Planning for a modern maternity

Moms should customize their plan for labor pain

A baby on the way means it’s time to prepare. Time to spiffy up what will be the baby’s room, buy clothing fit for a newborn and stock up on diapers. But it’s equally important to get ready for what could be a long and arduous labor and the (ahem) unique sensations of giving birth.

Many women rank labor as the most painful experience of their lives. Powerful uterine contractions, cervix dilation and pressure from the descending baby can add up to intense feelings unlike anything a woman might have experienced before, particularly since the birthing process occurs in an area of the body that is loaded with nerve endings. Still, it’s difficult to predict how much pain each woman will feel, and even for the same woman, the amount of pain can vary from birth to birth, says Farrah Deselle, MSN, RN, CLC, the perinatal education coordinator at Catholic Medical Center.

Some discrepancy in the amount of pain women feel during labor can be chalked up to physiological differences, says Nora C. Fortin, MSN, RNC-OB, nurse director at Portsmouth Regional Hospital. Plus, pain is subjective. But it can also be influenced by emotional factors such as how much support the woman has, who accompanies the woman to the birth and if the woman has had children before, what her previous experience was like, Fortin says.

Given labor’s reputation for causing great pain and the uncertainty that surrounds childbirth as well as the woman’s impending life with a new baby, it is understandable that expectant moms might show up at the maternity ward filled with trepidation. But fear and anxiety prompt a hormonal response that heightens the pain response, Fortin says. “Keeping moms calm, keeping them relaxed and getting them to focus on other things during the labor pain” doesn’t make the pain go away exactly, but it at least helps prevent moms from compounding the pain, she says.

To help ease their minds and boost their confidence, just as athletes gear up for a big competition, women should mentally and physically ready themselves for labor, Deselle says. Those who learn about pain management and head into labor armed with a variety of tools that will help them cope with pain tend to feel less anxious, Deselle says.

They have a lot to choose from. Some women favor hypnobirthing, which promotes use of mindfulness and breathing to help expectant moms naturally stay calm and mentally disassociate from labor pain. Other women choose techniques at the opposite end of the spectrum such as anesthesia and epidurals, in which drugs are administered to mask pain. Still other ways to deal with labor pain include aromatherapy, acupuncture, massage and hydrotherapy, which aims to soothe laboring moms with water. A relatively recent addition to US hospitals, nitrous oxide, is similar to the “laughing gas” used by dentists and is quickly becoming a popular way to handle labor-associated pain (see sidebar). Women can also hire a doula, or birth attendant, to provide support throughout the pregnancy, during labor and for a brief time after the birth, potentially enhancing confidence and feelings of well-being.

It’s great that women have so many choices, given that they are likely to want to vary their method for coping with pain as labor progresses. And what a woman chooses and when is, by and large, up to her. “It’s really a very individual choice,” Fortin says. “What works for me in labor might not necessarily be what works for you, and there are so many different things that can impact that — age, our physical shape, our pelvis, how big our baby is, the baby’s position — all of those things.” Many moms begin labor relying only on breathing exercises or hypnobirthing techniques, but then feel that they want to switch gears and try something different, Fortin says. “And there are some mothers who come in and say, ‘I don’t want to do any of this. I want an epidural,’” Fortin says. “It all depends on how they know themselves, who they’ve talked to, if friends have told them that they should do one thing over another” and whether they’ve had children before, she says.

Women who pigeonhole themselves and vow to follow only one particular route no matter how they feel during labor do themselves a disservice, Deselle says, because they run the risk of panicking if their plan doesn’t work as they’d hoped and they are suddenly left thinking What do I do now? “We try not to have them attached to one particular way,” Deselle says, but rather to learn about different approaches so that if they want or need to switch tactics during labor, they can easily do so.

It’s important not to overlook the emotional and psychological aspect of birth, Deselle says. Moms who head into labor determined to just breathe their way through it and eschew all pain killers but then end up needing an epidural, say, or a cesarean, should be able to feel that they did the best they could, Deselle says. Before the big day comes, women should question why they so strongly want to avoid pain killers, an epidural, a cesarean or whatever. “Ask ‘Why do I want to avoid that?’” Deselle says. “What are you telling yourself it would mean about you if you had a cesarean birth? Are you putting yourself in a certain category and, if so, why is that?” Focus instead on the fundamentals that are important to you and that will allow you to be the best mom, she says, rather than being determined to stay a certain course no matter what labor’s progress brings.

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