Labor Pains- Natural Birth? I Hope Nobody Reads This!

If nobody reads this, maybe we can continue to label those women that say they want to have natural birth as a bunch of hippies and wierdos. Then when we fail to provide them with resources to maximize their chances of achieving what they want, we won't feel as bad. Great idea!
If nobody reads this, maybe we can continue to smile knowingly everytime we meet someone who wants to try labor without an epidural.We can continue to make mental bets on how long they will last. After all, what else is there to offer them?
If nobody reads this, maybe when our patients say they want to try natural birth we can go on telling them, "sure just come in on the day and we'll see how you manage!".
Perhaps many of those that want to have a natural birth like the idea of it but don't want to put much time and effort into preparing for it anyway. I tried this philosophy on running the marathon once. It didn't work out too well!
The question is, who has time for all of this when things seem to be working just fine? How can change happen?

If we really wanted to make a change, we would initially create a sense of urgency. Then we would put together a guiding team that would include patients, physicians, midwives, nurses, hospitals etc. (if you can't tell, I've just read "Our Iceberg is Melting" by John Kotter!). The solutions would be decided upon as a TEAM.
Since no one will hopefully reads this, I can be honest and say that many women who choose a non-pharmacologic approach to pain management are often ill-prepared. Some of the ones that succeed look at the pain as a side-effect of a normal process (labor). They may even say crazy things like they felt "able to transcend their pain and experience a sense of strength and profound psychological and spiritual comfort during labor". Yeah! Whatever!
So what are some of the things that we do know about this option?
In contrast to epidurals, the primary goal is not to make the pain disappear. Instead, the woman is educated and assisted by her caregivers, childbirth educators, and support people to take an active role in decision-making and using self-comforting techniques and nonpharmacologic methods to relieve pain and enhance labor experience. If a woman after a few hours in labor decides to get an epidural it is not a sign of failure. For some, just the ability to walk around for a period of time and feel more in control can be very satisfying.
The birth environment and continuous labor support from the father, family member or doula are very important aspects of this approach. A doula that is familiar with the family and the physician can provide tremendous support. A prior meeting or discussion will make sure that everyone shares the same mental model of what to expect when the time comes.
These are some of the options for non-pharmacologic pain management in labor even with the system that we have in place now;
Water Immersion: Many women find the feeling of being immersed in warm water very comforting and relaxing especially in the beginning phases of labor. It has been shown that in "low risk" pregnancies this is a safe practice.
Sterile Water Injection: Also called a "water block", usually involves four small injections in the skin of the back to primarily relieve pain in that area. The injections can be painful but the relief can last 45 to 120 minutes.
Touch and Massage: Women clearly appreciate these and they appear to reduce pain and enhance feelings of well-being.
Acupuncture and Acupressure: As long as this approach is performed by trained practitioners it seems to be safe and provides a great deal of satisfaction to those that have tried it. It remains to be seen how it can be integrated in healthcare institutions.
Hypnosis: Hypnosis used for childbirth is almost always self-hypnosis; the hypnotherapist teaches the woman to induce the hypnotic state in herself during labor. Sometimes her partner is taught to signal her into the hypnotic state. I have seen the positive effects of this technique in my patients that I have referred to Dr Jay Stone. He makes his materials available on line at http://www.drjaystone.com/ .

There are many techniques that can help decrease the pain of labor and sometimes eliminate the need for epidurals and medications. Not all of them may be available or appropriate depending on the risk level of the pregnancy. Most of these methods need a good deal of preparation and time investment by the woman and everyone involved in her care. Although our current system is not fully set up to support these approaches it doesn't mean that they are completely out of reach.

It does seem like a lot of work though! Like I said I'm glad nobody's gonna read this.

Labor Pains-Regain Control

"A large number of women want to avoid pain. Some just don't fancy the pain [of childbirth]. More women should be prepared to withstand pain… pain in labour is a purposeful, useful thing…such as preparing a mother for the responsibility of nurturing a newborn baby," (Dr Denis Walsh-Associate Professor of Midwifery, United Kingdom, July 2009).
OMG! (Oh my god!) WITRMBSATITDAA?! (Who in their right mind believes such a thing in this day and age?)
I feel a little nervous starting a series of blogs about labor pain management. The discussion many times becomes overwhelmed by extremes of beliefs that accuse each other of often untrue and imagined practices. On one side are those that passionately advocate for natural, unmedicated labor and on the other those that believe medicalized pain relief is often the best choice for most women. The former at its extremes paints a picture of scalpel wielding, episiotomy cutting physicians who want to expedite delivery in time for the first “tee-off”. The latter on the other hand portrays an image of incense burning, oil rubbing midwives who would go beyond the boundaries of safety to achieve natural birth.
In my experience neither of these portrayals is anywhere near accurate. However it’s the extremes that grab the headlines and leave pregnant women confused and sometimes forced to choose sides.
Forgive my slight detour but this is very similar to our current debate on healthcare reform. If one listens to the loudest voices the choices are either granny killing death panels on one side or gun toting poor people haters on the other. The majority of us want to hear a reasonable mature discussion where all sides are heard and acknowledged, (I know people tell me I’m naive!).
Over the next couple of blogs I will discuss what options may be available to manage pain during labor. From medications and epidurals to meditation and guided imagery. Whatever pain management technique you may be drawn to, knowledge is empowering.
Some of my patients tell me that they are used to being in control and are fearful that they have none when it comes to pain in childbirth. In my opinion, control is a function of knowledge and together with your readings (but not googling at random!) and discussions with your healthcare provider team you will feel in charge. It is important for you and your healthcare provider team to have a “shared mental model”. This means that all of you agree on a common goal: a healthy baby with a healthy and happy mom.