This post continues the blog series I’ve been focusing on with maternity care and birthing in the USA. This post spells out a little more about the options that birthing professionals often offer to people giving birth (such as tranquilizers, narcotics, and other analgesic medications), and discusses gravity / movement and birthing positions.
A note about language: I also wanted to be sure that I note that some of my past posts have said only things about “mamas” giving birth. I want to be clear that I’m working more and more on my language everyday. I want to do my best to be sensitive to the fact that not only women give birth. People give birth. People whom do not identify as women and all other variations in terms of gender and sexual identification. Let us all remember this: people give birth, not just women. I’m going to stop using “mama” and “the woman” when I describe who’s going through the labor and delivery process. It’s a big shift to make, because all of my teachers and all the readings I’ve done, and a lot of the people I work with, use “the woman” , “the mama”, but I realize it’s no longer relevant to only use those terms.
Medications for Pain Relief: Surely when we think about birthing really seriously, most of us may think about pain medication, at the very least as a consideration or fleeting thought. Some may know they want it or need it without giving it much deep thought. Others may know it’s definitely not for them, and then in the midst of the birthing process they’re wondering what kind of extra support is available. It’s important to know the advantages and disadvantages of these options, as they can often look and feel quite different than what our assumptions or what our medical provider may lead us to believe.
One of the most frequently commented on and utilized form of medication is the epidural. It’s a medication given by injection of a numbing drug into the lower back outside of the spinal cord. A fine plastic tube is inserted and left in place in the skin in case more pain relief is needed. The epidural numbs and weakens the lower body (everything from the spinal injection spot and below, so you cannot walk for awhile after the birth is finished). In some hospitals more than 85% of patients get an epidural.
The advantages of an epidural include: no nausea or vomiting and no spinal headache (these can come with other forms of medications); people can usually be quiet and in one place. It’s usually chosen for cesarean births due to it having some ease around the process and it leaves the birthing person awake and alert.
The disadvantages / risks of an epidural include:
– there can be a dramatic drop in blood pressure (for this reason people who have an epidural are required to have an IV in place)
– fever (in which case the baby goes under a septic workup which usually means needle jabs and sometimes a spinal tap and always separation from the person who gave birth after labor and delivery is over)
– they don’t always work (3% of women don’t get relief and 12% get some relief but not complete)
– sometimes the effect is undesirable and people complain about feeling detached from what’s happening
– accidental lumbar puncture which means no epidural can be given and a spinal headache lasts for days or weeks
– slowing or stalling the process of labor and progress
– the person birthing cannot feel the lower body and may have trouble pushing. With an epidural, you are more likely to result in cesarean or forceps / vacuum extraction birth than non-epidural
– the injection site can become infected
– due to not being able to feel, the person giving birth can be injured from improper positioning that they are unable to feel until later
– rarely, an epidural (about 1 in 5000 cases) can result in maternal death or permanent paralysis
This used to be the preferred method of anesthesia for labor and delivery but was mostly given up when the epidural became available. This procedure often produces breathing difficulties in babies. It can cause nausea and vomiting and can (rarely) result in aspiration pneumonia. The up side is it can be administered quicker than an epidural and is still used when an emergency cesarean birth is required. It does not cause a drop in blood pressure.
This is similar to the epidural through an IV being set up and a local anesthetic being put in through a needle into the back. The pain relief can be more reliable / effective. However, a catheter is not left in place so it can wear off quickly. The complications are similar to that of an epidural and about 1% of people have a spinal headache after the birth.
There is no advantage to this. Valium is most commonly used and it’s supposed to reduce anxiety and tension. It’s a mental relief and does not relieve pain. It crosses the placenta and interferes with the baby’s ability to breathe, suck, and maintain health muscle tension (tranquilized birth babies tend to be limp). A tranquilizer, sleeping pill, and sedative all have negative effects on babies and they do not reduce any pain for the person delivering the baby.
Inhaled Pain Medications
Nitrous oxide is a gas inhaled through a mask. The effects are immediate and short lived. No side effects have been found in babies. A disadvantage of this is it takes effort to show the person birthing how to use the mask effectively and many people don’t like it. Most hospitals in the USA do not offer this method.
A dose too high of a narcotic drug that may relieve pain is not safe for the laboring person or the baby so they are given in smaller doses and are not very effective. A safe dose can cause sleepiness and often causes nausea, vomiting, and a drop in blood pressure. It should not be expected to significantly lower pain levels. Some studies have shown a long lasting effect in the baby showing them to be irritable, poor at feeding, and overly sleepy.
When something causes nausea, drugs can be prescribed to help ease it. However, these drugs themselves can cause dizziness and drowsiness which can interfere with the progression of labor.
The Role of a Doula
A way to help be informed and make decisions about all of these options is to have a doula. I have my own view since I am trained as a birth doula, but I can’t say enough how satisfied people seem to be that they hired a doula. Doulas are people too, of course you should meet them and interview them like any other professional whom offers service and find the match for you. But who doesn’t want more support? The role of the doula is to help you feel as comfortable as possible and to reassure family or partners you have involved in the process. Doulas are knowledgable and sympathetic companions for this process that may feel foreign and new to you. Hiring a doula cuts the odds in half of having an unnecessary cesarean birth. It also cuts in half the odds of having a vacuum extractor or forceps delivery (not to say these interventions never happen, they do, but it reduces the odds). Having a doula can shorten labor, reduce pain and anxiety, and the doula may be the only one you bring with you to the birth whom has the sole responsibility of being concerned with your comfort and well being, to help you labor effectively, and to help you advocate for what it is that you want and agree to.
I have my partner, why do I need a doula? If you have a partner or family support as a birth partner, you may wonder if it makes sense to get a doula. One huge role of the doula is to comfort other people involved in the birth, because they are the one the laboring person trusts and relies on the most for emotional support. A calming doula presence can have a significant impact on the fears and anxieties the family / support / partner (and possible parent of the coming baby) of the laboring person may have.
A doula will typically spend time with the expecting parent(s) with private prenatal visits and then do postpartum visits after the birth. They may also be available to attend your prenatal visits with your medical provider if you request it. Many doulas often offer education classes and other community events you can attend to get to know them better.
Movement and Gravity
This may be an easily forgotten, but always helpful thing to be aware of. An upright labor position is easier than lying down on your back. People almost always choose to be upright for laboring when they are given the chance. Gravity does powerful things to help the baby descend and be delivered without the need of intervention. Lying on the back puts the baby in a very difficult position to make it out without the assistance of interventions (a nicer word for intervention is “detour”). It might help to look up birthing positions used by people in cultures outside of the USA. Standing and pulling on something that can take away the pressure of holding your own weight, hanging onto another body, squatting, leaning on chairs and leaning onto one’s hands and knees, are all common and very effective laboring positions. It helps the baby move into an easier position if they are not and it helps the person laboring feel relief when they are able to change and move themselves freely.
The list of benefits of an upright labor position include:
– better usage of gravity
– maximizes circulation between the laboring person and baby
– better alignment for the baby to pass through the pelvis
– stronger rushes (another word for contraction, it feels nicer right?)
– increased pelvic diameter when squatting or kneeling (a baby who may not come through in one position magically makes it through in another!)
Does all of this freak you out and make you want to run away? The good news is there is always soothing available to you. Here are some other things to be aware of that may help:
– Be aware of your clothing. Wearing the hospital clothes may seem like no big deal but people whom are birthing are extremely sensitive to everything including cloth / texture / touch etc
– Be sure to drink extra fluids and pee often. Being hydrated is crucial because when you use the toilet, it creates a conditioned response for your pelvic muscles to relax which helps labor progress
– Use touch to help with pain relief and ease. Shake the muscles of the lower body (especially the butt and upper legs) and it reduces holding and tension in the pelvis. Find out the ways you can be touched that soothe you, so the person supporting you knows and you don’t have to explain it to them while you’re in the midst of laboring
– Learn breathing exercises and other tools such as imagery / hypnosis depending on how you cope
– Use the shower and bathtub. Most people get immediate pain relief from being in water as it’s calming and relaxing and provides a stimulation to the skin that helps a person be in a state of ease
– Request, and keep asking for, PRIVACY. This lowers the levels of stress hormones, especially with people who are more private
I hope this has been a fruitful read for you. I’m getting closer and closer to finishing this birthing blog series, and it’s been such a pleasure to write. I sincerely wish you the absolute best with your birthing journey, in whatever way you are entering it whether you are birthing or whether you are supporting someone or whether you are processing and digesting your own birth of coming into this world. Please feel free to reach out if you ever have questions / needs / or just want to be pointed in a direction and don’t know where to go. Until next time, with love, Alicia