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“What other options do I have for pain, besides an epidural?” I get this question asked of me almost every shift! The truth is, some mamas are not crazy about getting a huge needle stuck in their backs. Some mamas want the freedom to walk around during labor, others just want to forgo the whole “not being able to feel your legs” feeling.
I get it. I was the same way.
You see, I’ve witnessed hundreds of epidurals. I would argue that I’ve attended more births of moms who had epidurals, than not. Epidurals are super popular in the US, and for a great reason! Most of the time they work very well, and very rarely do women have life-altering side effects.
In fact, if you’d like to read more about epidurals, head on over here to this post.
Since I’ve been through so many, you would think that would be my go-to, right? Eh, not so much.
Here’s a little secret, even though I’m a nurse, I HATE NEEDLES. I hate them with a passion. I was not so crazy about the idea of having a huge injection near my spine. I almost caved though, you see labor is so intense that women are willing to get a huge needle stuck in their backs to make it go away!
Luckily for me, when I was on the edge of contemplating an epidural, I was 9.5 cm. My son was born about 30 minutes later. I was in transition. (Transition: A non-rational, crazy place every laboring woman goes when they are on the verge of delivering. La-la land) Thankfully, for my oh-so-awesome nurse (YAY BETH!), she helped assure me that I could do this and I WAS NOT GOING TO DIE.
Okay, let me get back on track though!
What are your other options?
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LET’S START WITH GOOD OLD BREATHING EXERCISES!
Okay, I know you’re probably saying, “Really, Liesel? Simply breathing is not going to really help me.” I’m sure you’ve heard women say “I tried those stupid breathing exercises that I learned in my prenatal class during labor, and they didn’t help at all!”
This is true, breathing isn’t going to take the pain away. But, I would argue if done EFFECTIVELY, it can make things much more manageable.
Let’s get scientific here for a sec. Do you know why those labor contractions hurt so terribly? Here’s one reason. Your uterus is a muscle. Muscles contract (That’s why they are called CONTRACTions). When muscles contract (regardless of whether it’s your uterus, your back or calf muscles), they tighten and restrict blood flow and oxygen to their surroundings. A lack of oxygen CAUSES PAIN!
So guess what you can do to get more oxygen to your uterus?
That’s the premise behind all those breathing exercises taught in prenatal classes.
Breathing deeply is also a great distraction! If you are focusing hard on your breath during your contraction, chances are you may forget about how bad you are hurting for a split second. Before you know it, you’ve made it through another contraction.
It’s hard to explain in words, but generally what I advise mamas to do (and what I focused on doing) is to breathe as deeply as possible and as slowly as possible during a contraction, without holding your breath altogether. This combo allows for a distraction, mental clarity, and also relaxation. The slower and deeper you breathe, the more your body and uterine muscles relax. This allows contractions to be more effective at pushing baby down into your pelvis and help you to ultimately dilate faster!
So yeah, that breathing helps!
I’m not really talking about drinking water (even though staying hydrated during labor is a MUST!), I’m talking about WATER THERAPY! There’s a saying that “water is nature’s epidural”. A warm bath or shower can be SO HELPFUL for easing contraction pain. This was one thing that I remember helped my back labor SIGNIFICANTLY. Warm water surrounding your uterine muscles not only helps with pain relief, it’s can also be very relaxing. And as I’ve said previously, relaxing those muscles is KEY to labor progression!
IV PAIN MEDS
Meds! A very popular option for pain relief during labor. Systemic IV analgesics (aka pain medications that go through your IV) are the most common option, and that’s what I’m most familiar with.
My facility uses a narcotic called Fentanyl, but different facilities use different meds too. Fentanyl is a short-acting opioid narcotic, that is much stronger than morphine (if you’ve ever had morphine before). It’s given during labor because it’s quick acting (it gets to your bloodstream quickly, and relieves pain quickly), and also has a short duration. A short duration med is important during labor because these strong narcotics do cross the placenta and can impact baby. We don’t want pain medication that lasts for hours, because baby can have difficulty breathing and/or be drowsy after delivery, if born shortly after it’s given. That’s why we want it to wear off relatively fast. It’s generally given earlier rather than later in your labor (not usually after you are 8-9 cm) for this reason.
The advantages to this form of pain control are that it’s a quick dose you can receive after you’ve got IV placement, and it doesn’t make your extremities numb at all. It doesn’t take contraction pain completely away, but it does minimize it. It makes most people sleepy, drowsy or dizzy, and most women say they are able to relax much better in between contractions.
Since it does cross the placenta, it makes baby drowsy and sleepy too while it’s infusing in your system. For this reason, we do need to keep you on the fetal monitor and watch baby’s heart rate for the duration that it lasts. It’s also important to stay in your bed for its duration as well, because we don’t want you to be moving around and falling over because you are drowsy!
I got Fentanyl during my labor, and I LOVED IT. It was exactly what I needed to relax for a bit before things got real.
Nitrous oxide is becoming a much more popular option for pain relief during labor, and more facilities are using it in the US. It had always been very popular in Europe, but the United States just started getting on the Nitrous Oxide train. If you’ve ever been to the dentist and had “laughing gas”, it will be a similar experience.
Nitrous Oxide is an odorless gas given via a facemask during labor, and YOU are in control of the mask. It does not take contraction pain away, but it does reduce some of the anxiety you are facing during labor, and women report being able to cope more effectively with the pain. From what I understand, it “makes you not care about the pain as much”. The advantage to this system is that it has a very short duration, so it makes it very safe for baby. You are in control of the mask, so if you feel the sensation is too much for you to handle, you can simply remove the mask, and the gas will leave your system in just a few minutes.
One thing to remember about Nitrous Oxide is that narcotic pain medication cannot be given simultaneously. That means if you decide you want a dose of IV pain medication, you cannot try Nitrous Oxide for a few hours, until the pain medication has worn off.
My facility uses this system, and I’ve had mixed reviews. Some women love it, others hate it. I tried it during my labor, and I did not like it at all. I felt like the mask was impeding my breathing exercises, and it was counterproductive.
Read about Trina’s birth story from Mom Smart Not Hard and her experience with Nitrous oxide here!
Aka, PUSHING ON YOUR BACK REALLY HARD DURING A CONTRACTION! Counter pressure, when done effectively, can reduce contraction pain significantly. I’m not saying it’s going to take it away, but I’ve seen it help mamas cope through that difficult transition period like bosses!
Counter pressure involves your partner/nurse/doula applying constant, steady pressure on the small of your back during a contraction. Pressure can also be applied to the sides of your hips, or on each side of the bottom of your butt using both hands. Spinning babies does a GREAT job of explaining the benefits of counter pressure, and the mechanism behind it. You must push VERY HARD for it to be effective. Counter pressure helps to relieve muscle tension, helps to open your hips a bit more to let baby down, and can immensely help women experiencing back labor.
As one of the least frequent pain options, a pudendal block is not something many pregnant women have heard of. Quite frankly, not many facilities or physicians perform them anymore, but they can be very effective. A pudendal block is a local anesthetic that is given into the pudendal canal where your pudendal nerve is located. This is positioned deep in your pelvis, right next to where baby is fixing to come out! This large nerve is responsible for any feeling you have in your perineum (aka your vagina/anus).
The procedure is typically done to reduce rectal pain from pushing. It will not do much to take labor contractions away. If desired, your doctor will insert a large needle into your vaginal/anal region, where the pudendal canal is located, and inject a local anesthetic (typically Lidocaine). It works pretty immediately, and will numb your vagina and bottom right before you begin pushing.
Just like any procedure, it’s not a cure all. You’ll still feel pain from contractions as you are pushing, and you will also still feel pressure. What it does take away, is the rectal pain you experience as you push. It will also make any vaginal repairs much easier after delivery, if you tear during birth.
This is a great option for women who cannot receive epidurals for medical reasons. With that said, it does take a willing and skilled provider to perform this procedure. Also, THIS IS A LARGE NEEDLE, so if you’re choosing NO-epidural for needle-fear reasons, this is probably not for you.
I remember my own labor and delivery nurse telling me I shouldn’t stay in the same position for more than thirty minutes at a time. This is so vital not only to labor progression, but also can help with pain as well! If something doesn’t feel good, change it! There are a TON of different positions you can labor in. And, unless your baby is in distress, you should have the freedom to move about your room and change positions as frequently as you want.
Some of my favorite positions were hands and knees, sitting on the toilet, and squatting, but there are many more
Ah, the birthing ball, one of my favorite labor resources!
Birthing balls are great for pain relief! They allow you to not only be upright during labor (which has been shown to decrease labor lengths tremendously!), but they rock and move naturally with you, unlike a chair or bed will do. Also, for mamas who like to like to stand during labor, you can also place the ball on the bed and lean over it, rocking back and forth through your contractions. Some women prefer this position, whatever works!
Also, in case you were confused, birthing ball = yoga ball. Same thing. A lot of hospitals/birth centers do provide balls already, but not all do. If you’d like to snag your own, you can get one here!😊
That pretty much wraps it up! As you can see, an epidural is not your only option for pain, during labor. Many women choose epidurals, but many do not as well for many different reasons! I hope you’ve learned some valuable information from this post and it helps you make a more informed decision as to what you choose for pain relief during labor. Have you tried any of these methods? What other questions do you have? I would love to hear from you! Leave me a comment! 😊
Wondering what actually happens during delivery? Be sure to check this post out!
Happy Laboring! 🙂
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