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Pain Relief

There is probably no area of obstetrics that generates more anxiety and more controversy than the subject of pain relief. That's not surprising when you consider the reputation childbirth has for being so painful. The truth of the matter is that the reputation is well deserved. The good news is that there are many ways available to cope with or ease the pain. These methods can be divided into three basic types: psychological, narcotic, and conduction anesthesia (epidural and spinal anesthesia).

You should learn all you can about each of these types and determine your preferences. But do not make any firm decisions before labor begins. It is impossible to know beforehand what your labor will be like. Committing yourself to one particular type of pain relief, and no other, is a setup for disappointment. You may find that you need something quite different than your original preference, and you should never feel disappointed, or reproach yourself, if you change your mind in the face of actual experience.

Psychological methods of pain relief have come to be known as "natural childbirth." They were formulated in the 1950s as part of a larger effort to wrest control of childbirth from the medical establishment and give it back to women. Natural childbirth depends, in large part, on becoming knowledgeable about the entire process of giving birth. If you know what to expect, you are less likely to be frightened by this incredible process. Assuming that increased fear leads to increased pain, knowledge and preparation become your first line of defense.

Psychological methods of pain control involve focusing and relaxation exercises specifically tailored to each stage of labor. Most of these exercises involve specific types and patterns of breathing that are designed to focus your concentration on mastering the pain. Many women find that what they learn during natural childbirth preparation is all that they need to negotiate the long hours of labor. The advantages of natural childbirth include absence of side effects from pain relieving medications and no slowing down of the labor process.

Unfortunately, to promote natural childbirth, some of its supporters have claimed that using the breathing techniques makes childbirth, at best, painless or, at worst, only slightly uncomfortable. Neither scenario is true. For the vast majority of women, childbirth is extremely painful. Although the breathing exercises will help you to maintain control in the face of the pain, they will not relieve pain; after all, they are just prescribed breathing patterns.

Many women who are determined to use natural childbirth techniques often become frightened as labor progresses. The pain is so much greater than they have been led to expect and they fear that something is wrong, either with the labor or with themselves. Nothing could be further from the truth. Part of being knowledgeable about the process of childbirth is understanding how painful it is likely to be.

At a minimum, you should be sure to take a childbirth preparation course (offered by most hospitals and birthing centers) in order to prepare for labor and to familiarize yourself with the techniques of natural childbirth. However, if you decide that you need a bit more than natural childbirth breathing exercises to manage the pain, short-acting narcotics are often the first choice. These medications, such as Nubain and Numorphan, are related to stronger narcotics, such as morphine or codeine, which you might be given after surgery or a dental procedure. They differ in that they are much shorter-acting; they will be out of your bloodstream within an hour or two. That way, they are unlikely to be present in the baby's bloodstream at the time of birth.

Short-acting narcotics are given by injection, either into a muscle (like the buttock) or through an intravenous line. They do not take away the pain; they just "take the edge off." Some women find that this is the boost that they need to help them continue with the breathing exercises.

Because of some disadvantages that are associated with short-acting narcotics, it is preferable to avoid narcotics if the delivery is anticipated to occur within the next hour. Given too early in labor (that is, before 4 cm. dilation has been reached), they may slow down the progress of the labor. Narcotics cross the placenta and enter the baby's bloodstream, which has minimal effects before the baby is born. However, if the baby is born shortly after their administration, it could result is a sedated baby that is reluctant to breathe on its own. The effects of the short-acting narcotics on the baby can be reversed by administering an injection of naloxone.