Archive for the ‘pain relief’ Category

This is where I am today – living in denial. I’m due with my third baby tomorrow, and while the contractions are taking my breath away, to be honest they haven’t organized themselves into a definite pattern yet, and I really can cope, and they really are not that bad. – Febuary 1st, 2011.

The above quote is from a post I started writing in early labor. I didn’t finish the post. I decided instead to go for a walk around the forest behind my house and through the neighborhood, a walk that takes 20 minutes on a normal day, but took an hour that day. I kept having to stop, and hold onto a tree or lamp post, and breath through the contraction, gazing on the beauty of the world around me that misty wintery day. By the time I’d circled back homewards, I phoned my husband to come back from work and called my midwife  – I could no longer live in denial, I knew I was in labor! My son was born by 5pm, that same day, at home. You can read the full birth story here.


I often talk to expectant mothers about the benefits of living in denial, and here’s why:

1: You end up focusing on the pain later, so your threshold is reached later. When I walk into a birth space and find the mother focused inward and breathing deeply through contractions, yet find that the contractions are either far apart, lasting much less than a minute or still unevenly spaced, then she might be using her coping strategies too early. I adore Hypnobirthing, but even using Hypnobirthing too early can mean exhaustion is reached after X number of hours, and that the techniques for coping with pain are sometimes “used up” by the time real, intense labor hits. Mom has tapped those resources, and reached the end of her rope before that rope was even needed. If you save your coping techniques and use them later on in labor, when things are so intense you can’t deny them anymore, then you still have those cards to play when you need them!

2: That old adage, a watched pot never boils? It is so true. Tension and anxiety produce the cortisol hormones that are not beneficial for labor. I know, the moment we tell you to “relax” and “enjoy yourself” and “don’t let yourself get stressed”, that just causes more stress! Man, how hard it is to convince yourself to not be stressed! Impossible. Instead, I encourage moms to look away; to plan a fun date or dinner or event to attend for their due date, and another for the day after. If you are looking forward to hanging out with friends or seeing that great movie, or going swimming with a girlfriend, or getting a pedicure with that cute niece who idolizes you – then you will be looking outwards and not meditating on inward frustrations. Bonding with other people encourages oxytocin – an essential labor hormone. There is an excellent idea in the comments section of this bringbirthhome post, where the mother looked over wedding photos and read old letters with her husband in early labor. The mother got a great dose of natural oxytocin through that beautiful bonding experience, which enhanced their labor process.

3: Lying to yourself WORKS. I was listening to a podcast about lying by Radiolab the other day (the third story on the podcast, the most interesting bit starting at minute 8) and I got so excited! I’ve used this method for such a long time, and never realized that researchers have identified the benefits of living in denial. Apparently, the happiest people in the world are the ones that lie to themselves, rather than focusing on the negative side of things. This approach works for many aspects of life: a simple example is how I coped with living for years in a hot country like Israel, after growing up in Alaska. We didn’t have any air conditioning for most of the time we lived there, and even our car was air-con-free. To cope, I would first: cross the street in order to walk on the side with the most tree shade (taking practical steps!) Two, I would tell myself, “Wow, it’s not nearly as hot as I expected today. I thought it would be worse! I’m just fine. Easy.” I find that these same words work well in labor as well. The language we choose to use, even aimed at ourselves, is a powerful weapon.

stay calm and deny everything

Let me assure you; when you are in active, full blown labor, you CANNOT POSSIBLY deny it any longer. You will know. Full on active labor takes all your concentration, all your focus. It cannot be ignored. So when you reach that point, forget living in denial – welcome to labor land. And you will be meeting your baby soon!

Does the thought of living in denial make you feel nervous? How can you know that you are not staying home too long, and want to know when to go into hospital? Read How Dilated Am I?

Will knowing how to catch your own baby just in case you do stay home too long put your mind at ease? For some, the practical tools put their minds at ease just a little bit. Read The Four Rules of Precipitous Labor

Many labor blessings-

Sarah Vine, doula



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Words easily trigger painful memories, according to this recent report in Science Daily. I read the article just before I took my 4 1/2 year old daughter to get some blood tests done yesterday, and decided to see if I could apply this with her. Last summer she had some immunizations; She screamed and cried, and for months after said “Please don’t take me to get another immunization, Mama, please promise?”

So she has a history with needles, and I was certain she’d get into histrionics with this one. When we arrived there was another little girl screaming over blood being drawn. But I spoke to Ana in positive tones, telling her and her brother that it doesn’t really hurt, it’s like a little tiny pinch that isn’t hard. I showed them both a little pinch on the arm and they agreed it didn’t really hurt. When she went in I showed her the needle. It had a little blue bow shape on top – I said, ‘look at the little blue butterfly! It’s going to kiss you now, like it’s drinking nectar from a flower’ I told the staff: ‘Ana’s not scared, she knows it’s just a pinch and doesn’t hurt.’

As the nurse took the blood, Ana watched in fascination, and didn’t cry, not even a peep. Nurses crowded around in amazement and praised Ana, amazed that a four-year old wasn’t crying. Afterwards, she reported proudly to her teacher at kindergarten that it didn’t hurt at all.

Pain IS suggestible. Changing our vocabulary,  like in the Hypnobirthing method by calling contractions ‘surges’ or ‘expansions’ does make a huge difference in our perception of what we’re feeling! I’ve seen a mother coping well with labor and enjoying the strength in her body, using vocalization and making healthy noise….but the staff thought she wasn’t coping because they’re used to quiet women on epidurals. So the doctor came in and suggested that she might be needing an epidural because it sounded to him like she wasn’t coping, and he thought she might not be able to make it without pain relief. Instantly, under that barrage of unbelief and doubt, she wilted before my eyes, and the contractions got visibly much more painful. She said that an epidural hadn’t even crossed her mind before he said that, but after those words she got scared about the length of labor and couldn’t do it anymore. We had the epidural. The birth was still beautiful, with a joyous outcome, but I was left amazed at the power of those sentences spoken by one doctor. Now, I agree that there are situations where a mother does need an epidural, and for her it is a right and good choice. But in this case the possible complications were not worth it: she could have kept going as she was, NOT suffering, but experiencing the power of labor, without the risks that come with an epidural. It was not necessary. Words that made it necessary.

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When offering a woman an epidural at childbirth, in my experience, midwives and anesthesiologists  rarely explain all the side effects that accompany this form of pain relief. I feel this is very wrong, if women are purported to have ‘free choice’ for childbirth! That is why I am including this information on epidurals.

The main reason I try to avoid epidurals because of the increase likely hood of other interventions that may follow: epidurals commonly cause blood pressure to go down, so a saline IV is introduced. Another side effect is that contractions may then tail off, so pitocin (a synthetic hormone that stimulates contractions) is added. Contractions suddenly get very strong with pitocin use, which may cause the baby’s heart rate to drop…. etc. I have met midwives who believe that the epidural can help a woman who is fighting contractions relax, and allow the dilation to take place, and in some cases this might be true. In preparation to allow this to happen without resorting to drugs, you can practice pregnancy yoga, and/or look into hypnobirthing techniques to help yourself relax and let go.

Epidurals also stop the release of oxytocin by your brain – oxytocin is the body’s natural pain relief. (I wish it were  stronger too!) As pain increases, oxytocin levels increase too. As soon as pain goes up a notch, you may start to panic that you can’t cope, but if you can mentally get on top of the panic, you may find yourself coping better again in a few minutes as the oxytocin levels increase in response. It is also an important hormone for bonding with the baby, and for breastfeeding. It doesn’t mean you can’t bond or breastfeed after an epidural birth, but the intuitive response, from my experience, sometimes seems lower. I have had both kinds of births, and the cocktail of hormones and joy make one so high for weeks after a natural birth, as opposed to a birth with lots of interventions which leaves you feeling like a train has run over you, and instead of positive hormones your body has drugs to flush out.

It is rare, but things do go wrong with epidurals. The placement of the IV is in the space just before entering the dura, the which protects the center of your spine where spinal fluid flows up to the brain. If the placement is wrong and the dura is punctured, spinal fluid leaks out and the result is an excruciating headache that may last for days or even weeks – severely interrupting the crucial period for bonding and learning breastfeeding techniques. (Dura puncture rate between 1 and 5 cases out of 100. See below for source.)  Another rare occurrence is when the epidural is only partially effective, meaning one half of the body is pain free while the other half feels everything. Sometimes it’s only a small patch of stomach that can still feel pain – but unfortunately, since the oxytocin (natural pain reliever) in the brain has been switched off, the pain in that one spot is even MORE excruciating than before, which can be very distressing for the mother, especially since she has been looking forward to being pain free.  The NHS suggests that 1 of 6 epidurals is unsatisfactory.

Now, if you do decide to have an epidural,  you can rest assured that you know all the side effects and that you are going into this with eyes wide open. Whatever you do, do NOT feel guilty or like a failure. Every woman’s pain is different, and modern medicine does have huge benefits when properly used. You have a free choice, you do not need anyone’s permission or approval here. If an epidural is what you need to give birth without fear, and welcome your child with joy, then take it. It is important not to bear guilt afterwards.

The ultimate goal is to be able to give birth in full knowledge of the miracle, the holy moment when the breath of life enters your child’s body and you gaze at each other, eye to eye. Embrace the experience!

Management of Accidental Dural Puncture and Subsequent Headache
By Stephanie Goodman, M .D. , Associate Clinical Professor of Anesthesiology, Department of
Anesthesia, Colum bia Presbyterian Medical Center, New York, New York

Epidural analgesia in labour St Mary’s NHS Trust

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