Pain management options with midwifery

A common misconception when planning a delivery with a midwife is that pain management options are not available for labor.

All pain medication options are available to women, whether they have a midwife or a physician. Choosing the type of medication that works best to meet your needs is an important factor when considering pain management options.

Comfort measures without medication

You can use comfort measures and labor support during childbirth with the help of your labor partner or coach. Comfort measures can enhance the effects of anesthetic or medications you choose for labor.

Comfort measures used during labor may include:

• Listening to your favorite playlist.
• Soft lighting with battery-operated candles or strand of lights.
• Hydrotherapy with a bathtub or shower.
• Breathing in a pattern.
• Changing position through walking, sitting or rocking in a chair.
• Using a labor ball.
• Counterpressure with a tennis ball.
• Diffusing or applying essential oils.
• Bringing a blanket, pillow or laboring gown.

Comfort measures with medication

Options for pain management during labor may be based on how labor is progressing, including:

• Continuous labor epidural
  A needle is placed in the lower back to allow a catheter to be passed through to the epidural space. The catheter provides a continuous infusion of a combination of local anesthetic and narcotic medication. Women who receive this type of epidural maintain the ability to feel touch and pressures while relieving the pain of labor.
• Intrathecal narcotic
  If labor is progressing quickly, a one-time injection in the lower back provides a rapid loss of feeling below the waist. This type of medication usually lasts two to four hours, and it is used for women who have advanced cervical dilation and may deliver soon.
• IV narcotic
  This pain management option may be used by women who are not sure if they want an epidural. IV narcotics are administered through an IV in a vein up to three times during labor. This can help women relax in between contractions and make contractions more tolerable.
• Nitrous oxide
  Commonly known as laughing gas, this orderless and tasteless gas is inhaled through a hand-held mask during labor. The gas takes effect within a few minutes to dull the pain and reduce anxiety, but it does not eliminate the pain. It can be used once as needed or continuously during labor.

Planning ahead

Whether you plan to use pain management options for labor, taking a childbirth education class is a good step to learn more about your options. Classes are available to teach women and their labor coach how to cope with labor pain. If your birth plan includes your preference and goal for pain management, your labor coach and the care team can support you in that path during labor.

Being familiar with the options for pain management and asking questions will help you select the option that works best for your needs. Your care team can provide the care and support to help you manage your comfort during labor.

Lisa Brown is a certified nurse midwife in Mankato, Minnesota.