Pain and Medication:
Making Wise Choices
Excerpt from Chapter 13
pregnant woman

PAIN AND DRUGS: YOUR SUPPORT CAN MAKE THE DIFFERENCE

Some women make the decision to use pain medication before the onset of labor. Others prefer to do labor without medication, but are open to using it, if needed. And some are committed to getting through labor without drugs. But the level of support a mother receives frequently influences whether drugs are used. You are often the one who makes the critical difference.

The medical staff on a labor wing of a hospital deals with birth every day. Their experience has taught them that many women who intend to go through labor without drugs request drugs once they are in the heat of labor. However, if you have a solid stance, abide in it, and demonstrate your skills by remaining grounded and

focused; you impact how the staff responds to your partner’s labor, as well as how your partner responds to pain.

In some labors, pain medication eases the mother through an exhausting or overwhelmingly painful labor. In other labors, pain medication creates problems requiring intervention that would not otherwise have been needed. In rare instances, emergencies occur that make intervention necessary. But if labor is progressing normally and your partner is coping, even at her edge, medication for pain can be detrimental.

It is possible the mother will make a drug request just as labor is rapidly advancing into transition, which is the shortest and most intense phase. Soon she will be pushing, but no one has a clue. It is the darkest hour before the dawn. Pain medication administered once your partner is in transition labor is problematic because it decreases sensation for pushing. It also increases the incidence of episiotomy, vacuum extraction or forceps, and cesarean birth. Many women experience the pushing phase as rewarding, and find a power and strength of which they were previously unaware. It is counterintuitive to have full sensation for labor, but then be numbed for the pushing phase.

TECHNIQUES TO USE TO ASSIST WITH PAIN

If the mother requests pain relief, you want to respond to her immediate need, but you also want to consider the larger picture. Confer with the staff to determine how dilated your partner is before administering pain medication. If you want to hold off on the use of drugs or if your partner expressed a desire to avoid medication, use the options below. Of course, if you are having a home birth, you will likely not have to deal with the decision of pain medication, but you can use these options to assist your partner to deal with pain. Use what you are instinctively drawn to use and discard the rest:

• Get her up to use the bathroom. Your partner must relax her pelvic floor to
  release her urine, and this may help get her through the impasse she is in.
• Monitor her breath. Is she using it to resist or run away from labor? Use the
  hand-on-upper-abdomen technique to help her focus and reestablish fluid
  breath flow.
• Monitor her face and use a touch-and-say to help her release tension.
• Encourage her to sound. Her sounds can be primal and roaring or subdued.
• Encourage a movement ritual like rocking on the ball; combine it with sounding.
• Use the five-to-one countdown technique several times in a row. She may be in a
  hot spot of accelerating labor and be able to cope again once she hits another
  plateau.
• Use touch, massage, acupressure points, or counterpressure on the lower back or
  hip joints.
• Use a chosen word or phrase.
• Change positions. Sometimes the baby is positioned in such a way that it creates
  additional pressure. When the mother changes positions, it encourages the baby
  to move, which may reduce pain.
• Get her into water. Encourage her to take a bath or a shower.
• Use cold or hot packs; you can also use them alternately.

The Gate theory of pain control explains why these strategies work to diminish pain. The theory is that perception of pain is altered or blocked by the brain when other stimuli are provided for the nervous system. By using a focus or other stimuli, the nervous system responds by blocking or lowering the perception of pain.