Pain Relief on Demand

When discussing pain relief in labor the epidural is the procedure that many people think about. This is where a small catheter is placed into the epidural space near your spine through a needle in your lower back. The needle is removed and the catheter is left in place and taped to your skin so that medication can continually be given through the catheter.

Epidural pain relief is used for many procedures and not just labor and delivery. It's use at the time of birth has been increasing since the 1980s. The pain relief provided is usually one of the more complete forms of pain relief. Some women would describe that they felt nothing, while others feel only pressure. How much a woman feels after an epidural can be dependent on many factors, including the types of medication given through the catheter, the timing in labor and her anatomy.

There are benefits and risks to this form of anesthesia, known as a regional block because it only numbs a certain region of the body. The benefits are the pain relief with few side effects on the mental faculties of the woman. She can be awake and usually thinking clearly without the pain of labor. The risks are mainly medical complications that range in frequency and severity. The most common side effects are usually the most minor, like drops in the mother's blood pressure. Most hospitals where epidural anesthesia is employed have safe guards in place to help prevent some of these minor complications. With careful monitoring, other complications can be watched for and treated by the anesthesia team at the hospital.

One of the complications that has cropped up where epidurals are concerned is the increase in cesarean births associated with epidural anesthesia. Some studies have indicated that using an epidural for pain relief in early labor can increase the likelihood of a cesarean delivery. This has lead some hospitals to require a woman be further established in labor, usually 4-5 centimeters, prior to receiving the epidural for pain.

Enter the American College of Obstetricians and Gynecologists (ACOG). ACOG issued a press release in January 2002 stating that they supported the use of pain relief on demand. While citing that there may be medical contraindications to the use of epidural anesthesia in labor for some women, women should not be denied the use of pain relief, including epidurals simply because they are in early labor. Previously ACOG and the American Society of Anesthesiologists (ASA) released a joint statement stating basically the same thing.

Prior to active labor, the point where epidurals might be delayed until, there are many other options for pain relief:

• Transcutaneous Nerve Stimulation (TENS)
• Relaxation, Breathing, Attention Focusing
• Movement, Massage
• IV Medications (Stadol, Demerol, etc.)

ACOG also believes that the use of a doula, a professional labor support person, can help in labor. Other studies have shown that women who use a doula have a lower incidence of epidural requests as well as cesarean deliveries. The use of a doula would be another way to make your labor more comfortable until the point at which a woman felt an epidural or other medication was of benefit to her.

Whatever route a woman chooses when dealing with the pain and discomfort of labor, it is clear that she should have all of her options open to her at all points of labor, barring medical indications. A woman's choices and requirements for pain relief are as wide and as varied as there are women who labor. The one size, or in this case centimeter, fits all mentality simply won't hold up in labor.