Ursula Miguel. CNM, MS

As a pregnant woman approaches her due date, one of her main concerns will center on her ability to deal with the pain of her upcoming labor. How will she be able to cope? Will she need pain medication? Is it important for her to experience labor without drugs or is the epidural (the most common pharmacological method of pain relief) the way to go? What are the effects on her and the baby? These and related questions can make the expectant mom quite anxious.

Expectations regarding labor pain are shaped by past experience, including your own and that of your family and friends. One cannot predict what labor will be like for an individual woman. How could there be just one right way to give birth when there are billions of women in this world? 

The midwives at Princeton Midwifery Care will encourage you to learn as much as possible about the management of labor pain by taking consumer-oriented childbirth classes and by discussing the various options well ahead of your due date. You might start to work on a birth plan which outlines your preferences for labor and birth. 

There are many choices for pain relief, both pharmacological (with drugs) and non-pharmacological (without drugs). 

It is certainly a misconception that midwives do not provide medication in labor, or that our patients have to “tough it out and do it all natural.” “Natural labor means doing what comes naturally, to you.” Midwives strive to assist you in the birth of a healthy baby and to provide you with a satisfying childbirth experience. We also like to leave you with a feeling of empowerment, which is derived from effective pain relief as well as the perception of active participation in decision-making. Should you require an epidural for pain management, or have an obstetric or medical emergency, the midwives can count on the collaborative care of our seven experienced physicians. 

The ideal pain relief agent in labor should provide good analgesia, be safe for mother and baby, not interfere with the natural progress of labor or the mother’s mobility, be predictable in its effects, be reversible and easy to administer. Currently, we do not have an ideal agent. 

Here is a list of the most common non-medical pain relief options the midwives offer. While looking at this list, keep in mind that these comfort measures are simple, effective, harmless, low-cost, have the potential of speeding slow progress in labor (do not keep woman tied to the bed) and can be used instead of, or as an adjunct to, narcotics and /or epidural. These measures may also decrease the total dosage of narcotic needed and/or delay the initiation of epidural until active labor: 

• Psychosocial support: the comfort provided by the midwife at the bedside 
• Relaxation 
• Environment: comforting, warm, dimmed lights, soothing music, scents 
• Positioning and ambulation: upright positions enhance labor progress 
• Birthing balls: good to sit and sway on, good to lean over for back labor 
• Visualizations and affirmations: creating soothing and peaceful mental images 
• Heat and Cold: to be applied topically, icepacks, heating pad, rice socks 
• Massage 
• Water Immersion: shower, warm bath, Jacuzzi (one of my favorites) 
• Hypnosis 
• Aromatherapy 
• Acupuncture and acupressure: stimulating specific points on body to enhance labor 
• Transcutaneous Electri-cal Nerve Stimulation (TENS): application of small doses of electrical stimulation to nerve fibers of lower back, causes body to produce its own pain-relieving substances.  
• Sterile Water Papules: for relief of back labor. Midwife will inject small amount of sterile water into four areas just under skin of the lower back.

 You might also use the metaphor of linking the pain of childbirth with that of running a marathon: Both will test the individual’s limits of pain, but then are followed by exhilaration and an unmatched sense of accomplishment. 

For initial information on our practice philosophy and the hospitals we go to you can look at our website at www.princetonmidwifery.com or call (609) 896-0777 ext. 228 or (609) 799-5010 ext.104 to schedule an appointment with us.