“Most importantly, each of us can recognize ourselves as the unique beings that we are. We can recall our own resources and daily affirm these resources. We can remind ourselves that we are here in life to grow and to learn. And, we can recognize that our birth experiences are a very special time in life, with many opportunities for this growth and learning to take place. Labor and childbirth are not endurance tests, but rather opportunities to discover deeper inner resources. Pain management is not a measurement of life strength, nor is it a grading scale of personal effectiveness. If natural childbirth is approached for anything less than growth, learning, and self-love, the psychological performance pressure will only further increase physical pain. We owe no one a performance. We owe ourselves continuous self-love.”
~ Claudio Panuthos
Today, class, we’re going to talk about pain medication in labor.
Specifically, we’re going to talk about how to make that choice in the throes of labor. You can talk all day (for nine-ish months) about how you WANT that choice to go. You can even type it up in a birth plan to make it official.
You can take solid classes, read some books, practice mindfulness and hire a supportive team. You can prepare daily for that (as yet unknown) pain.
But until you’re IN it, until you are hours into contractions, fatigue and sleep-deprivation and are standing in front of the vast unknown, it’s all just abstract theory and imaginings. When the waves are crashing down, then you have GOT to find a buoy to grasp.
Here’s a buoy.
Here are all the things I’ve learned in 11 years as a doula about making that call in the moment (for pain meds or no pain meds). The end goal is NOT to chain yourself to what you said before labor started. The end goal is to do what needs to be done in THIS moment, with THIS labor and THESE circumstances.
And then afterwards to feel really good about how you navigated that journey, no matter what it asks of you.
This article is a list of suggestions. Take each point and determine how it applies (or doesn't) to YOU. Ask yourself at each idea, “Is this an approach that resonates for me?”
To help, I've created a quick guide to help you sort through your hopes and talk about them with your birth companions.
Loading the Front End:
While many women truly want to “take labor as it comes” and not commit to a preference for pain medication, more women have some idea ahead of time if they want to accept or avoid it. No matter where you are in your approach, it's helpful if you can express this preference to your partner and support people ahead of time.
This needs to be more than a “Pain Meds: check ‘yes' or ‘no' ” conversation. Finding out how strongly you feel in either direction matters. I can line up five different clients who want to avoid pain medication and find out that they each have a different upper limit to that plan. Some would like to labor as long as possible without them, but some want their doulas and partners to actively talk them out of an epidural. You can imagine the pressure and stress this can add to your supporters!
Nailing it down in specifics is good communication and can also help dramatically in the moment.
A super-duper tool for this conversation is the well-known Pain Medication Preference Scale created by Penny Simkin. This is a fantastic metric to establish exactly where you fall on the spectrum of preferences (ahead of time). It also has a column for partners and support people to know how best to serve you through labor. Print this off as a starting point for a solid conversation with your partner and other support people (doula/mother/sister/cat).
If you know you want an Epidural, then your request for one during labor has a straightforward response: go get the nurse!
If you are wanting to wait until a certain point in labor or the staff is wanting you to wait a little longer, then some of these tips below can still help. If the decision to utilize pain medication is made, there are TONS of helpful ideas in my post Maximize the Epidural Experience.
If you are leaning more toward “wait and see” or “I'd prefer to labor without pain medication”, then the following can be HUGELY helpful for the conversation during labor. These are all things I've learned over years of being a doula. This is wisdom I've learned not only from doing it well, but also screwing up a few times.
An Ongoing Conversation:
Truly, the decision for pain medication is often an unfolding one. Because contractions are coming every few minutes to punctuate your speech, this alone forces the decision to take time. Rarely is it a snap decision.
You may talk about pain relief in a general way during contractions, saying something like “This hurts!” or “I can’t.”. Then you may speak more soberly between contractions about it. After trying a few different coping options, you may be more certain which path you want NOW.
Sometimes a woman will mention it or cry out, sometimes as a way to vent, then never bring it up again. But if her support person or staff is (understandably) quick to respond, they may call for anesthesia before she’s firm about this decision.
Instead, it can be helpful to hash out ahead of time how you want your supporters to respond to your requests for medical support.
The goal is to clarify if you want a change in plan. By receiving closer support, reassurance and steadiness from your partner, the decision can be made with your full presence.
What to do to clarify the decision:
Clarifying your decision DURING labor can make the difference between regret and satisfaction with either choice. If you feel strongly against medication before labor begins, then you will likely be grateful for a strong clarity in your decision DURING labor.
Care and compassion are needed from your helpers to mindfully respond to your requests.
Here are some suggested ways that your supporters can respond to you. As you go through the list, write down the ones that you would like to incorporate into your prenatal conversations.
(You can also access full list in the quick-guide to clarifying the pain-meds decision.)
Try something new:
Change the energy in the room
– A more intimate environment can work in some situations like creating darkness, candle light (or LED candle light), privacy.
– If you were laboring all night and feel like burnt toast, your supporters can open the blinds with the morning light. That lovely dawn light is so soothing after a night of hard work. Many mothers (and support people) will be revived and ready to work some more.
– Putting on your favorite music or labor playlist. Some situations call for the hippie Enya playlist. Some births need the “Eye of the Tiger” playlist.
– Private, intimate connection. Occasionally, I will step out and allow the couple to have good alone time. You will feel free-er to discuss your full experience and worries with just your partner. Eliminating the doula or staff can remove self-consciousness.
– Everyone brushing their teeth, using babywipes on their pits and perhaps putting on clean clothes can really reset the motivation.
The back-pocket option:
Some women will hold a pain-relief technique in mind for that tough moment that they do ask for pain medication (or just to get them through the tough part).
Perhaps there's a pain-coping trick that really appeals to you. If you keep that in your back-pocket and use it strategically, it can serve two purposes: 1) give you relief when labor is hardest and 2) reassure you that “Yep, I did everything I could think of. No doubts now. Drugs, please!”
Here are some possible ideas:
– If you haven't been in the shower in a while, try that! 30 minutes in warm water might get you over the hump. Even better if her partner can get in with her and give her that good lovin' vibe.
– If a tub is available, this is an excellent time to get it filled and ready. I’ve seen water therapy (showers or tubs) get many women through the hardest parts of their labors.
– If you've been lying down for a long time, try getting up to move. You can experiment with how movement through labor can ease contractions and help the labor be more efficient.
– Have your supporters encourage you to try 20-30 more minutes (especially if you are already changing the energy in the room and using new coping tools). This gives you a measurable window, then a plan to revisit the pain-med conversation. Adjust this time to suit your situation.
-One client I worked with asked us to pretend an Epidural was Beetlejuice. If she asked three times, it was official. This isn't an approach I suggest for other clients, but it worked for them. Her partner was relieved to know he had something quantifiable to help support her during a big unknown.
-Using a “safe word”. As in, “If I say ‘cacao', I MEAN it. Get me anesthesia.” I used to balk at this one because it implies that women won't just say what they need. Yet one client chose this because she needed the freedom to kvetch and complain without worrying her partner. He was reassured knowing that there was a clear marker. And it worked for them – she had a challenging labor and he was emboldened to focus on non-pharmacological pain relief (as long as she didn't say the magic word).
Words of Reassurance:
Words have immense power to reassure, to redirect and to offer love. Just like Marathon watchers and sports fans will line up with hand-made signs of encouragement, your birth people can offer you phrases of encouragement and reminders of your strength.
Below are useful phrases or reminders. Write down the ones that appeal to you. (also in the quick-guide.) and circle them!) Share them with your partner.
– You only need to do one contraction at a time.
– We are with you. We support you.
– You are safe and your baby is safe.
– Trust your instincts, wherever they are guiding you.
– You are doing beautifully.
For more ideas of how to talk to a woman in labor, check this article out.
Your unique journey:
Birth is unpredictable. In fact, it's as unpredictable as life gets. And there are times when the birth itself changes your plans, times when your vision of “being strong” starts to shape-shift into “resilience”, “flexibility”, “self care”, “trust in my team” or “interdependence”.
Are there conditions under which you are more open to pain-medication?
Common scenarios that can change the plan:
– A long labor. It's common for a first-time labor to run 14-24 hours, yet they can be 2-3 days long. That changes the ability to cope with pain, the need for rest and the emotional toll.
– Back Labor. Sometimes the baby's position can make the contraction pain more intense in the sacrum, and for some that pain is felt even between contractions.
– An induction. For many reasons, medical inductions bring more to cope with. They are often long and require uncomfortable procedures.
– Augmentation. If you're utilizing Pitocin to progress your labor, it can make the contractions more intense. (CAN. It's an individual response.)
– Fatigue. If for any reason you're exhausted, an epidural can give you a break to sleep or at least rest. Once the baby arrives, sleep deprivation is a way of life. Starting the journey with a rested body makes sense.
– Navigating Medical Decisions. If there is a question of baby's safety or if you need to navigate medical choices, an epidural can give you time to focus and make those decisions without being distracted by pain. I've also seen a mother change her mind about an epidural because the baby's heart rate was making a Cesarean birth more likely. It was important to her that she have the medication in place to avoid general anesthesia (being put under) if surgery was called for.
– Support wains. If your people are fatigued or you recognize the stress the labor is bringing to people you love, then you may change the plan.
Above all, both parents can remember…
The choice to accept or reject pain medication in labor is NOT a moral choice. It does not make you a better person or mother to go in either direction. We must also not confuse pain with love. Experiencing or not experiencing contractions is not an act of love for your baby, in and of itself. The meaning and intention behind the choice is what indicates love.
While I hope this break-down of a common scenario is helpful to you, I want to reiterate my previous statement. The goal of sorting out the pain-medication question during labor is NOT to rigidly stick to ideals you had before-hand. The goal is to be awake and present to what THIS moment needs. And my hope for you is that you emerge from your birth experience seeing your own brilliance through a hugely intense journey, and even trusting yourself a little more.