$Unique_ID{PAR00436}
$Pretitle{}
$Title{Pregnancy:  The Eighth Month:  Ask the Doctor}
$Subtitle{}
$Author{
Editors of Consumer Guide
Ellis, Jeffrey W
Ellis, Maria}
$Subject{Eighth Month Ask Doctor Pain Relief Methods Childbirth unique labor
delivery relievers contraction intensity contractions tolerance drugs
pain-relieving risks medication medications Analgesics Morphine meperidine
Anesthesia anesthetic anesthetics local regional general paracervical pudendal
block infiltration perineum episiotomy spinal epiduralcaudal cesarean vaginal
delivery Visit Visits}
$Log{
Levels of Anesthesia*0043601.tif}

Miracle of Birth


The Eighth Month:  Ask the Doctor


What Methods of Pain Relief are Used in Childbirth?


     Just as each pregnancy is unique, each labor and delivery is unique, and
it is often difficult to determine beforehand if pain relievers will be
needed.
     The circumstances of your labor and delivery will ultimately affect the
types of pain relievers used.  The intensity of your contractions, the
condition of the baby, the speed of your labor, the type of delivery, and your
own tolerance of pain will determine what, if any, drugs are used.
     It is important to keep in mind that pain relievers, like other drugs
taken in pregnancy, have effects on you and may therefore have effects on your
baby.  None of the pain-relieving drugs used during childbirth are
completely without risk, and, in general, the stronger the drug, the greater
the risk of complications.
     On the other hand, medical advances have greatly reduced the risks
associated with these medications, and there are times during labor and
delivery when the administration of pain relievers is essential for the
comfort and safety of mother and baby.
     Your primary goal, therefore, should be neither a painless birth nor the
refusal of all drugs regardless of the circumstances.  Rather, you should
strive for a safe labor and delivery with a tolerable amount of discomfort.
Practicing and using various breathing exercises and methods of relaxation
(see The Second Trimester:  Planning and Preparation) can play a vital role in
helping you to reach that goal, since they can help make childbirth more
comfortable and may decrease the need for pain relievers.
     During your prenatal doctor visits, you should ask your doctor about his
preferences regarding medication.  You should also inform him of your
preferences if your labor and delivery are proceeding normally.

     Analgesics

     Analgesics, the mildest form of pain reliever used, decrease the
sensation of pain.  When used during labor, these drugs are usually injected
into a muscle or directly into the bloodstream.
     Morphine and meperidine are the two analgesic drugs most commonly used in
obstetrics.  Shortly after injection, these drugs will reduce your pain,
though you will still be aware of the peaks of your contractions.  You may
feel nauseated and dizzy shortly after receiving the injection, but these
sensations usually pass quickly.  Pain relief may last from one to two hours,
after which another dose may be given.  Analgesics are generally used only in
the early and middle stages of labor, since using them nearer to delivery can
interfere with the baby's ability to breathe at birth.

     Anesthesia

     Anesthesia means the absence of sensation or feeling.  Depending on where
they are injected, anesthetic drugs provide varying amounts of pain relief for
different lengths of time by causing numbness.
     Anesthesia maybe either local, regional, or general.  In local
anesthesia, nerves supplying a certain small area of the body are affected.
Three types of local anesthesia are used in childbirth--the paracervical
block, the pudendal block, and infiltration of the perineum (the skin and
muscles below the vagina).
     In the paracervical block, the doctor injects the drug on either side of
your cervix, thus blocking pain sensations from the uterus and cervix.  The
paracervical block is generally used during the later stages of labor or if
analgesics are no longer enough to make pain tolerable in earlier stages.
     To block pain in the vagina when the baby's head emerges or when an
episiotomy is performed (see Labor and Delivery), an injection into the vagina
to block the pudendal nerve may be used.  With a pudendal block, you will not
feel pain, but you may feel some pressure.  Once the anesthesia is injected,
it takes about ten to 15 minutes to take effect.
     If an episiotomy is necessary and the delivery is progressing too rapidly
for a pudendal block to be used, an anesthetic may be injected into the
perineum to relieve pain, although pressure and burning will still be felt.
This type of anesthesia is not as strong as the pudendal block, but it takes
effect much more quickly.
     A more powerful form of anesthesia used in childbirth is regional
anesthesia.  For regional anesthesia, a drug is injected at certain locations
that contain nerves supplying large areas of the body.  The three forms of
regional anesthesia used are the spinal block, the epidural block, and the
caudal block.  Any of these will cause you to lose all pain from labor and
delivery, although you will still feel contractions and pressure.
     In the spinal block, a drug is injected directly into the fluid-filled
space that surrounds your spinal cord.  This effectively blocks all pain from
the uterus.  By adjusting the amount of drug used and the position of the
patient during the injection, the spinal block can also be used to block pain
in the abdomen.  It can, therefore, be used for either cesarean or vaginal
delivery.
     The epidural and caudal blocks involve injection of a drug into a space
outside the covering of the spinal cord.  By adjusting the amount of drug used
and the position of the patient when it is injected, the epidural can block
pain from the toes all the way to the navel, so it is suitable for either
vaginal or cesarean delivery.  The epidural can also be used to relieve
intense labor pains during the later part of labor, when analgesics can no
longer be used and local anesthetics have not proven adequate.  The caudal
block is generally used only for a vaginal delivery.
     General anesthesia, the strongest pain reliever, causes you to lose
consciousness.  This is usually done through the administration of various
gases.  General anesthesia is usually used only for emergency cesarean
sections or for complicated deliveries when there is an immediate threat to
the mother or baby.


This Month's Visit

During this month's visit, your doctor will probably:

  -  Check your weight.  By now, you will have gained 22 to 24 pounds.
  -  Check your blood pressure.  This should be at your normal prepregnancy
     level.  An elevated level may indicate preeclampsia.
  -  Check your urine for sugar and protein.  Protein in your urine may
     indicate preeclampsia; sugar in your urine may indicate diabetes.
  -  Ask about symptoms of pregnancy.  You may be experiencing shortness of
     breath and occasional heart palpitations.
  -  Ask how you are feeling.  Report any dizziness, blurred vision,
     headaches, or swelling of the face and hands, since these may be signs of
     preeclampsia.
  -  Ask about the baby's movements.  The baby should be moving vigorously; if
     you ever feel that movement is less than usual, inform your doctor
     immediately.
  -  Check the growth of your uterus with a tape measure.  By the end of this
     month, the top of your uterus should be just beneath your breastbone.
  -  Listen for the baby's heartbeat with a doppler or a stethoscope.  The
     baby's heart will now beat about 120 to 160 times per minute.
  -  Check the position of the baby by feeling the uterus.  The baby may
     either be in the cephalic (head-first), breech (buttocks-first), or
     transverse (sideways) position.
  -  Give you a blood test and perform a complete blood count to check for
     anemia.