Hi everyone my name is ilao and I'm a registered Midwife and childbirth education instructor I practice in a very large urban center in Canada and as the mom to two children this is all familiar to me as a new parent for the second time around in addition to my clinical practice I love educating families about about prenatal care birth and the postpartum and today I'm going to talk about pain management options in labor so let's get started when it comes to pain management and labor we talk about interventions in the way you would the rungs of a ladder so we start with more natural methods at the Bottom Rung something like position changing or heat therapy can be really really nice at this stage if you're going to use heat therapy stepping into a warm bath can be very soothing the warmth encourages your muscles to relax and relaxation encourages the release of oxytocin and as we know oxytocin is very very important to bring on those contractions and to bring that baby to you when we use heat therapy in labor we recommend just plain tap water and the water not being too too hot in the bath make sure that you're not adding Epsom salt or oil or bath fizzes at this time just plain tap water at body temperature or just a little higher is best if your water happens to be broken just check in with your care provider before jumping into the tub to make sure that it's still okay in that case another good option at this stage in labor would be something called a t machine so if you've never heard that before T stands for transcutaneous or through the skin electric nerve stimulation I have a unit right here and there is a section that you control the electricity with and then these little sticky pads that we use to press on in four areas around your lower spine or the sacral nerve bundle when you press the button it releases a very small jolt of electricity just on the skin surface and it does not go through or affect baby in any way you increase the intensity at the peak of the contraction and decrease it as the contraction Fades away it does take some time to get used to so I encourage folks to give it a try anywhere from 37 weeks in the pregnancy onward if they're interested in using the tens a couple of things to keep in mind about the tens because it is using electricity we don't want you to use it in the bath or the tub at all and make sure that your skin is nice and dry before you apply the electrodes tens unfortunately is not available everywhere so you can try to find it online sometimes you can rent it or buy it from a pharmacy or even borrow it from a friend but if you're interested in using that you can uh do some research ahead of time and see if it is available to you our next option for pain relief and moving up our rungs of the ladder would be something like acupressure or counter pressure these are really nice depending on where that baby is situated in the pelvis and can be done by your support person or using things like uh dough roller or a little tennis ball that can be nice and soothing on the lower back additionally application of heat using a heat pack or warm towels can be really nice and sometimes people like the opposite so cool cool cloths on the shoulders on the forehead on the lower back can also be nice nice and relaxing and relieving at this stage the next step in our pain relief ladder is going to be a pharmacological medication and generally this is an opioid that's injected it's suitable for use in early labor only because it does pass into mum circulation and some into the baby when we administer an opioid it's only done in the hospital setting and we closely monitor your and baby well-being and we want to make sure that baby is not about to be born if baby is born very quickly after we put an opioid medication in then we need to have extra team members present at the birth because sometimes it can affect baby's breathing right after birth so ideally we're using this injection in early labor only the next step on your ladder of pain relief options is something called nitrous oxide or laughing gas nitrous oxide is a blend of 50% nitrous and 50% oxygen and it works very well to take away the intensity of the contractions or the way that we perceive the contractions so it does not eliminate the pain but it makes you care a lot less about it the way that it's administered is Mom would use a mask over the nose and mouth and take a breath in at the start of a contraction another breath at the peak of the contraction and then another breath as that contraction Fades away it can take a few tries to get the hang of the timing with the contraction and the breathing pattern so I always encourage folks to try it out for a few contractions to see if they like it of course at this time we're still keeping a close eye on you and your baby and listening to baby's heartbeat every 15 minutes for a full minute to make sure baby is tolerating that labor well nitrous oxide is best used in active labor so remember once you're about 3 to 6 cm dilated and progressing at a very predictable consistent Pace towards being fully dilated and open one of the benefits of nitrous is that it is very safe to use a very small amount passes to the baby and there are no known side effects for Mom sometimes you can feel a little bit dizzy a little laded a little bit giggly but as soon as that mask comes off and you breathe in room air that side effect will wear off very quickly another benefit to the nitrous is that you can stay mobile we don't want you standing up because of those slight side effects for mom sitting on a ball on a chair on the birthing bed those are all great great options or even sometimes in the bath having your hydrotherapy and nitrous at the same time can be very very effective next up we have an epidural which you may have heard about before an epidural is regional anesthesia and it is by far the most effective tool we have in our toolbox to help manage the discomfort and pain of contractions in this phase of Labor the way an epidural works is it freezes you from the waist down and it eliminates or almost completely eliminates most of the discomfort and the muscle work from those contractions an epidural is placed by a specialist doctor called an anesthesiologist they'll have you sitting in a particular position usually at the side of the bed curled around your baby and sticking the middle part of your back out in a c shape the first step is to find the right spot so with the world's worst back massage the anesthesiologist will feel along your back to find the right spot once they've identified I the place to put the epidural they'll get their equipment set up and their medications and tools laid out and that's the part that takes the longest the actual placing of the epidural itself is quite quick so first thing they'll place a sterile drape on your back and clean the area with an antiseptic the next step is a tiny little pinch of local anesthetic or freezing on the skin layer just like have at the dentist when you have fillings put in and after that they will insert a long needle and you won't feel this part you'll feel pressure you'll feel touch but you won't feel any pain or discomfort it's really really important to stay still and steady at this stage so if you feel a contraction coming on be sure to let your team know once we're in the right space the anesthesiologist will insert a fine plastic flexible catheter that stays in place and the needle comes out there's nothing sharp left in your back and it's just a small little thin tube that delivers continuous medication and that is attached to a pump after the tube is in place we put a sterile dressing and then tape it down really really well so it doesn't migrate r or move out of place with an epidural we need to be monitoring baby a little more carefully and we would have you on continuous fetal monitoring the little bands elastics around your tummy and a constant print out or readout of baby's heart rate either on a computer or on a strip of paper the epidural can have some side effects for mummy the most common of those is blood pressure dropping down a little bit so before the epidural can be placed we have to get intravenous access or an IV because that is the fastest way we can bring someone's blood pressure up if it drops down that would be with some fluids a Bolis of fluids in the IV line with an epidural you won't be able to feel when you need to go to the toilet so we also place a catheter into the bladder to keep it empty throughout the course of the labor the epidural is continuous and the medication is released at a set rate programmed onto a pump by the anesthetist sometimes you're also given a little extra button that you can press when the medication starts to wear off a little bit if you've been in a position for a long time maybe one side's a bit more Frozen than the other side or babies's very very low in the birth canal and you're starting to feel that pressure and that intensity of the baby's head giving yourself that little extra boost of medication can really be beneficial there are risks and benefits to epidurals just like any other intervention and labor one of the benefits is that epidural is by far the most effective method of pain management we have and when it works it works very very well we don't notice the intensity of the contractions but we're still able to move around and that can be really helpful for the second stage of Labor or when pushing the baby through the birth canal there are some risks with epidurals one of the most common is a drop in Mom's blood pressure this is why before an epidural is placed we always put an intravenous and have access to Mom circulation if Mom's blood pressure drops down we can add fluids and Bolis and bring that blood pressure up quickly with an IV line when Mom's blood pressure drops another side effect is baby's heart rate can drop as well we know this we're prepared for this so we will try to rotate mom side to side sit up back down again a little bit of extra fluid and most of the time this will resolve every once in a while it doesn't resolve and that means we're headed into a C-section fairly quickly with an epidural you won't be able to feel when you have to go to the toilet so we also place a catheter into the bladder to keep it nice and empty throughout the duration of the labor you will still feel some touch and pressure but not colder heat so we don't use any heat packs after an epidural goes in place to protect your skin another small side effect of epidurals is something called a positional headache and it happens less than 1% of the time in that case when you are sitting upright after the baby's born you can experience a very intense headache almost like a migraine and as you lay down it disappears again this is something that we can fix with a blood patch so make sure that you let your team know if you develop these intense headaches in the immediate postpartum or after you're discharged home in the first week or so very very rarely there is risk of nerve injury or paralysis with the placement of an epidural they are practiced very frequently in Canada and most anesthetists are extremely experienced and have done hundreds if not thousands of them epidurals are a tool and sometimes your doctor Midwife will actually recommend an epidural for theraputic rest believe it or not there are times where an epidural is just the thing particularly if you've been in labor for many days and nights and are just absolutely wiped out and need a little bit of rest to recuperate energy hopefully catch up on sleep a little bit as your body continues through the labor process that brings us to the end of our section on pain relief I hope you found this video informative and have some new information to take home with you we have lots of other videos in the series so please be sure to check them out take care and we'll see you next time