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Childbirth Pain Management

Clip Number: 27 of 40
Presentation: Women's Health -- Common Conditions, Tests, and Procedures
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Reviewed By: Arthur Schoenstadt, MD
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Two questions that almost every woman wants to know the answer to before labor are:
• How painful is labor?
• What are my options for pain relief?
Some women feel very little pain during childbirth, and don't need much pain medication. But for many women, childbirth is very painful, and they need more pain medication. Since you won't know ahead of time how painful your labor will be, it's a good idea to learn about your options for pain relief and discuss them with your doctor ahead of time. The decisions of whether or not to have pain medication, how much and what type to have, are personal and vary from woman to woman. Also, knowing what to expect during childbirth, and being prepared for it, can help decrease your anxiety. If you are less anxious about the upcoming experience, you may need fewer medications for pain.
Your three choices of pain relief include:
· Analgesics, which relieve pain throughout your body
· Local anesthetics, which eliminate pain and numb a SMALL area of your body
· Regional block anesthetics, which numb a LARGER area of your body.
You and your doctor may also choose to use a combination of these methods for pain relief.
Certain analgesics, also called painkillers, may be given through your IV, or by injection if you don't have an IV.. These usually reduce the pain of contractions, and can also have a relaxing effect, so that you can rest between contractions. But, analgesics can ALSO make your baby's breathing rate slow down too much at birth, which is why your doctor may not want to use them when your delivery is close.
Local anesthetics can be injected to numb a small area around your vagina and rectum. Anesthetic may also be injected around a nerve that goes to these areas. This is called a pudendal block, and it numbs a larger area. Local anesthetics and pudendal block are often applied just before delivery to reduce pain while the baby is moving through the birth canal. And they may also be used to help reduce pain if you need an episiotomy, which is a small incision made to widen the opening of the vagina for the baby. BUT, neither local anesthetics nor a pudendal block relieve the pain from contractions.
Spinal anesthesia and epidurals are regional blocks, which block pain and other sensations over a larger region of your body. Both of these CAN relieve the pain of contractions. Spinal anesthesia is given by injecting a small dose of medication into your lower back. It can take effect faster than an epidural.
An epidural is the most common anesthesia used during childbirth. It's usually given after your cervix has dilated to 4 centimeters. To receive an epidural, you need to sit up or lie on your side. A small area in your lower back will be numbed, and then a tiny, flexible, plastic tube, called an epidural catheter, will be inserted and taped into position. Once in place, it may take a short time before you begin to feel relief from the pain. You may feel heaviness in your legs, and some pressure in your abdominal area. Most women who have epidural anesthesia can deliver normally. If the epidural makes it difficult for the mother to feel the baby's head in the birth canal, it may be more difficult to bear down. This may slow down labor. Medication can be given through the catheter when needed. After your epidural is removed your sensations will eventually return to normal. The time it takes for this to occur will depend on how long it's been since the last injection into your epidural catheter, and the type and dosage of medication given.
Be sure to discuss the risks of anesthesia with your healthcare provider. It is also important to know that even if you have chosen certain options for pain relief before your birth experience, what you actually need during labor may be different than you expected. You may need more or less pain relief than you originally thought. So, be sure to tell your birthing team how you are feeling as your labor progresses.

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