Whenever a pregnant woman lists “no pain medication” in her birth plan, I cringe and then urge her not to be stoic. Women who are not in pain tend to progress better in labor, contrary to myths and fabrications. According to medical studies, labor can cause pain similar to an amputated finger. The American Congress of Obstetrician-Gynecologists states that it is unacceptable for “an individual to experience untreated severe pain” that can be corrected with anesthesia while under the treatment of a physician. As long as there are no medical reasons prohibiting medication, pregnant women should ask and receive pain relief while in labor.
Untreated labor pain has been associated with the development of post-traumatic stress disorder. Post partum depression is more common in women who did not receive pain relief during labor and men are also affected when their laboring partners are in pain. A discussion of pain relief should be done by OB care providers prior to the patient’s hospital admission including whether the anesthesia services will be covered by her insurance plan, including Medicaid.
Not all pregnant women need to receive an epidural although it should definitely be an option. There are many options for pain relief in early labor including IV medications, acupuncture, assistance from a doula, and water therapy in showers or whirlpool baths. As the labor progresses, an epidural may be requested.
An anesthesia evaluation should be done by an anesthetist or anesthesiologist prior to the placement of an epidural, including informed consent for the procedure. Information such as bleeding disorders, low blood pressure and the use of blood thinners should always be obtained. The most common side effect of an epidural is low blood pressure which can be corrected provided that emergency equipment is readily available. Fetal monitoring should be continuous while the patient is receiving an epidural as well as monitoring of her blood pressure. Many hospitals now offer a patient-controlled epidural pump that allows the patient to sit up or walk while in labor.
Contrary to popular belief, epidural anesthesia does not increase the rate of cesarean sections but it can increase the second stage (time that the patient is pushing) by 15 to 30 minutes as well as the use of forceps or a vacuum extractor. It’s equally important to make certain that the anesthesia has not eliminated the patient’s ability to feel the urge to push.
Giving birth is one of the most pivotal moments in a women’s life. Please do everything in your power to make it enjoyable.
Do you know how to anticipate and manage the unexpected events that could occur during your pregnancy? You will if you purchase The Smart Mother’s Guide to a Better Pregnancy available on Amazon.com or wherever books are sold.