Labor pains

Inform yourself about labor!

What are the signs of labor?
*Contractions get longer, stronger, and closer together. If you think you may be in labor, drink a large glass of water and lay on your left side. If it stops, you know your body is doing preparation "toning" contractions. Preparation contractions stop and start, while labor contractions get longer, stronger, and closer together.

*Water breaks (rupture of membranes)

What are signs of labor coming soon?

*loss of mucus plug (clear mucus)

*bloody show which is mucus and blood (indicates cervix is dilating)

*diarrhea

*low back ache

*menstrual cramping

When am I overdue?

***The average first time pregnancy lasts forty-one weeks and three days*** Prior to 37 weeks the pregnancy is considered pre-term. Full term pregnancy is from 37 to 42 weeks. Your estimated due date is at the 40 week mark. Post-term or post-dates is when you are past 42 weeks. However, when you pass the estimated due date of 40 weeks, care is taken to watch for large babies and/or low amniotic fluid.

What causes the pain of labor?

*Labor pain is from the uterine muscle contracting and pulling up the lower segment of the uterus to dilate the cervix.

*Not relaxing your muscles/having muscle tension increases pain

*Being afraid, anxious, and stressed increases pain

*Medical procedures such as blood draws, continuous fetal monitoring, vaginal exams, and episiotomy all cause pain

*Being forced to stay in bed increases pain of contractions

*Having strangers enter your laboring room to examine you

*Not having labor support

*Not being allowed to labor in water

*cytotec causes more painful contractions

*pitocin causes more painful contractions

Is labor pain beneficial?

Natural labor pain is beneficial as it fuels the feedback mechanism:

*The feedback mechanism is very important to dilation. Pain at the dilating cervix tells the brain to make more oxytocin, which fuels labor, which increases dilation.

*Pain allows a woman to assume proper labor positions instinctively

*Pain raises the endorphin levels (natural pain killers), which releases more oxytocin, which fuels labor

*Stretching pain gives the urge to push (which is why women with epidurals have a greater likelihood of having their baby pulled out by a vacumm extractor as they don't feel this stretching pain)

Artificial labor pain from cytotec and pitocin stop the feedback mechanism, so your brain isn't producing natural oxytocin (pitocin) at all; instead the medication is doing the job. Due to this, your brain doesn't release natural pain killing endorphins, which is why women get epidurals for pain relief when artificially induced (their own body isnt giving them pain medication naturally).

How can I decrease the pain of labor?
*Birth is less painful if you feel safe in your birthing environment
*Education- knowing what will be happening to you and your body will help alleviate fear. If you decrease fear, you decrease tension, which decreases pain. Take childbirth classes & read Gentle Birth Choices by Barbara Harper.

*Hire a doula

*Slow deep breathing

*Relaxation

*Stay active! Change positions!

*Bellydance

*Listen to music

*Walk

*Nutrition-Good nutrition helps to decrease pain in labor by feeding your muscles. Not feeding your body lowers your pain threshold. You need energy during labor.

*Decrease the length of labor by getting rest, eating and drinking fluids.

*Excellent hydration allows the perineal area to stretch minimizing the chances of tearing.

*Emptying the bladder reduces pain and helps the baby move down further into the pelvis. It will also help to prevent trauma to the urethra during pushing.

*Emptying the bowels allows more room for baby and thus shortens labors
*Make noise, groan, sing, moo

*Massage

*Laugh

*Kiss

*Hug

*Counterpressure on the lower back
*Place heating pad or rice sock on the back or abdominal areas
*Water helps to alleviate pain by making your body more buoyant and relaxed. Use a birth tub or shower.
*Visualize your body opening up and letting your baby be born.

*Relaxation will allow a woman to "open up" and dilate. In an atmosphere of tension, women tense up and have more difficult labors and births. Use candles, music, dim lights and aromatherapy to create a relaxing atmosphere.
*Support-Love and encouragement is needed

*Avoid pitocin during labor

*Avoid cytotec induction

What do I need to know about hospital inductions?

What are the risks with epidurals?

Risks for the mother due to epidural use:

hypotension (severe drop in blood pressure)

maternal fever

need for antibiotics due to maternal fever

yeast infection secondary to antibiotics

allergic reaction to antibiotics

spinal headache

itching

nausea

vomiting
backache
fluid overload from IV therapy
infection from epidural site
respiratory arrest

death
anaphylaxis
nerve damage from needle insertion

future need for blood patch to stop spinal headaches

fetal distress

C-section

urinary tract infection (from the urinary catheter which is placed for epidural)

bruising on arms (from IV which must be placed for an epidural)

swollen breast tissue from increased IV fluids, making breastfeeding difficult

long term urinary incontinence after epidurals

Risks for labor due to epidural use:

slow prolonged labor

longer pushing phase

lead to increased Pitocin use

lead to low-forceps deliveries

lead to vacuum extraction

increase in C-section

fetal heart rate problems

fetal distress

baby cannot descend into birth canal

increase uterine infection

increase risk of OP position (face up, instead of face down)

increase incidence of deep vaginal tears that extend into rectum

decreses pelvic diameter when forced to lie on her back

epidural fever (25% have fever in four hours; 50% have fever in 8 hours)

epidurals cause the inability to dissipate heat generated in the labor process

loss of sweating over the lower half of body

Risk for baby :

reduced muscle tone at birth

decrease sucking

interference with breastfeeding

lowered neurobehavioral scores

increased incidence of jaundice

increased risk of needing bili lights due to jaundice

bili lights require separation from mother

higher risk of going to NICU

high risk of newborn fever: leads to blood draw and spinal tap of newborn

higher risk of newborn needing antibiotics

antibiotics means newborn needs an IV

higher risk of newborn getting thrush/yeast

epidural anesthetics do cross the placental barrier (1/3 maternal level)

48 hours is required to eliminate anesthetic

What are the risks of Pitocin?

The FDA removed its approval of Pitocin for the elective induction of labor in 1978. But it continues to be used for elective induction. I do not use Pitocin during labor.

The following are risks associated with Pitocin for both elective induction and labor augmentation:

Risks for the mother:

higher rate of complicated labors and deliveries

more use of analgesia or anesthesia because of the intensity of the contractions

postpartum hemorrhage when used with induction of labor

higher rate of ruptured uterus

higher rate of placental separation from uterine wall

water intoxication

(pitocin is an anti-diuretic--leads to irregular heart beat, vomiting, excessive swelling, and difficulty nursing)

Risks for the baby:

fetal distress

higher rate of jaundice in the newborn

low Apgar scores at five minutes

permanent central nervous system damage

brain damage

fetal death

decreased platelet aggregation (clotting capacity)

Judicious use of pitocin?

Are there situations in which the benefits of pitocin outweigh the risks? Yes. Pitocin can get a stuck labor moving again. Pitocin can be useful when waters are broken and contractions are weak; in this case, the danger of infection may be avoided because pitocin helps the baby be born in a timely manner. However, for midwives, pitocin is last on the algorithm, only to be used after natural methods have failed. Midwives use: nipple stimulation, herbs, castor oil, etc. With all this said, there is a time for the judicious use of pitocin (which should be rarely, and only after alternative natural methods have been exhausted). When pitocin is needed, a hospital transfer must occur, as pitocin for augmentation purposes is only given in a hospital.

*What are the risks of a C-section?

I do everything possible to facilitate a vaginal delivery. I do not encourage elective C-sections. The C- Section Rate in the US has exceeded 30%. There are circumstances which warrant a C-section, but statistically these circumstances should be approximately 3% of births not 30%! A rate of 30% and climbing is simply unjustifiable.

Risks of a C-section for a baby:

accidental surgical cuts

respiratory problems

higher risk of not breastfeeding

developing asthma

Risks of a C-section for a woman:

maternal death

emergency hysterectomy

blood clots

stroke

injuries from surgery

longer hospital stay

infection, infection, infection!!!

bowel obstruction

pain at the incision site

poor birth experience

decrease contact with newborn baby

depression after the birth

potential for decreased maternal bonding

Future reproductive complications and risks:

risk of infertility

ectopic pregnancy

placenta previa (placenta attaches at or near cervical opening)

Placenta accreta (placenta grows into the wall of the uterus)

placental abruption

rupture of the uterus

Future pregnancy risks:

Higher risk of stillborn

lower birth weights

increase risk of premature birth

increase risk of birth malformations

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