from exercise, and maybe a few other things). Those types of pain are pathological - they are telling us something is wrong and we need to fix it! Labor pain is physiological pain, pain with a purpose! We don’t want to fight this pain, we want to work with it, melt into it, not clench and run from it. As a doula, a huge part of my job during labor is helping you to find ways to do just that. Some of that work starts prenatally with childbirth education and practicing coping strategies like meditation, affirmations, breathing, and visualizations. During labor, comforting touch and emotional support can help block or dampen pain signals to help you better cope. We really want to encourage natural pain relieving endorphins to flow! Below, I have included a transcript from the Evidence Based Birth podcast on pain management that speaks to the pain relief vs. coping, Gate Control Theory of Pain and Central Nervous System Control Method vs. pharmacological pain relief, and pain vs. suffering. If you want to check out their whole series on pain management, check it out here.
A little more on pain vs. suffering. As a doula, I never want my clients to feel like they are suffering physically or emotionally. I will never discourage someone from getting an epidural or IV pain relief - but I will always encourage that they be informed of the risks and benefits before choosing either. It is important to me that my clients know what sort of side effects they may experience and what may come next after choosing either of these options. At our prenatal appointments, I strongly encourage clients to labor as long as they can without getting an epidural in order to allow some of the body’s physiological processes to do their jobs and for baby to get into a good position. Epidurals put you in bed and sometimes lead to other medical interventions that can change the trajectory of labor. That said, I have seen very successful vaginal births with epidurals, and have been at births when an epidural helped to relieve emotional suffering as well as physical suffering. There is a time and a place, but they do not need to be for everyone!
Now for the transcript:
"Welcome to the Evidence Based Birth® series all about pain management in labor. My name’s Rebecca Dekker, and I’m a nurse with my PhD and the founder of Evidence Based Birth®. In this first video we’re going to do a quick overview of a topic about pain in labor.
Pain seems to be the number one thing that a lot of people worry about when it comes to being pregnant and going into childbirth. I work with a lot of college students, and in the beginning when I start working with them, a lot of them are terrified of the pain of childbirth. What most people don’t know is that there’s two main ways that you can look at the topic of pain in labor.
Two Perspectives of Pain Management during Labor
Researchers named Leap and Anderson proposed these two different viewpoints or perspectives. One perspective is the perspective of pain relief during labor, and the other is “working with pain or coping with pain.”
Pain relief Perspective
Many doctors and labor and delivery nurses believe strongly in the pain relief perspective. They many believe that pain during labor is unnecessary in today’s society and that we should eliminate pain, and that the benefits of pain medications always outweigh the risks. Some of them may not understand why someone would want to go without pain medication during labor, and that’s because a lot of nurses and doctors were trained in medical school and nursing school that it’s very important to assess people’s pain and eliminate it as much as possible.
Coping with Pain Perspective
On the other hand, a lot of people believe in the coping with pain or working with pain philosophy. In this perspective, people believe that pain is a normal part of labor and that it’s necessary to entice you to move around and try different positions that will help the baby come down and out. In the right environment, an environment that feels supportive and private and lets you feel not anxious, people can better cope with labor pain in an environment like that because they feel safe and supported. Also, it helps them release natural pain-relieving hormones called endorphins.
The Difference between Pain and Suffering
People who believe in the coping with pain perspective also believe that there is a difference between pain and suffering. Penny Simkin is a famous doula and author who has written a lot of about the topics of pain versus suffering. She teaches people that you can have pain without suffering. You can also have suffering without pain. They don’t necessarily have to go hand in hand.
For example, people may experience pain without suffering during things like running or training for a marathon, or undergoing a planned surgery, or even for some people having labor may be painful but not suffering because they’re prepared for it and they have lots of support.
Things that can help you cope with pain and prevent suffering including things like being educated so you’re not as scared or fearful, companionship, reassurance, touch, feelings of safety and other positive factors.
On the other hand, it’s possible for some people to be pain-free and to still suffer. People with an epidural might feel no or little pain, but could still suffer emotionally. They may feel distressed due to a long labor, to the numbness that they’re feeling in the body, to feeling isolated or alone, or they may suffer if they’re worrying about their baby for some reason.
Or you could have a situation where both pain and suffering are happening at the same time. Many healthcare providers that I’ve worked with are very attuned to their clients and noticing whether or not if they’ve crossed that line from pain to suffering. I prefer personally to talk about pain management. Because even with medication, sometimes it’s impossible to completely relieve pain, so I believe we should talk about managing pain and helping people learn how to do that with as many methods as they need.
Approaches to Pain Management During Labor
Now pain management strategies during labor can be divided into two different kinds of approaches. There are pharmacological approaches which are using drugs and medications, and there are non-pharmacological or non-drug approaches to managing pain.
Pharmacological approaches
In this video series some of the drug approaches that we’re going to talk about include epidurals and spinals, nitrous oxide, also known as laughing gas, and drugs that they can put through your IV to help with pain.
Now researchers think our bodies perceive pain in a couple different ways. The first way is by how intense the pain is, and the seconds way is how we perceive the pain to be unpleasant, how unpleasant it is to us. Now there are several different non-pharmacological approaches or non-drug ways to manage pain that help reduce either the intensity of pain or the unpleasantness of pain, or both.
Non-pharmacological approaches
Gate Control Theory
One of the ways that we can help manage pain during labor without using drugs is called the gate control theory. This is a really cool concept. Basically, the gate control theory says that if you activate your nerves in a non-painful way at the same time that you’re experiencing pain, that that blocks the pain signals from reaching your brain. That’s because there’s a gate. There’s a limited amount of information that can go up to your brain at once, and if you flood the nerves with non-painful stimuli, that prevents the painful messages from getting through.
For example, I have chronic migraines. I could have really intense pain in my head like it feels like there’s an icepick coming one of my brain. But if I eat a spoonful of ice cream, the second that that ice cream gets in my mouth, it’s so sugary and sweet and creamy, the pain in my head actually goes away. I can’t feel it anymore because of the gate control theory. My nerves are being flooded with non-painful stimuli so the painful messages can’t get through. Now that does not make the migraine go away, and as soon as I finish eating ice cream the pain comes flooding back, but that’s just one example of how we can use that gate control to manage pain in labor.
What are some ways you could help block painful messages during labor? Some things include laboring in a warm tub of water, having someone massage you during labor, or put pressure on your back what their hands, positioning yourself and movement and using things like birth balls. You can even use warm packs or little TENS unit, spelled T-E-N-S. All of those things help flood your nerves so that the painful messages can’t get through as well.
Central Nervous System Control Method
Another really important way that you can help manage pain during labor is through controlling your mind. That may sound kind of crazy, but scientists call this the central nervous system control method of pain management. By controlling your mind and what you’re thinking, you can actually help control the unpleasantness of pain. Some examples of central nervous system control include taking childbirth education classes, hypnotherapy or using hypnobirthing or hypnobabies, continuous like from a doula, aroma therapy, music, and relaxation and deep breathing.
Some people might be skeptical and think that these non-pharmacological approaches don’t work. But in 2014, researchers looked at all the research that had ever been done on non-drug approaches and found that they were actually very effective. Both using gate control methods and central nervous system methods helped decrease the chance of your needing an epidural and greatly increased your chances of being satisfied with your birth.
When people were randomly assigned, like tossing a coin, to either having a drug approach or a central nervous system approach, researchers found that people who had the central nervous system approach offered first actually experienced fewer caesarians, fewer forceps and vacuum-assisted deliveries, less use of Pitocin to stimulate labor, and they also had a shorter labor on average.
What was most effective in the study was when researchers combined multiple methods and tailored them to the individual, and also having continuous labor support from a doula was one of the most effective methods. ACOG, the American Congress of Obstetricians and gynecologists, actually recommends that people in labor be offered non-pharmacological methods because no adverse or no side effects have been found to these methods.
Some of the non-pharmacological for pain management during labor methods that we’re going to talk about in future sessions include water immersion, relaxation techniques, acupuncture and massage, and support from a doula.
Bottom Line
In summary, people can feel intense pain during labor, and we can help people and you can manage labor using both pharmacological and non-pharmacological approaches. For some people, all they will need is non-pharmacological approaches. For others, they may require pharmacological or drugs as well. However, it’s probably best if everybody went into childbirth while equipped with a toolkit of things that they can use to help manage pain and cope with labor. Even if you’ve chosen to use medication, there is going to be probably a period during labor when you don’t have medication, in which case those non-pharmacological approaches might be very helpful. Also, when people are using those first before they get medication, they actually report increased satisfaction with their childbirth.”
