Alternative Pain Relief to Epidurals!

DISCLAIMER: Please make sure you discuss all your options and ideas for pain relief with your medical care provider to ensure that you are safe and properly cared for.

A lot of people have heard of epidurals as being the medical God-send making childbirth tolerable.  It’s true, it does provide great pain relief in almost all cases.  However, there are also several risks and results associated with epidural use and, depending on what is important to you for your birth, they can affect the outcome of birth.  Here is a quick list of pros and cons of epidural use:

PROS:
– pain relief
– able to get some rest if labour has been long
– can relieve anxiety and tension
– can lower blood pressure in birthers with hypertension

CONS:
– first: it’s a needle into your spine
– can affect baby’s & birther’s heart rates
– can slow labour progress requiring oxytocin augmentation
– can create longer labour
– requires IV for fluids, heart rate monitors, possible bladder catheter
– restricts movement & options for positions in pushing stage
– makes pushing harder due to numbness
– pain at injection site
– doesn’t always work completely
– increases risk of instrumental birth
– possible shivering, itching , fluid retention

“So what am I supposed to do then, Vanessa?  Labour is hard work and I don’t love pain!”
– You

Ah, good question.  Of course no one is really fond of pain, but it’s pain with a purpose and it’s natural — not like breaking bones or when the body is saying there’s something wrong.  Here are some alternative pain relieving methods:

Laughing Gas
A 50/50 mix of nitrous oxide and oxygen is an option available at the hospital.  It may not make the pain go away, but it more so makes you not care about it so much.  Side affects are not common, but may include sedation, dizziness, nausea, and vomiting.  It’s only in your system for about 35 seconds, so most people have little to no lasting effects.  According to the Journal of Midwifery & Women’s Health, “Nitrous oxide labor analgesia is safe for the mother, fetus, and neonate and can be made safe for caregivers. It is simple to administer, does not interfere with the release and function of endogenous oxytocin, and has no adverse effects on the normal physiology and progress of labor” (Rooks, 2011).  Check out more facts here.

TENS Machine
TENS stands for Transcutaneous Electrical Nerve Stimulation (transcutaneous means “on the skin”).  This handheld device is a non-medical option that stimulates your nerves via an electrical current through four soft pads stuck to your skin.  It’s great for relieving some of the muscle tension in the back and hips.  Gotta take it off if going in a bath or shower, but the pads can be re-stuck.  More info and details about TENS here.

Sterile Water Injections
This is one that not all hospitals or doctors/midwives can offer, but you can request. It would be best to make the request prior to labour starting (in a prenatal appointment with your care provider) to see if it is an option for you.
The procedure involves four syringes of sterile water being injected just under the skin of the lower back / sacrum area.  This can be great especially for intense back labour, and can provide pain relief for up to 6 hours!  Relief is immediate, but the injection pain is comparable to wasp stings.  Here is an interesting research-based read from the UK.

Heat
Most people have heard about using heat to help with pain.  A rice sock or Magic Bag type thing that can be heated and held or moved around the birthing person’s back during contractions and offer really nice comfort.  And most hospitals (and homes!) have microwaves to heat those up.  Hot showers offer similar comfort.

Bath / Birth Pool
Labouring in water can be really great pain relief.  Floating in water offers relief through buoyancy, and warmth which can relieve tension.  Some hospitals have tubs now, and pools are available for home births.  Care providers may recommend against getting into a pool or bath if waters have broken due to a slightly increased risk of infection.

So there are a few!  What are some other pain relieving comfort measures that you have used or heard about?  Comment below 🙂

The WHY & HOW TO Prep for Birth

I recently saw this very interesting infographic on a fellow doula collective’s page:

costs

Puts things in perspective, huh?!  So true though, that we spend so much time, effort, and money on a wedding day, yet birth is thought of soooo differently!

Birth will be the most memorable day of your life — likely even moreso than your wedding day.  You are, afterall, bringing a human that YOU MADE into the world.  Adorable.  So why not at least put as much loving preparation into it as you might for a wedding.

1. Take prenatal classes!
If you are having your first child, do yourself a favour and take prenatal classes.  For reals guys, they are worth the money.  It’s not even that much money (usually less than $300/couple)!  I am partial to the ones at Childbearing Society in Vancouver (I am apprenticing to teach with them), but there are so many options out there depending on your specific birth plans.  You will learn about what birth REALLY looks like (nothing like what Hollywood shows us), what to expect, how your partner can support you, not to mention meeting a bunch of other people who are also preparing to have a baby!  Speaking as a doula, they help get the bulk of the information covered so that we can discuss the specifics of what you would like YOUR birth to be like in our prenatal visits and address all your questions and concerns.  Prenatal classes — they’re fun and chill and SUPER informative.

2.  Prepare your body
Birthing a baby is unlike anything you have ever done in your life.  You wouldn’t go do a marathon without training (I hope!), so why would you go into childbirth without doing some preparation?  Whether it’s prenatal yoga, swimming to feel light and buoyant, personal training at the gym to work your squats n’ lunges, or doing some preparatory stretches and exercises at home, it’s all useful.  Add to that some breathing exercises.  YES, I said it– Breeeeaathiiing.  It’s only, like, the most important thing to keep us alive and to achieve and maintain a more relaxed physical and mental state in times of challenge.

3.  Prepare your mind
Tell all your friends/moms/aunts/grandmas to keep their traumatic birth stories to themselves.  Birth has changed a lot over the years, every person and baby are different making every birth different, and you can make decisions for your own body.  Read/listen to positive birth stories, educate yourself on the process and your options (with a doula!), go to pregnancy and breastfeeding group meetups.  Read as many or as few books as you like!  Ask people for specific recommendations–here some are mine.  Open up the birth conversation with your partner about what you both feel and envision.  Acknowledge your fears, talk about them if you like, then set them aside, and get yourself into a positive frame of mind about birth because worrying isn’t going to do anything good for you in labour.  All you can do is prepare your mind so that you can make good choices for yourself and  be in a good headspace for birth–it truly helps.

4.  Prepare to be busy
In a prenatal class I was attending, one partner said that she was preparing for the birth of their baby by coming home from work and keeping busy with household tasks…instead of sitting and relaxing.  Uhhhh AMAZING IDEA!  It can be a shock to the system when you realize just how much work it is having a newborn at home.   You’re going to (likely) be at home all day with the baby wishing your partner was there to help, so partners can expect to be needed — even if they’re tired or have had a stressful day.  Keep it in mind and expect it.  Make the necessary arrangements to have family/friends help out, or hire a postpartum doula if you need extra baby help (overnight even!).

Doulas & Caesarian Birth

A lot of people believe that a doula is only useful if a natural, holistic, vaginal home birth is the goal, but it’s not the case.  Quite the contrary!  As birthing mothers and their babies are all different, so doulas offer support in all variations of birth, including Caesarian sections.

A Caesarian is the ultimate in birth intervention since it is the last resort (or should be) medical approach.  So is a doula still useful if a mother is having a C-section?  YES!

First, let’s ask a couple of questions:

  1. Is the C-section planned?
  2. Are there any pre-existing medical conditions?
  3. Is the C-section a doctor’s recommendation or a personal preference?

If a C-section is planned, then birth is not likely to begin spontaneously.  The process will be medically induced and on the mom’s and doctor’s schedules.   When labour is allowed to begin and progress naturally, the body and brain have time to release all the necessary hormones that are crucial for cervical dilation, pelvic opening, and baby descending.  Plus, we have to remember that baby is also getting some of the hormones that mom is releasing, so in a way, they are already communicating with each other about the upcoming process!  AMAZING, huh?!  C-section babies often need more time to get breathing on their own, get adjusted to being outside the womb (because they didn’t have the hours of prep), and can take a bit longer to start breastfeeding.

If there are serious medical conditions that cause a caregiver to recommend a C-section, then it can be beneficial to follow those recommendations.  However, the choice is still mom’s!  If a caregiver is recommending a C-section for a subsequent birth because a prior baby was a C-section, it is still possible to have a vaginal birth after Caesarian (VBAC).  My mom did it after two C-sections!  There are many factors that can affect the outcome of this including how much time has passed since and method of uterine stitching that was used in the previous birth, whether this birth has been induced or augmented, and general health of the mother, but if a mother really wants to try to have a VBAC, it should be encouraged!

And if the C-section is a personal preference, we should first ask “why?”  Is it a fear of pain?  A scheduling matter?  Or a worry that birth will destroy your vaginal tissue?  Whatever the case may be, the opportunity to birth one’s baby should be celebrated!  No need to dread it.  The fear of the pain is what makes the pain worse.  Knowing that it’s pain for a purpose and perfectly natural can make so much difference.  As for scheduling, well, we can’t control everything in life (I know, I wish we could too sometimes).  And about destroying the “downstairs business”, there are ways to heal and return things to normal — they may be a slightly different “normal”, but pelvic rehabilitation does exist and it is important.

Despite what the movies and TV might make us think, a vaginal birth is a lot more peaceful and calm than a surgical birth.  Surgery is SURGERY afterall.  There’s the bright operating room, probably 6-10 medical professionals in the room, anesthetic, IV tubes and needles, heart monitors,  stitches, and then recovery time.  It’s definitely not the “easy” way out of birth.

“So what? Where would a doula come in then, VANESSA?” — you
Ok ok, I’m rambling.  Doulas provide parents with information and education on the birth process, including Caesarian birth, and postpartum procedures.  If ultimately a mother decides that a C-section is right for her and her baby, then she will have made that decision from an informed place.  Sometimes, depending on the anesthesiologist, a doula will be allowed in the operating room.  A doula will be there to help keep the birth process a human experience, keep the calm and normalcy.  She may describe what is happening on the other side of the curtain in a calm manner.  She may whisper in mom’s ear that this too is a beautiful birth experience and that her baby will soon be in her arms.  She may remind the partner to go with the baby and talk to her while the nursing staff clean baby up so she has a familiar voice to connect with.  She may tell the partner to open up that shirt so baby can get on his/her chest ASAP.  And after the operating room business is complete, a doula will be with you to help establish breastfeeding and additional bonding with baby and then do a postpartum visit with you a day or two later to make sure all those things, and healing, are going well.

Moral of this (long) post:  Don’t underestimate the usefulness of a doula!  Besides knowledge, a doula can provide confidence and comfort in an otherwise stressful situation full of unknowns.

The 5 Ps of Doulery

DOULERY: (noun) a doula’s work.

I can invent a word!  Midwifery is just as weird a word and everyone is ok with it.  Anyway….
Today’s post brought to you by the letter ‘P’.  There are a lot of key elements of birth that start with the letter ‘P’, so let’s explore some!

Positive
No good can come out of listening to your grandmother’s story of birth in warn torn Poland, or a waitress who had to have a Cesarean because her baby was in distress after 46 hours of labour, or a stranger on the bus telling you how much she tore.  Good grief, be quiet world!  People are all too willing to share their horrible experiences without thinking that maybe you might already have some anxiety about this process.  Surround yourself with positive stories (or no stories at all!) and visualize what you want your experience to be.  It’s your process and your baby’s, nobody else’s, and every birth is different.  I think the stories and images on Apple Blossom Families’ site are amazing and beautiful and empowering.

Peaceful
Things can get hectic when birth is imminent, especially in a hospital setting.  There is a lot going on in mom’s body as well as in her surroundings with people rushing around getting things ready, care providers checking in, family members coming and going. It’s important to make your birth as peaceful as you need.  I say “need” because peace is a relative term — some moms want to have distraction at certain points, while others want privacy, silence, and darkness.  But one thing is for sure, when mom is feeling peaceful, labour will likely progress nice and smooth because her process is not being interrupted unnecessarily.

Profound
Accordingly to a website called www.google.com, “profound” means 1. (of a state, quality, or emotion) very great or intense, or 2. (of a person or statement) having or showing great knowledge or insight.  Birth is both!

Of course we all know that it’s very intense, but it also demonstrates the great knowledge and wisdom of the female body.  It is doing things that it has perhaps never done before — stretching, opening, shifting — all the while knowing exactly what hormones should release when to open the bones of the pelvis, soften the cervix, communicate with baby who is getting into position, produce milk, and so on.  Amazing.  And once baby is born and the hard physical work of labour has ended, of course there is the profoundness of meeting the new human you made!

Proud
Birth is birth is birth.  Whether it takes place at home, in a hospital, or in the back of a cab.  I’ve read too many stories about mothers who have been shamed or are disappointed that they had a planned Ceasarean, or their birth plan changed last minute.  We can’t plan or predict everything.  Sometimes we gotta do what we gotta do in order to protect mom and baby, and sometimes that means going for the epidural to be more comfortable.  The main thing is that all moms should feel proud that they birthed their child the way they wanted to, proud of their wise bodies, and partner’s should be proud of all mom did to bring that baby into the world.  Be proud of yo’ birth!

Postpartum
Just because the baby is out doesn’t mean that we are done taking care of mom.  Au contraire!  Moms may be superwomen, that’s for sure, but we cannot forget that they need support just as much postpartum, if not more, than when they were pregnant.  In addition to having to care for a tiny human being, there’s figuring out breastfeeding, healing from birth, sleep deprivation, and hormonal adjustments on top of all the other everyday life things.  We as a community need to make sure that new parents have enough support by providing nutritious meals, helping around the house, and offering rides to doctor’s appointments — not just a flouncy baby shower.  New moms also need to know that there is a lot of assistance available to them: breastfeeding clinics and lactation consultants, pelvic floor physiotherapy for healing muscles, counselling for any postpartum depression, and of course, postpartum doulas.

***

Of course there are like a bazillion other words that start with the letter P involved in pregnancy and birth, but I like these key words the best.  They are all good reminders of where the focus should be placed.  Make us feel all zen — Oooommmmmm….

5 Reasons Why Doulas are Useless

(1)    Your body already knows what to do.  It is wise and you have an innate sense of what needs to be done to bring your baby into the world.

…but then the birthing process starts to get really uncomfortable and you don’t know what to do to cope with these new and ever intensifying sensations because you’ve never done this before / this is different from your last birth and you’ve tried taking a shower and sitting on a stupid yoga ball and breathing but nothing is helping!

…then you might need a doula.

(2)  Your partner is already so encouraging and supportive.  That’s just one of the reasons why you married / shacked up with / love this person.  They truly know your great strength and what you are capable of.

…unless he/she doesn’t know exactly what to do or say as the birthing process becomes more active because he/she isn’t 100% comfortable with this new situation because he/she didn’t go to med school and you can see right through his/her fake confidence and then there’s a sudden flash of doubt and–OH MY GOD!

…then you might need a doula.

(3)  You are birthing at a hospital and there are so many trained medical professionals to make sure that you are taken are of.

…except that your doctor is busy with several other births too and that annoying nurse keeps coming into the room to poke your cervix and call you “sweet pea” and ask so many questions, plus there’s that hospital smell and why is it so bright? and so many people coming in and out and in and out and –GET OUT!

…then you might need a doula.

(4) You are an intelligent woman capable of making informed choices for her birth.

…however, you’re new in town and you don’t really have anyone you truly trust to talk to on a daily basis which is making your confidence waiver and what are all your options in this city and maybe you should listen to your mom and just go back to Edmonton for the birth–NO!

…then you might need a doula.

(5)  Birth is beautiful and wondrous no matter how it happens because — BABY!  Every woman and every birth has their own unique set of requirements and, no matter what, it will be a profound experience you will remember for the rest of your life.

…although it can be stressful and there are a lot of things going on and what if? what if? and maybe you’ll take that epidural but no but YES but no and how much longer?!

…then maybe you need a doula.

***

Having a doula has been shown to reduce the use of epidurals and oxytocin, reduce the risk of Caesarean section, and increase the likelihood of a spontaneous vaginal birth.  As a doula, I provide you with information to make informed choices and provide non-judgmental support to help make your birth experience as stress-free as possible.