All throughout your third trimester of pregnancy, the thought of your baby’s arrival is constantly in your mind. Getting to hold your newborn for the first time will be one of the best days of your life. But with the excitement of that new baby, you undoubtedly think about the labor that will get you to that point.
What do contractions feel like? How long will labor be for my first birth? What are my pain management options? Should I use medical interventions? What pain-relief strategies should I try first? during childbirth? What medical practices in pregnancy should I avoid?
I know these questions well, because I felt the exact same way! You want to have a great plan for dealing with pain, but you also need to have a thorough understanding of medical pain relief options that will be available to you too.
Even if your goal is to have a ‘natural’ birth, I’m so glad you’re here and learning about pain intervention options. It’s impossible to know what labor and delivery will be like for you. Planning for every possible outcome is the best way to birth smart.
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What does it mean to have a natural birth?
Natural birth in mainstream media has come to mean birthing without medical pain interventions. It means using breathing techniques, pain-coping strategies, and non-medical pain relief supports (such as hydrotherapy and massage). There are a wide variety of childbirth class options to help support your wishes for a natural birth, such as the Mama Natural Birth Course.
The one problem with this line of thinking? Setting yourself up for disappointment and the contrast that a birth that does utilize pain interventions is unnatural, tainted, or wrong. I bring this up because I fell into this trap, and processing my birth was difficult.
I had mom-guilt in my first moments of motherhood. Getting an epidural for me felt like failure. Now, I know this is FAR from the case, but because of the way I created my birth plan, I set myself up for this unhealthy thinking.
Planning for a natural childbirth with realistic expectations
This isn’t to say you shouldn’t create a birth plan that emphasizes a natural childbirth. Just make sure you understand what other options are available should things progress differently than you imagine. Be open to the idea of a change of plans. Know that childbirth is wildly unpredictable and often very long in first labors. Fluidity and flexibility in your birth plan will benefit you.
If you do hope to have a natural birth, simply wanting it is a necessary, but small first step. I made the mistake of wanting it, but not really preparing for it. Next time around, I still hope to deliver without pain interventions, but I will prepare myself to achieve this with a proper birth class aimed at a natural childbirth.
What are some of the first medical interventions I may need in labor and delivery?
About one in four labors in the U.S. requires a medical induction. This usually occurs when you go past your due date by more than 7 days (41 weeks). At this point, it is considered safest to get labor started with medical assistance. It is unusual and not considered safe to opt to start labor artificially before the 40-week mark. While there are providers out there that do allow for elected inductions, the medical community at large agrees that it should be avoided until you are past your due date at the very least.
Membrane sweeping, also known as membrane stripping, is usually one of the first ways that your provider will help get labor started. It is often offered at your 40-week prenatal check-up as a way to try to get things moving.
In a membrane sweep, your healthcare provider will use a sterile, gloved finger to separate the amniotic sac from the wall of your uterus. This can often provide your body the jumpstart that it needs to get labor going. When your body feels the sac release from the wall, a flood of hormones spark into motion that can start contractions.
It’s not a sure fire way to start labor, but it will increase your odds of contractions starting within 12-24 hours of the membrane stripping, This is considered a medical intervention, but is minimally invasive and can be just what your body needs to get labor started.
As your body prepares for labor your cervix naturally ripens. This is the softening of your cervix to allow for dilation throughout labor. This occurs unassisted as your body prepares for a spontaneous onset of labor. In some situations, your provider may medically ripen your cervix using an oral medication or suppository drug.
Alternatively, your provider may recommend ripening your cervix to help jumpstart labor with the use of a Foley catheter. This is basically a catheter with a balloon at the tip. The balloon is filled with water and is inserted, over time it stretches and ripens the cervix artificially. This is usually left in for around 12 hours and may dilate your cervix enough to trigger a rush of hormones your body that will bring on labor.
Pitocin is a medication that is an artificial version of oxytocin, the hormone responsible for starting labor in your body. If you are past 41 weeks and have tried the medical interventions listed above, you will be scheduled for an induction using Pitocin. You will check into the labor and delivery unit of your hospital and will be given Pitocin through an IV to help get contractions and labor started.
What can I expect if labor comes on naturally?
It is difficult to predict or know exactly when labor is going to begin and there are many ideas out there about how to help your labor start. The spontaneity of it is frustrating, but a natural part of the childbirth process.
Once your labor does begin, you will likely have quite some time when you are in the “early labor” period. This is when contractions are still far apart (10 minutes to even 60 minutes apart). They will feel milder, but they won’t go away with movement and hydration the way a Braxton hicks contraction will.
Pain management in early labor
Early labor is a time for distraction techniques. You don’t want to start in on any serious pain-coping strategies or even breathing yet. Utilizing your pain-coping strategies too early in labor can lead to exhaustion. Your goal now is to distract yourself and pass the time. This might be spent doing some meal prep in your home, a last minute clean/declutter of your space to bring baby home to, or a hilarious movie or sitcom series to distract you.
Another good idea for early labor is to rest or even sleep if possible. There’s no way to know how long your entire labor will be, so if you can sleep, it will be your best bet. You may find you’re too excited to sleep or rest, or that moving around feels better. If it feels right, movement in the form of yoga or a walk outside can be a great option. Movement can aid in dilation.
When should I go to the hospital?
The rule of thumb for going to the hospital is 4-1-1. This mean you are having contractions that are four minutes apart, last about a minute, for at least one hour. If this is the case, it’s time to call your provider and head to the hospital. You may feel most comfortable calling and heading in before this point if you live far from your hospital or are feeling anxious about your labor progression.
What medical interventions and pain relief are available in labor?
Once you head to the hospital, it is because you have most likely entered the active phase of labor. Active labor is when the bulk of your dilation takes place, typically going from 3-10 cm. This stage can last varying amounts of time and is when you will have options in the way of both natural and medical pain-relief strategies and interventions.
Let’s talk about the most typical medical pain interventions that will be available to you. Learning your options before creating your birth plan will help you determine your comfort level of various interventions. You will also know what a typical progression of interventions looks like, and at what points in your labor/dilation it makes sense to try certain options.
Fetal Heart Rate Monitoring
The most basic and routine medical practice during labor is Fetal Heart Rate Monitoring. When you arrive at the hospital you will be given a tight band to wear on your belly. This is so that the instrument used to monitor baby’s heart rate can be slid in and stay in place.
The benefit to fetal heart rate monitoring is that if baby’s heart rate changes or becomes abnormal, your provider can quickly take action to help baby. It is also useful in labor to know that baby’s heart rate is normal and steady so that mom can continue with the labor she desires. Fetal monitoring is generally done with the same device you’ve probably come to know from listening to baby’s heart beat during prenatal exams.
Constant vs. Periodic Monitoring
Whether or not your baby needs constant monitoring, or periodic monitoring will depend on your pregnancy. You will only need periodic monitoring if:
- You go into labor spontaneously
- Have no prior complications
- Do not elect to do an epidural
Periodic monitoring at least every 30 minutes is supported as best practice by the American College of Obstetricians and Gynecologists (ACOG).
Generally, continuous monitoring will be needed if:
- You have previously known pregnancy complications
- Any complication arises during labor
- You need Pitocin to induce labor
- You get an epidural
Find out what type of monitors are available to your hospital
Some hospitals do have wireless fetal monitor devices which is a great option for mamas who do need constant monitoring but want to be wire free. While this wouldn’t really matter if you have an epidural, during an induction being able to move about will be a huge plus!
There are also mobile monitoring devices available. Be sure to ask about this when you create your birth plan or let your partner know so that he can be in charge of asking your nurse during labor.
Narcotics/Opiates in Labor
One of the first options available to mothers during labor to help with pain beyond natural pain-coping strategies are opiates. This is typically administered through an IV in small doses and generally is only offered early in labor. This is because they are not strong enough to have a significant effect later in labor, and because it can affect your newborn baby.
Side effects related to the use of narcotics in labor for baby include:
- Decreased alertness and impaired ability to breastfeed
- Respiratory depression
- Altered neurological behavior
- Decreased ability to regulate body temperature.
Mom can also experience uncomfortable side effects including nausea, drowsiness and vomiting.
Be sure to learn as much as you can about the negative and serious consequences of using narcotics as a pain-relief option in childbirth before including it on your birth plan. You can find more information in the sources at the end of this article.
Nitrous Oxide in Labor
Nitrous oxide is a coping intervention used widely across Europe during birth. It is popular because it is minimally invasive, does not cross the placenta, and is out of your system as soon as you exhale. The issue? This option is not yet widely available across the US.
Nitrous oxide is a helpful medical intervention during labor because it is known to have anti-anxiety and pain reducing effects. It is given in a blend of 50% oxygen and 50% nitrous oxide and is self-administered under the supervision of a nurse. To put it into perspective, this is far less than the amount given at the dentist, and in my experience, you will still feel present and in control.
Don’t rule it out!
Women have different thoughts and experiences with nitrous oxide, but I highly recommend at least considering it in your birth plans. If you try it and don’t like it, that’s it, it can be over. But if it does wind up being successful, then it might be the less invasive pain intervention you need. This could help you get through your birth without an epidural, if that is your goal.
My experience with nitrous oxide
At only 4 centimeters, I was already begging for an epidural. Nitrous Oxide allowed me to get from 4 to 7+ centimeters. It helped me focus on the breathing strategies I knew, calmed me down, and really put me as ease. While I did still wind up needing an epidural because it stopped being effective, I’m so glad I waited until 7cm to get my epidural. This meant my epidural lasted through my entire labor, pushing, and stitches.
Epidural during Labor
An Epidural is a regional aesthesia that will provide pain relief in a specific area, in this case most of your lower body. I think it is important to learn that the goal of an epidural is not complete numbness from the waist down, but rather to ‘block the nerve impulses from the lower spinal segments. This results in decreased sensation in the lower half of the body.’ (see sources at the end of this article).
Types of Epidurals
There are basically two types of epidurals available, Regular Epidurals and “Walking” Epidurals. Regular epidurals will reduce most sensation to the lower half of your body and you will be in bed. It is most likely that you will need nurse support to move or change positions in order to progress your labor.
A walking epidural will still have you in bed, but your ability to move around and change positions will be greater. The benefit to this type of epidural is that you will still feel waves of your contraction (with FAR less pain) which can be beneficial during pushing. You can also always opt to increase your dosage to a ‘regular’ epidural if you need greater relief.
Possible Pros to Epidurals:
- You will be able to rest or even sleep, which might be essential if you have had a long labor
- You are still alert, awake and able to be present in your birth
- You may have a more positive birth experience
Possible Cons to Epidurals:
- Continuous fetal monitoring
- Might make pushing more difficult
- Numbness may remain after birth
- Can cause blood pressure drops
When to get an epidural during birth?
You don’t want to get your epidural too early in your labor because you run the risk of it wearing off before labor ends. Generally, being dilated at least 5 cm is a good time for an epidural to be placed. Be aware that it takes at least 30 minutes to take effect and time for the anesthesiologist to get to your room. For this reason, you also won’t be able to get one if you have already progressed too far in your labor.
How can I learn more about medical pain relief options and make informed decisions on my birth plan?
It is best to research and understand all of the options that are available to you, regardless of your birth wishes. Becoming knowledgeable ahead of time is important, because in the moment you won’t be able to rationalize or understand pros and cons.
- Ask for an overview of options and follow up with specific questions at your prenatal visits
- Go on an additional hospital tour and find out more details about the types and variations in medical pain relief options available at your birth place
- Take a birth class! Most give details about medical pain relief options, pros and cons and risk factors
- Utilize the planning sheets and checklists in The Nesting Planner to help guide your birth decisions and plans
What natural pain coping strategies should I try?
Now that you understand the medical pain-relief options available, let’s make sure you’re also equipped with natural strategies. Even if your plan is to get an epidural, it’s beneficial to know these strategies and put them to use before your epidural.
You also never know if your labor might progress too quickly for an epidural (yes, this can happen!) and you’ll be glad you had some other options in your birth toolbox.
Birthing Ball, Stretching and Yoga
Using a large exercise ball is an amazing tool in labor to help you get more comfortable during contractions. You can drape your upper body and arms over the ball while your knees are on a mat and gently roll from side to side through a contraction. You may find it helpful to sit in a wide-legged squat on the ball and hold onto a chair or the edge of a bed and breathe through a contraction in this position.
Using a yoga mat without a ball is another great option. I found child’s pose, and sitting with my legs butterflied to be two great options during labor. I also did cat/cow poses with inhales and exhales. This is when you go on your mat on all fours and alternate arching and rounding your back to the breath.
Water was an immense relief to me in my first labor, which involved very intense and painful back contractions. A hot shower or warm tub is a great way to find relief. Find out if your hospital has hydrotherapy showers (many do!) which will allow you high water pressure and varying jets and water speeds.
Some hospitals and birth centers may also have labor tubs. These are large Jacuzzi-type tubs that many women find to be absolutely heavenly during labor.
Be sure to pack a nice fluffy towel and robe in your hospital bag because hospital towels often leave a lot to be desired. I wound up chilled after laboring in the shower for a while. I will definitely be bringing a warm robe the next time around.
Physical touch in the form of massage and counter pressure can be a great labor support and source of relief during labor. You should learn and practice these techniques with your partner ahead of time because there is some strategy to it. You also want to practice ahead of time so that your partner already has an idea of what amount of pressure you prefer and where it feels good to be massaged.
Two online childbirth classes that teach partners how to provide relief through massage and counter pressure are KOPA Prepared and Supporting Her. This is a great way to get educated about childbirth in general while also learning a variety of pain relief strategies to use yourself and for your partner to use.
Hot compress or heating pad
A hot water bottle or heating pad will be very helpful during contractions, especially if you wind up having back labor (it’s impossible to predict!). I utilized my hot water bottle on my back extensively while laboring at home but forgot to bring it with me to the hospital! Don’t make this mistake.
Slow Dancing and other movement
Movement during labor is going to help your dilation progress and help you work through your contractions naturally. While I did wind up with an epidural after 14 hours, I didn’t make it that long laying in a bed. I did a lot of ‘slow dancing’ with my husband during labor. He was basically supporting my upper body weight while we swayed back and forth through a contraction.
Breathing techniques and strategies are very helpful to get you through a contraction and I highly recommend learning some prior to labor. There are many birth classes available that specifically teach breathing techniques, meditation and visualizations as pain-coping mechanisms in labor.
Consider your birth wishes, set yourself up for success and keep an open mind
Now that you have a better idea of the pain relief options available to you, and what natural pain-relieving strategies to try, you can create a more informed birth plan.
Get educated! Learning as much as you can about all of your options will set you up for success. If there is a specific birth you want or envision, you need to do more than just want it. Find a birth class that will support your vision. Prepare for the birth you desire!
Keep an open mind. Try not to rule anything out entirely, or set yourself up for a negative experience. I did this. I villainized certain options and wound up needing them. Stay flexible and open-minded surrounding birth. In the end, your baby is the greatest gift of all.
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Alli Wittbold is a wife, mama, blogger, and online teacher. She feels passionate about connecting expectant mothers with childbirth class educators, and supporting them to achieve the birth they desire. After having her first baby delivered by a Certified Nurse Midwife, Alli is an advocate for midwifery prenatal care. She has learned so much about labor and delivery by attending and reviewing dozens of birth classes to help mothers learn and explore options. Alli co-authored the Week-by-Week Bump Smart Course, the Nesting Planner and the Breastfeeding Handbook, resources she is proud to share with as many expectant and new mothers as possible. Read more about Alli.