Ep 129: Your Options for Managing Pain in Labor

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This is an episode which I originally did almost 2 years ago so I figured it was time to update it! In this episode you’re going to learn all about your options for pain management during labor. And here’s the thing: everyone who’s having a baby needs to know all the options - whether you plan to get an epidural or you plan to have an unmedicated birth or you’re somewhere in between.

For those who choose an unmedicated birth there are many tools at your disposal such as massage and movement. If you opt for a non-epidural medicated birth it’s good to know what choices you have and what the pros and cons are of each. Even if you plan to get an epidural there will still be a time when you have to manage pain without it. I recommend that people stay home as long as possible so that you’re in good active labor by the time you get to the hospital and to reduce the chances of unnecessary interventions. This means that everyone, medicated or not, will need to familiarize themselves with tools and techniques to manage pain.

In this Episode, You’ll Learn About:

  • Why it’s important to think about labor pain differently than other kinds of pain
  • Why everyone needs to learn about all the pain management options
  • How having a pain management plan is crucial
  • Medication free pain management techniques
  • What are the pros and cons of an unmedicated birth
  • Medications that are not an epidural and how the can affect you and your baby
  • Epidurals - and what are the pros, cons, and risks and some surprising things you probably don't know

Links Mentioned in the Episode

Keywords

epidural, labor pain, nitrous oxide, opioid pain management, pain management, unmedicated birth

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Keywords

epidural, labor pain, nitrous oxide, opioid pain management, pain management, unmedicated birth

Categories

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Ep 129: Your Options for Managing Pain in Labor

Nicole: In this episode of the podcast, you're going to learn all about your options for managing those contractions during labor.

Nicole: Welcome to the All About Pregnancy & Birth podcast. I'm Dr. Nicole Calloway Rankins, a board certified OB GYN who's been in practice for nearly 15 years. I've had the privilege of helping over 1000 babies into this world, and I'm here to help you be calm, confident, and empowered to have a beautiful pregnancy and birth. Quick note, this podcast is for educational purposes only and is not a substitute for medical advice. Check out the full disclaimer at drnicolerankins.com/disclaimer. Now let's get to it.

Nicole: Hello. Hello. Hello. Welcome to another episode of the podcast. This is episode number 129. Thank you. Thank you for spending some of your time with me today. So this is an episode that I actually originally did, like almost two years ago, a hundred episodes ago, actually. So I figured it was long overdue to update it. So in this episode, you're going to learn all about your options for managing pain during labor. And here's the thing. Everyone who's having a baby needs to know all the options, whether you plan to get an epidural or you plan to have an unmedicated birth, or you're somewhere in between. If you plan to get an epidural, there will be a period of time that you have to manage pain before you get the epidural. I actually recommend that you stay home as long as possible before you go to the hospital, assuming everything is okay with your pregnancy, so that you're in good, active labor by the time you get to the hospital, that actually reduces the chances of unnecessary interventions. So even if you plan to get an epidural, you need techniques to manage contractions before you get to the hospital. And if you plan to go without an epidural or have an unmedicated birth, which some people say is a natural birth, I actually believe all birth is natural.

Nicole: And when we, I refer to birth without medications as unmedicated birth, as opposed to natural birth. So if you plan to do an unmedicated birth, then you want to know about some of those other things that you can use that are short of an epidural to help you as well. And then if you're somewhere in between, not sure what you want to do then yet definitely need to know all of your options. So in this episode, you're going to learn about medication free techniques for coping with pain, like hydrotherapy, massage, and movement. You're going to learn about medications that are not an epidural, specifically opioid medications and nitrous oxide. And you'll learn the side effects, risks, pros, and cons of each. And then finally, we'll end with epidurals. And again, the side effects, risks, pros, cons of getting epidurals. Now there is a ton of great information in this episode that you are going to want to remember, but you don't need to take any notes because I've created a free guide that you can download that includes all this information. Also includes some pictures in the guide, as well as questions that you want to ask your doctor about pain management options. So you can grab that free guide at drnicolerankins.com/pain. And that link will be in the show notes. Now, before we get into the episode, let's do a quick listener shout out. This is from Ashleyanne2021. And I hope I said that correctly. And the title of the review says a million thanks. The review says Dr. Rankins has absolutely been a key part of getting me through this pregnancy so far, first pregnancy, now in my third trimester. I've been listening since early on in pregnancy and it has helped me really feel informed and calm in these chaotic times of COVID. I feel like I'll be on the way to the hospital, listening to her.

Nicole: I love that. I love the balanced evidence-based information that she and her guests provide. It's a great mix of excellent information, strategies, tools, resources, advocacy, and my all time favorite the birth stories, I'm all over this podcast and recommend it to all my pregnant friends. It is also informative for providers, support partners and people considering pregnancy. Thank you. Thank you. Thank you, Dr. Rankins. Well, thank you for taking the time to leave that calm review in apple podcast about the podcast. I so, so appreciate it. And yes, that is exactly why I'm here to provide information, strategy, tools, resources, and help you advocate for yourself. So you can have that beautiful pregnancy and birth that you deserve. All right. So let's get into the episode on your options for managing pain in labor. All right. So the first thing we need to do is just talk a little bit about labor pain in general.

Nicole: Now people sometimes call contractions or labor pain, different things, some call it things like surges or waves, and that is an attempt to help mentally kind of wrap ourselves around it a bit better in a different way, and sort of dissociate it from it being something as pain. And you can definitely call it however you feel like, you know, if you want to call it waves or surges, if that works for you, then that's totally fine. I'm going to refer to it in the episode as pain. Now, of course, although women experience labor differently most will interpret contractions as painful. And I don't think we have to be afraid to name it as pain. You know, it is what it is, and then we'll talk about it and strategies to manage it. Now, the reason that it's sometimes challenging to talk about labor pain is because this is often thing that concerns women the most about giving birth.

Nicole: There is a lot of fear surrounding labor pain. Now I know that some of that comes from what you see on TV and depictions of labor being this like crazy overwhelming event, where women are screaming and it's chaotic and losing control. Um, some of it comes from personal experiences where maybe you've had a friend or family member go through the labor process and you saw how intense that can be. Now. All of that fear is totally normal. It's also very common, but do know that you don't have to let that fear overwhelm you like it doesn't have to be this chaotic, overwhelming process, managing pain during labor. So it's okay to fear it. This is something that's new to you. You've never done it before, but there are strategies that you can use to really help you manage it and take control of the process and not have it control you.

Nicole: Now, one of the really important parts of that is you have to rethink how you think about pain. Okay? And I'm going to explain that in a minute. And when you do this, when you rethink the way that you think about labor pain in particular, this will help you work with your body to manage the pain, instead of fearing it and working against that pain, you want to work with your body to manage the pain and use it to birth your baby. Okay? So here's what I mean by saying that we have to think about labor pain differently. Pain is normally something in our bodies that we interpret as a problem. That's the way that our bodies let us know that something's going on, right? So if you fall and hurt yourself, then you have pain. If you stick your hand on a hot stove, it's going to be painful.

Nicole: If you break a bone, it's going to be painful. If you have something going on inside of your body, you know, like appendicitis or something like that, that's going to manifest as pain. Pain is a signal that our bodies give us that something is wrong and that something needs attention. However, in the case of labor, pain is different. It's actually a pain that's caused by something that's good. It is the process of you birthing your baby. So it's different in that regard, it's also different in that this pain is definitely going to come to an end. We know that there's an end point and you have this beautiful thing at the end of it. You have your baby. Also, this pain comes and goes at mostly predictable intervals. So you can predict when the pain is going to come, contractions come in a regular predictable pattern. So if you can understand those things and think about labor pain in that way, that it's a different type of pain. It's actually not signaling a problem. You have some guidance about how to predict when it's going to come. So you can be prepared for it. When you think about labor pain that way that can help make it easier to manage. Okay. It makes it easier to work with your body and that pain and not against it because when you work against it and tense up and fight it, then it can actually make the process of labor even more painful or even longer. All right. Now, another thing that I want you to know is that as far as how you manage pain, there is absolutely no one right way for how you manage pain in labor. This is very, very much so a personal decision. And it's one that you have to make for yourself.

Nicole: Your friends can't make it for you, your mom, your sister, your family members, social media, can't make it for you. You have to make it for yourself and know that whatever choice you make is the right choice for you. Be confident that you've made the right choice for yourself. Okay? L also it's important to understand that it's okay if you change your mind, um, you don't have to stick to any one particular way. You can change your mind at any point in the process. All right. So let's now get into the actual options for managing pain. First, we're going to talk about medication free pain management techniques.

Nicole: So, as I said earlier, all women need to know some familiars to manage labor pain without medication. Even if you plan to use some sort of medication, because again, there's going to be a period of time that you will experience labor before you can get any medications or before you can get an epidural. Okay. Also, I will say that sometimes things can go kind of fast. Okay? Labor goes a little bit faster than you anticipated. There can also be delays where you can't get an epidural right away. An epidural is considered an elective procedure. It's not a necessity necessarily. So sometimes there may be delays in getting an epidural. So you really want to have these techniques available to you in your back pocket. So you can manage those contractions without pain and not feel overwhelmed by it. All right. Now, I do want to say that if you are planning to have an unmedicated birth, then you're going to need more in-depth preparation than what I'm going to talk about in this podcast episode, you need to have a more detailed plan in place for how you're going to cope with that pain. Um, some folks think that you can kind of just come in and go with the flow and see how things go. If you want to do an unmedicated birth. But I have found in my 15 years of experience now doing this, that if you have a plan in place for how you're going to manage pain without mat medication, then that pain is not so overwhelming. And you find it easier to manage, especially in the hospital where options for medications are so easy to get to. If you have that plan in place from the beginning, then it's much easier to have an unmedicated birth in the hospital. Okay? If you don't have a plan again, and you just sort of go with the flow, then the pain can sometimes be overwhelming.

Nicole: Often I will say, be overwhelming. So again, we have that plan in place. It'll help you manage pain better. So if you're wanting to do an unmedicated birth, you're going to have to do a little bit more in-depth preparation than what I'm going to talk about today. All right, with that being said, let's talk about some important aspects of medication-free pain management techniques. Number one is support. Support is really, really important. So you want to have your partner there, a friend or family member, whoever you want, and they need to be ready to support you. They need to be ready to assist you with things like moving around. They need to be able to assist you with some of the techniques that I'm going to talk about there. They also need to be able to advocate for you and for your wishes when you can't, when you're in the throes of labor, it's kind of hard to have a detailed conversation about something.

Nicole: So you need someone there who can advocate for you on your behalf, who knows what you want for your birth, who can get things for you, like a sip of water, if you want something to drink or some ice cubes or a cool washcloth, all of those things. So you really need a supportive partner or friend or family member with you to do those things. And one of the things that I see people miss sometimes is that that support person has to feel comfortable seeing you experience pain. It can be very hard for a partner or a mother, sister, your friend, to see you in pain, especially if they're not anticipating it. And they're not, um, you know, ready or familiar with what that looks like. It can be hard to physically watch if it's not something that you've seen before. So they need to be prepared ahead of time to understand that again, this labor pain is something different.

Nicole: It doesn't mean that something's wrong and they need to be ready and comfortable and able to deal with that. Some of the ways that you can help with that is just look at YouTube videos of labor. And you can see what labor looks like just to give people a feel for like how the process looks. So they're not freaking out when you have those first contractions that something is wrong and they understand that this is a normal part of the process. Now, some people also consider having a doula and a doula can be a great support, especially for a medication free birth. Okay. And a doula for those who don't know is someone who is not medically trained, but they are trained to support people during labor and birth. I highly support doulas evidence shows that they can help decrease your need for pain medication increase your chances for having a vaginal birth decrease your cesarean risk.

Nicole: So a well-trained doula can offer you a lot of techniques to help you manage pain and not just techniques for you, but techniques for your partner as well to help you manage pain without medication. Now, some of those techniques that are commonly used, one of the most common ones that's used is massage. And I should say, I'm going to talk about several techniques because as you're going through the process of, um, managing pain without medication, you may find that some things work, some things don't, some things you thought might work, you actually hate when the time comes. So you really want to have a lot of options in your toolbox, and then you can pick and choose and go through the different options as you go through your labor. So one of the most common things that's used is massage, and that can work really well.

Nicole: A couple of specific places that work well for massage are low back massage. And I have a picture of that in the free guide that you can download. Also, the double hip squeeze is a really common technique that's used as well. You can just Google YouTube videos of double hip squeeze. Okay? Now another technique that works well is focused or patterned breathing. The classic one that we think of is the Lamaze. Like that's one that can be used, but there are lots of different ways that you can use. It's really just focusing on your breathing. Another common thing, you can breathe in to a count of five, then exhale out to a count of five. It's really just focusing on your breath and being intentional about that. When you are focused on your breathing, I know it sounds crazy, but it will actually take your attention away from the pain and you won't be quite so fixated on it.

Nicole: Okay. All right. Now another great option for managing pain without medication is position changes and position changes or movement are important, both for helping relieve pain. And they're important to help get your baby in an optimal position for birth and help your baby move through the pelvis. So movement is going to be really key and there are lots of things you can try. You can do squats, you can do lunges, you can lean against a wall. You can lean against your partner. You can lean over the bed. All of those things can help. And I have some pictures in the free guide for some options you can try there as well. Just plain old walking around can help with relieving discomfort and pain. Another thing that you can use for position changes is a birthing ball. A birthing ball is just a big exercise ball.

Nicole: You can, um, open your legs, um, keep them open wide to help keep your pelvis open. You can roll around on it. It can help just relieve that pain and pressure and birthing balls. Um, most hospitals, these days will have those. So you can use that in the hospital. And if you want to get one at home, they're like pretty inexpensive on Amazon. Another one that people swear by in terms of positions is sitting on the toilet. I have had some folks. I remember birth story episode in particular, where she said all she could do was just sit on the toilet. That was the only thing that helped to relieve her contractions while she was at home. So sitting on the toilet, whether front facing or, um, facing backwards can be really helpful as well. All right. Now another thing that can help is hydrotherapy and that's just using water.

Nicole: So getting in the shower or bathtub, lots of women swear by using water to help manage pain during labor, it can be really, really outstanding. Now, keep in mind that not all hospitals have showers and tubs, so you may not be able to use this option at the hospital. You want to check ahead of time on that, but you can definitely use this at home. You know, when those early contractions start, take a nice shower or warm bath to help relieve the discomfort. All right, now, if you're planning to go completely unmedicated and have a medicated birth, there is another option. I don't think you need to pursue this, if you're not planning to have a completely unmedicated birth, but hypnobirthing is also something that women can use to help manage pain without medication. Now keep in mind that hypnobirthing does require preparation and a class, and it actually requires quite a bit of practice. That was something I was surprised to learn. In episode 95 of the podcast, I interviewed someone who teaches hypnobirthing. So you can check that out. It's drnicolerankins.com/episode95 and that's episode all spelled out, but hypnobirthing is something that you can use to help manage pain without medication.

Nicole: All right. And the final thing that I will say is that there are some books that folks find useful when they are looking for medication free techniques or stories or supportive things for going without medication during birth Anna Mae's Guide to Childbirth, of course, is a tried and true popular book as well. I have read that book. Um, it's a great book. It does have some outdated statistics and information. Like some of the numbers in there are outdated, but the overall premise of the book is great. I actually really liked the book birthing from within, and I don't get anything for mentioning either of these books. I've just actually read them myself. Um, and I like that book a lot. I thought it was really helpful. Um, there were some parts of it that were a little bit like, like it asks you to draw and do these sort of artsy things.

Nicole: And I like, okay, maybe that part is not for me, but the overall premise of the book and the content is good. There's also some outdated statistical information in that book as well, but numbers are always going to be outdated in books, but, you know, as you get more information, so, you know, just know that going into it. And then another, um, book that folks use or classes actually too, is the Bradley method is another option for unmedicated birth. Um, and then there's hypnobirthing books as well. So you can check out all of those now, as far as some of the pros and cons of medication free options, um, for the pros, there's no exposure to medication for you or your baby. And that can be a bonus for some people, some people that makes them feel better. Okay. And I will say that most women will really feel very empowered after an unmedicated birth.

Nicole: Um, I do see some circumstances where folks feel overwhelmed because they weren't expecting to have an unmedicated birth and it went very fast. But for the most part, women feel very, very empowered after having an unmedicated birth. And then also women recover faster from an unmedicated birth, you're up and walking around faster. You don't have to wait, you get to get your feeling back. You just feel more like yourself, um, after an unmedicated birth and then the cons. And I don't know that these are necessarily cons about an, a medicated birth, but if you're giving birth in the hospital, it can be tempting or easy to get an epidural because it's readily available. Okay. So that's where planning really comes into place. If you want to do an unmedicated birth for the distance, you need to be prepared ahead of time to deal with that.

Nicole: And then another con I say, and I'm doing like air quotes around cons is that if you have a completely unmedicated birth and you end up needing, um, stitches after birth, because you had some vaginal tears, sometimes that can be hard to get comfortable. We use numbing medication, but injecting a lot and in the right spaces. That can be a little bit tricky. All right, now I actually have a whole separate bonus lesson in the Birth Preparation Course on unmedicated birth in the hospital and the Birth Preparation Course is my signature online childbirth education class, that gets you calm, confident, and empowered to have a beautiful birth. And that a bonus lesson has six additional powerful tips specifically related to a medicated birth in the hospital. So you can check out all the details of the Birth Preparation Course at drnicolerankins.com/enroll.

Nicole: All right, so let's move on to medications that are not an epidural. These can be divided into two categories. One is opioid medications, and the other is nitrous oxide. Both of these medications work by reducing your awareness of pain. Now we're familiar with opioids, or you're probably familiar with opioids from the opioid epidemic. It's the same opioids, just given a different way. Opioids are a very powerful class of medications to help relieve pain. And in the context of labor, they can be given into a muscle or they can be given intravenously. That is through an IV. And most often they are given through an IV. Sometimes we give a big dose in the muscle. If someone is having a long, early labor and they need to get some rest, but most of the time we're giving it through the IV. Now, just so you know, all opioid medications will cross the placenta and they will get to your baby.

Nicole: However, your baby's going to clear the medication out of its system, the same way that you do, all right, it just takes your baby longer to do so. We also have to watch the baby's heart rate carefully because there may be some changes in the baby's heart rate because of the opioid medications. If you've ever taken opioids before, and some common pill ones are things like Percocet or Vicodin, they may make you kind of sleepy and that can do the same thing for a baby. So your baby's heart rate will look a little bit different. Typically we want to see a heart rate bounce up and down. That's something called the variability and opioids can cause a loss of variability in the heart rate. We just have to keep a close eye on things. We also have to be careful about giving too much opioids, close to delivery, because if the baby has those medicines in their system, when they're born, they may have some difficulty breathing.

Nicole: They may have trouble suckling. I've never seen those happen, but you do have to be careful about giving opioids close to delivery. Now, the thing about opioids is that they do work pretty quickly. They take effect in about five to 10 minutes. Doesn't take long and the effects can last anywhere from 30 minutes to an hour, usually longer, as long as six hours. In some cases, it really just depends on how your body metabolizes the medication. And as I said, it's going to take your baby a little bit longer to clear the medication from their system. That's why we have to be careful about the timing of it in relation to your birth, because it takes babies longer to clear it. And we don't want to give it too close to delivery. Once folks are in active labor, I usually limit it to two doses during active labor. And I don't give it beyond seven centimeters to avoid those risks.

Nicole: All right, now, moving on, let's talk about nitrous oxide. Nitrous oxide is the other non epidural medication that you can use. And it's also known as laughing gas. It's an inhaled gas, and it's actually been used for decades to provide pain relief in labor it's used a lot more extensively in Europe than it is in the United States, but it's popularity and availability is definitely increasing in the US and the way that you do nitrous oxide is that you give yourself the medication through a mouthpiece or a face, a face mask, and it contains a combination of nitrous, oxide, and oxygen. Um, there are some things that have to be in place. You have to have equipment in place. So you only get the medicine and other people in the room aren't exposed to it. And the way that you do nitrous oxide is that you give yourself the medication through a mouthpiece or a face mask.

Nicole: And it contains a combination of the nitrous oxide gas and oxygen. Usually it's a 50 50 mix. Now, unlike opioids, nitrous oxide is cleared very quickly from your system and very quickly from your baby's system. So it really doesn't have any risk for the baby. And it can be used up until the very end of birth. I find that in my experience is kind of like maybe a little more than 50 50 in terms of whether or not people find nitrous oxide useful. It does have like a tank and equipment and things that you have to use. So it can be a little bit cumbersome, but for some people it works. Um, some people, it, you know, it doesn't work as, as well, but it's certainly worth giving a try. Okay, let's get into some of the side effects and risks, and we're going to talk about the IV medications first. Some women are allergic to them. So you have to be careful with that. Some can have an intense itching after getting opioids. It's actually not an allergy. It's more of an adverse reaction where you just have intense itching. Some folks can have nausea or vomiting, and some folks again, can feel just kind of drowsy and out of it. For the nitrous oxide. It can also cause dizziness or nausea, vomiting, or sort of a drowsy feeling. Again, that's why it's called laughing gas. But I don't see an experience that people experience that a lot. Now, in terms of the pros and cons of each, for those IV opioid medications, they can be fantastic at helping you get through a rough patch of your labor. So if you're having like a long part of labor, those opioid medications can be great to help you get some rest and regroup and get back in the game for the remainder of your labor. For the nitric oxide benefits.

Nicole: Um, you can still be mobile. You can move around, you have control over. It is short acting. Like I mentioned, it also does not require continuous monitoring of your baby's heart rate. So you don't have to be on the monitor all the time. Whereas with the opioid medications you do. Now, as far as the cons and the biggest cons, and I don't know that this is a con. I just want to say that this is something that you need to be aware of. These medications are not as effective as an epidural. Do not think that these can be a substitute for the type of pain relief that you will get with an epidural. They just are not that level of pain relief. All right. So let's talk about epidurals. Epidurals work by decreasing most sensation, including pain. So it's not just that your pain level will be decreased.

Nicole: You won't feel a lot of anything from a certain level down with an epidural, decreases all sensation. All right. So you won't feel your legs as much. Um, you won't feel when you have to go to the bathroom and I'll talk about that in a minute. Now, the way an epidural works is that a catheter is placed in what is the outer most part of the spinal canal that's called the epidural space. And when you put that catheter there, it allows for repeated administration of pain medication. So what that means is that you can keep getting doses, or you can get a continuous infusion through a pump. So once you get an epidural, that pain relief is going to last for the duration of your labor, no matter how long your labor is. That's a common thing that people ask about is the epidural going to run out?

Nicole: No, it will not. Whether it's a few hours or a couple of days, the epidural lasts the entire time. The epidurals can actually be given at any point in labor. And I've seen the full gamut. I've seen folks, who've got an epidurals at two centimeters. It's not true that you have to be four or five or a certain number of centimeters. Before you get an epidural, you can also get an epidural at 10 centimeters. 10 centimeters is when you're completely dilated. It's not common, but it can be done to get an epidural when you're completely dilated. They really can be given at any point in the labor process. Now, do understand that they need to take some time to set up. It doesn't happen right away. There's about 30 minutes or so of preparation before an epidural happens. And then it takes about 20 minutes or so for the pain relief to kick in.

Nicole: So it doesn't happen immediately. Also know that there are a few circumstances where women cannot get an epidural. If you have issues with your platelets, platelets are what helps your blood clot. If they're too low, you can't get an epidural because that puts you at risk for something called an epidural hematoma, which is a blood clot around that epidural space, extremely dangerous could lead to paralysis. So if your platelets are too low, you may not be able to get an epidural. Also, if there's something different about your anatomy, for example, if you have scoliosis, then you may not be able to get an epidural, or if you've had surgery on your back, you have any sort of hardware in your back from surgery. Then you may not be able to get an epidural. If you have any of those things, then you definitely want to see an anesthesiologist during your pregnancy.

Nicole: Yes, that is possible. And they can give you an idea of what your options are for getting an epidural. Now, contrary to popular belief, epidurals do not increase your risk for a cesarean. When you look at all the research studies, that just is not the case. Epidurals do, however, increase your risk of having what's called an assisted vaginal birth with either using vacuum or forceps. And I think that that's related to the fact that if you're not feeling as much, then it's harder for you to know where to push you, end up pushing longer. And then we get into the vacuum or forceps situation right at the end. But there's only a slightly increased risk of that happening. Epidurals will also slow down labor, but only by a little bit. Studies show the epidural slow down labor about around 30 minutes or so. So it is not a significant amount of time.

Nicole: Now I do want to say a quick word about walking epidurals, where you're able to get up and move around with an epidural. This is really a misnomer. I have not seen this happen. And I've seen, you know, I've been doing this for 15 years. It's not really common. The anesthesiologist do walking epidurals. Um, most women do not have enough sensation in their legs to walk with an epidural in place, but what we can do is make it so that you're not completely numb. We can decrease the amount of medications so you can feel something but not everything. And it's actually important that you're not completely dead numb because if you're completely numb, when it comes time to push, then it's very difficult to push because you need to feel some sensation. So you know, the right place to focus when you do push, all right?

Nicole: So you don't want to be completely numb. You want to feel something you don't want to be in like screaming pain or intense pain, but you want to feel something. So don't go into this even if you plan to have an epidural thinking that you're not going to feel anything, you're never going to feel a single contraction, a single bit of pain, please do not go into your birth with that mindset. You want to go into it thinking that the epidural is going to help decrease the sensation of pain so it's manageable for you and you can feel something when it's time to push that it's going to make your labor and birth go the smoothest. There are side effects to epidurals. The most common side effects are itching. It can cause pretty intense itching. Actually, sometimes folks have nausea and vomiting, a weird one.

Nicole: And we don't exactly understand why it happens is shivering really, really intense shivering that you don't have control over. Even though you're not cold. I learned a trick from one of the midwives is that you can actually stick your tongue out and the shivering will stop. But obviously you can't sit there. You don't want to add with your tongue stuck out all the time, but that will help decrease the shivering. Epidurals can also cause a drop in your blood pressure where your blood pressure drops. And when that happens, then the blood flow to your uterus can drop. And if the blood flow to your uterus drops and that can affect the baby's heart rate. And typically that happens right after the epidural is placed. If it's going to happen, if that does happen, then the fix for it is to fix your blood pressure. This is where sometimes obstetricians get into trouble. And where folks talk about the cascade of interventions and how epidurals can lead to an increased risk of C-section. Is that get an epidural blood pressure drops, baby heart baby's heart rate drops. And instead of fixing the problem with the blood pressure, the solution is because the baby's heart rate is low, is to deliver the baby via cesarean, but that's not what should happen. What should happen is when your blood pressure drops, you need to fix your blood pressure.

Nicole: Also, some folks really have headaches after an epidural, a and slightly reduce your effectiveness of breastfeeding. That is short-term and gets better very quickly with time. All right, now another side effect is that I shouldn't say side effect or risk is that epidural sometimes may need to be replaced. Occasionally they don't last the duration. They may move. The catheter gets bent and it may need to be replaced during the course of your labor. Sometimes they can be one-sided where you get more relief on one side than the other. So it doesn't feel balanced or in rare instances, epidurals do not work at all. Okay. As you need to make, you're aware of that. All right, again, it doesn't happen commonly, but sometimes they don't work. Now I'm not trying to like scare you off from epidurals or anything like that. It's just that it's the biggest intervention that we're talking about.

Nicole: And with the bigger intervention it's going to come with more potential things that can happen with it. These things don't happen very commonly. The vast majority of people, they get an epidural don't have any issues, but you do want to know about these things going into it so that you're prepared for some of the pros of having an epidural. Number one is that without question, when the epidural works, it works. It is excellent pain relief. There is no getting around that. When you have a great epidural, you will have excellent pain relief during labor. The other pro is that it's going to last up until delivery. Um, that catheter is there. You can keep getting the medication, so it's not going to wear off. They can also be used for a C-section if necessary. And then really little medicine from the epidural reaches the baby.

Nicole: The medicine really almost exclusively stays in that epidural space around your spine. So it doesn't reach your baby. Whereas opioid medications, for example, well now some of the cons of having an epidural, probably the biggest con is that you're going to be tethered to stuff. You're going to be connected to stuff. You're going to have an IV. You have to have an IV, so you can get IV fluids. So it helps prevent your blood pressure from dropping. You have to keep getting IV fluids. You can't feel the sensation to use the bathroom with an epidural. Remember it, doesn't just decrease pain and decreases all sensation from a certain level. So there's a risk of your bladder overfilling because you can't feel the sensation to go. So periodically we have to do a catheter so that we can empty your bladder. Also, you're going to be confined to the bed for the most part, walking epidurals don't happen very frequently.

Nicole: Now we do do position changes, move you around in the bed, use peanut balls and things like that. But for the most part, you are going to be convinced confined to the bed when you have an epidural. And as I mentioned, they take to, oh, sorry, one more thing. You have to be continuously monitored. When you have an epidural, you're going to have continuous, fetal monitoring where you're monitored, we're monitoring your baby all the time. And then as I said, they take time. They take preparation anywhere from 30 minutes or so to get everything set up. Also, the anesthesiologist has to get there in the hospital and not have other things going on. Uh, so it's just going to take some time, just be aware of that. Okay. So just to wrap up your choices for managing pain in labor, you have medication free techniques, which include things like massage, focused or pattern breathing, position changes, hypnosis, hydrotherapy, equipment like the birthing ball.

Nicole: You have medications that are not an epidural like IV opioid medications, or they can also be given in a muscle. You can also use nitrous oxide as well. Remember that nitrous oxide is not available at all hospitals. So you do need to ask about that first, if that's something that you're interested in. And then of course we have epidurals. Also remember that in order to really best manage pain, you have to think about it differently. You have to rethink the way you think about pain. This is a different type of pain. It's not signaling that anything is wrong in your body. It's actually part of the normal process of birth. And when you look at it that way, that it's not something that's bad, it's necessary in order to bring your baby here, then you can work with your body, work with the contractions in order to have a more beautiful birth.

Nicole: Also remember that whatever you choose to manage pain is a personal choice. Whatever choice you make is the right choice for you. All right now don't forget about the free guide at drnicolerankins.com/pain. It contains the information in this episode, as well as some additional information, as well as images and questions to ask your doctor about pain management in labor. And if you want an even deeper dive into pain management options, then definitely check out the Birth Preparation Course my online childbirth education class that gets you calm, confident, and empowered to have a beautiful birth. There is a bonus lesson in there on unmedicated birth, specifically in the hospital where you get some really powerful tips to help you rock that unmedicated hospital birth. There is a beautiful printable guide with even more medication-free techniques and images and descriptions of how to do the techniques and then some other special bonuses as well.

Nicole: So check out all the details of the Birth Preparation Course at drnicolerankins.com/enroll. So there you have it, be sure to subscribe to the podcast and Apple Podcast or wherever you're listening to me right now, Google podcasts or Spotify. And if you feel so inclined, I'd love it if you leave an honest review on Apple Podcast in particular helps other women to find the show, helps the show to grow. And I do shout outs from those reviews from time to time and also come follow me on Instagram. We can continue the conversation there. I'm on Instagram @drnicolerankins would love to see you there as well. So that's it for this episode do come on back next week. And until then, I wish you a beautiful pregnancy and birth.

Nicole: Thanks so much for listening to this episode of the All About Pregnancy & Birth podcast. Head to my website, drnicolerankins.com to get even more great information, including free downloadable resources on how to manage pain in labor and warning signs to look out for after birth. You'll also find information on my free online class on How To Make A Birth Plan That Works as well as everything you need to know about my signature online childbirth education class, the Birth Preparation Course. Again, that's drnicolerankins.com and I will see you next week.

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