Pain Management

by Pat Jones, CNM

Giving birth is more than the act of expelling a baby from the body. It is a very complex social, emotional and physical process. The way a woman and her family experience birth will deeply affect their feelings about themselves and their baby. A birth experience is never forgotten but is remembered forever.

Birth is a very normal, physiological body function. Your body knows how to birth. Just as your body knows how to cough, sneeze, produce waste, digest and process foods into energy, so your body knows how to grow and give birth to a baby. Women have been giving birth for many years, some estimate close to one million years. The same process which occurs today was happening a thousand years ago in exactly the same way. We have not perfected birth, although birth is safer today because of the knowledge and technology now available to us.

How to cope with the pain of childbirth is a common concern of women and their partners and provides motivation to prepare for childbirth. There are many ways of dealing with the pain of labor and birth. Anesthesia, chemicals, and instruments can be used to help you through labor, however, many women choose to avoid any intervention in the birth process. Instead they use their environment, their body, and their minds to create the acceptance necessary to allow the birth process to occur without fighting or holding back.

Ideas about how the pain of labor should be delt with and experienced have changed in the last 150 years: During the 19th century, birth was seen as a time of suffering for women. Queen Victoria was the first woman to accept chloroform for the delivery of her eighth child in 1853.

The use of anesthesia and hospitalization for birth spread rapidly in America and by the 1940's most all birth was managed in this wav But during this time also. women began to be dissatisfied with the new way of birth. Women who were completely anesthetized for birth sometimes felt as though they had not given birth at all, feeling both removed from their experience and disinterested in the baby,

Improved methods of birth control resulted in more planned pregnancies. Women began to worry about the mounting evidence the obstetrical medications were harmful to their babies. An increasing number of parents are no longer willing to accept birth as a medical procedure which must be supervised by an expert whose word is to be acted upon without question but instead see birth as a natural process for which they themselves are ultimately responsible.

Pain is experienced differently and uniquely by each woman and is based on cultural expectations, previous painful events and subsequent resolutions and each woman's present resources. Pain is enhanced and increased by hunger, exhaustion, fear, isolation, tension and worry.

Tension during childbirth is a natural response to the tensing of the uterus and the body's response to pain. Tension causes exhaustion, oxygen depletion, lowers the pain threshold and can prolong labor. As tension increases so does the fear of more pain and the tension- fear-pain cycle perpetuates itself.

Most childbirth education classes aim to reduce the tension with relaxation techniques, eliminate fear with education about the body process and consequently reduce the amount of pain when the woman is relaxed and at peace with the process of labor. When the mind is calm and knowledgeable about events, the body responds with calm

The messages your body gives you in labor are interpreted as "pain" by many women who are afraid of the body's normal and natural functioning during birth. Your body must give you powerful messages in labor so you will know to go to a place of safety and gather people around you to assist you while giving birth to your baby. The pain messages your body gives you during labor and binh are normal and are much different than the messages of pain you receive when your body tells you something is abnormal, such as the pain from injury or illness.

Childbirth education classes and preparation goals are to give women support for their own inner resources. Couples learn what to expect in labor and women are taught relaxation and breathing techniques to cope with the discomfort and allow the body to work without interference from tension and fear,

In the hospital setting, other resources such as pain analgesic and anesthesia are also available. Some pain medication does not completely eliminate pain but makes you less caring about the pain. These drugs are administered through your IV or as an injection. The biggest disadvantage is that they may also affect the baby Usually a woman feels she needs pain relief close to the end of labor, at a time when she is most vulnerable and dependent but also at a time when there is the greatest effect on the baby - just before birth.

Regional anesthetics such as epidural are popular because they completely eliminate feeling from the lower half of your body, however, the effects on the baby are controversial. There are many side effects to epidural anesthesia such as inability to move or walk. You will not be able to get up and go to the bathroom. You will not be able to walk, squat, or use your body to help get your baby out. You will be at greater risk for cesarean birth due to failure to progress or fetal distress. You will not be able to feel the contractions and consequently you will be unable to push as effectively so you are at greater risk for needing forceps and/or an episiotomy to make room for the baby.

Whatever your choice for your birth experience either using pain relief from drugs or regional anesthesia or choosing to experience the birth process without intervention, it is important that your choices are made through educated, well-informed communication with your birth attendant.