Who says labor is painful? What is your PLAN?

There is no way to predict the level of pain each woman will experience during labor.  Some women need little or no pain relief while others may find that pain management using medication assists with relaxation and provides a more enjoyable experience. 

Your nurse will be there every step of the way to help guide you through this process.  There is no right or wrong answer to this decision, but preparation and knowledge is key to feeling like your pain was managed they way you would choose, and well controlled during your stay with us.

St. Luke's offers a variety of classes to provide education as you make decisions regarding your care during your labor experience.  

http://www.stlukesonline.org/classes_and_events/boise_and_meridian/pregnancy/index.php

Here are some things to think about when considering the pain management plan you will choose while in labor:

Natural Childbirth: refers to labor in which no medication is used to manage pain.  Patient's who choose Natural Childbirth are most successful when they have prepared and practiced their plan to work through contractions with their support person/team.  This can include relaxation techniques such as massage, Jacuzzi tub, or more formal methods such as Hypno-birthing, Bradley Method, rhythmic breathing or Lamaze.  Frequent position change and active support person involvement is key to being successful in this labor decision.  

Nitrous Oxide: is inhaled through a tube or mask which makes this a great way to take the edge off while avoiding some of the "loopy" feelings that other medication may cause, or limits on movement with an epidural.  Nitrous Oxide takes about 30 seconds to be effective and lasts for 1-3 minutes.  Timing on the breathing of Nitrous Oxide is key for it to be most effective at the peak of each contraction.

A "Nitrous Oxide for Labor" teaching sheet is available on our Labor and Delivery Unit if you would like additional information about this practice before you arrive in labor.

IV Pain Medication:  Various options of pain medication can be given through IV access.  This will depend on your provider's preference and your stage of labor.  IV pain medication typically takes effect within just a few minutes of delivery and effects last for approximately 1 hour.   Small amounts of IV pain medication can cross the placenta and both mom and baby may be sleepy.  For this reason we try to avoid IV medication within the last hour of labor.

Anesthesia:  We have anesthesia providers available 24 hours every day on our unit.  Certified Registered Nurse Anesthetists (CRNA) place hundreds of epidurals and spinals for us, and are the experts in their field.  They have the back up on the strongest Anesthesiologist team in the valley.  We feel very lucky to work so closely with Anesthesia Associates of Boise!

Epidural:  An epidural is the placement of a tiny tube which delivers pain medication directly into the epidural space around the spinal cord.  This tube remains in place for the duration of your labor.  It typically takes 5-10 minutes for the CRNA to arrive once the epidural has been ordered by your physician and requested by your nurse.  You will sit on the edge of the bed supported by your support person or nurse.  

Your position does make a huge difference in how easy or difficult placement of the epidural may be.

Placement typically takes 5-15 minutes and then a bolus, or larger dose, of medication is given to initiate pain relief.  The epidural tube is then hooked up to medication and programmed into a pump to manage medication delivery throughout the remainder of the labor process.

A patient controlled button is provided for some control over the amount of medication you receive and how numb you choose to be for your desired experience.  

After placement, epidurals take about 20 minutes to completely set up.  During this time contractions start to feel shorter, as the beginning and end of the contraction becomes numb. Most people with an epidural will still have control of movement, but will no longer have the strength or sensation to be able to get up and walk without falling so we insist that you remain in bed.

Because of this, a catheter will be placed to help keep your bladder empty.  This helps to keep the pelvis unobstructed and reduce the risk of damage to your bladder as the baby descends.  The catheter will be removed when it is time to start pushing.

Epidurals work by gravity.  The medication delivered through the tube will cover the nerves and settle onto the side you are laying on.  For this reason, frequent position changes are necessary for the epidural to be effective.

Most women still feel pressure and an urge to push which is very helpful during the 2nd stage of labor.

After delivery the epidural pump will be turned off and within 1 - 1.5 hours you will have the strength to stand and walk to the bathroom with assistance from your nurse.

Epidural catheters can be used to deliver stronger medication if the need for a cesarean section were to arise.

Spinal:  Patients who plan to deliver surgically by cesarean section are given a spinal.  This is a one-time dose of medication which is strong enough to block pain in the lower half of your body.  By providing pain management through a spinal block or epidural, our patients are able to remain awake during the surgical delivery.  An anesthesia provider remains at the head of the surgical bed throughout the procedure.

Anesthesia Associates of Boise have a great website where you can see each of the providers and read the answers to Frequently Asked Questions. 

http://anesthesiaboise.com/

 If you have additional questions you can call them directly at  (208) 489-6789