Every woman experiences labor pains and the associated discomfort differently. The most helpful support for coping well with contractions is reliable emotional support, such as from your midwife or birth partner. But sometimes that isn’t enough, and the pain becomes too intense. In this article, our midwife Sissi Rasche shares tips to help you relax again and explains the different medical options for pain relief during natural childbirth—from epidural anesthesia to nitrous oxide and opioids.
What is an epidural anesthesia?
The epidural anesthesia (EDA) is a anesthetic that blocks the transmission of pain signals from the spinal cord to the brain. An anesthesiologist administers the anesthetic via a catheter between the second and fourth lumbar vertebrae—this keeps the anesthesia localized and allows it to be dosed easily. Usually, you receive the epidural after a local anesthetic, which typically causes only a feeling of pressure. It is placed while you are sitting, during the pause between contractions. The effect usually begins after about 15 minutes and lasts for one or several hours. You remain fully conscious and still feel the contractions, but less intensely, which makes them much easier for many women to tolerate. How effectively the epidural works varies from woman to woman; most feel only a pulling sensation and pressure. Even though the anesthesiologist’s goal is always to keep you as mobile as possible, numbness in the lower abdomen can sometimes restrict your freedom of movement and coordination in your torso and legs. Again, the effect is very individual; most women are able to stand and move even with an epidural.
When will you receive an epidural anesthesia?
"Before you receive a PDA, I want to find out, as a midwife, what is causing the pain and why you’re not coping so well right now. Often, there is a reason for the pain, and it can be improved by, for example, changing your" Posture ", having yourself massaged, or relaxing in the birthing tub," says our LILLYDOO midwife Sissi. "Unfortunately, due to staff shortages, there is increasingly less time for extensive emotional support, and a PCEA is requested more quickly. However, the administration of pain medication should in no case be due to a lack of support."
The PDA might be the right choice when you reach a point where you realize you can’t go on : the birth has already been going on for a very long time, you have been having Contractions for hours, the cervix is no longer dilating, and you are unable to relax at all—instead, you’re experiencing increasing pain. In such a case, an epidural can be a blessing. It can give you calm and renewed patience. In some cases, the epidural allows you to sleep again without pain and regain strength. Labor pains are very intense, and every woman processes them differently. For many women, an epidural is a great help, especially when labor has already been very long. It often relieves pressure in this situation and allows you to relax, which—together with mobilization, movement, and changing positions during labor—can help the baby settle better in the pelvis without causing you severe pain.
Administered at the right moment, the epidural not only relieves pain but also serves as a therapeutic means to enable a vaginal birth in a stalled situation.
Whether you are during childbirth or decide for or against a PDA, you should always make the decision together with your midwife and your birth team . It’s important that you remain open . Many women plan for an epidural during pregnancy but realize during labor that they can manage well without it. And vice versa: even if you firmly intend to experience childbirth without an epidural, it is not a failure if you change your mind.
How does epidural anesthesia affect the course of labor?
Negative effects of the anesthetic on your baby are not known. However, births with an epidural usually last a little longer. One possible reason is that many women do not feel the urge to push due to the anesthesia. The anesthetist should therefore reduce the dosage in a timely manner.
A PDA intervenes significantly in the birth process. If your labor progresses smoothly and you have strong contractions, we midwives will first try other methods to avoid disrupting the dynamics of the birth.
What are the side effects of epidural anesthesia?
Depending on which anesthetic is used for your epidural, side effects can vary. Your anesthesiologist will inform you about this in advance. Common side effects include:
Dizziness, nausea, and headaches, mostly due to low blood pressure
Possibly limited mobility
Water birth is not possible in combination with an epidural
Disruption of labor activity
Fever
Problems urinating
Very rare: seizures and heart rhythm disturbances
After the birth, it’s possible that your muscle coordination is somewhat limited in your trunk and legs. If you experience severe pain, nausea, shortness of breath, or muscle cramps, you should definitely inform your doctor. In addition to physical side effects, some women also experience a feeling of regret because they didn’t fully feel the birth. Be sure to share your thoughts with your partner and your midwife.
What other painkillers are available during childbirth?
If methods such as acupuncture, bathing, and aromatherapy no longer help, there are other pain relief options besides the epidural that can provide relief and interfere less with the birth process.
Muscle relaxants
"Especially in the early phase of labor, I often recommend antispasmodic medications in the form of a" suppository "—they work quickly and are generally well tolerated," says Sissi. These so-called spasmolytics relax the muscles of your uterus and cervix, which can ease labor pains.
Nitrous oxide
The administration of nitrous oxide is possible at any point during labor, but it is especially beneficial in the final phase. The advantages of laughing gas for midwife Sissi: "Nitrous oxide can be used flexibly, and you still have a good" freedom of movement . "Because it is administered via a mask, most women become more focused on their breathing again. In addition, you gain a sense of control because you can dose it yourself and decide whether you want to manage the contraction with or without nitrous oxide. Another advantage is that the gas goes directly into your body and is gone immediately—so it has no effect on your baby." However, nitrous oxide can also have side effects like nausea and vomiting, and it does not relieve pain quite as effectively as a PDA or opioids.
Opioids
You usually receive opioids intravenously via an IV line. They relieve pain quite quickly, but can cause side effects such as nausea and impaired consciousness. Care is taken to ensure that the medications do not have a sedative effect, so you can actively experience the birth and enjoy the bonding phase. Opioids are generally not administered shortly before birth so that the medication can be broken down before your baby is born, because, like all medications, they are transmitted through the umbilical cord . If you receive opioids during the pushing phase, they could impair your baby’s breathing and other reflexes. In connection with opioids, you should be aware that they are significantly more invasive than the other pain relief methods used during childbirth.
Whatever you do to cope with labor pains, it is entirely your decision whether you want to experience childbirth with or without pain medication, and you don’t have to justify yourself. Trust your gut feeling and don’t cling too tightly to preconceived notions: a birth rarely goes exactly as planned.
