epidural

Pain Relief in Labour: What Are My Options?

While you are thinking about and planning for your birth, options for pain management is a hot topic! While some women will plan for non-medical pain management in labour, whether you intend to use other methods of pain relief, it’s still important to know your options, weighing the benefits and risks of the decisions you might be faced with. 

Depending on your hospital or birth centre, the options for pain management will vary. At our local hospital, the options you’ll typically be offered are: Nitrous Oxide, Fentanyl, or an Epidural.

Each of these are very different, and all of them have their pros and cons. Each labouring person will react and respond differently to each of these methods of pain management, and it’s important to realize that what you might have hoped would work, may or may not work for you. 

 

Let’s take a closer look…

 

Nitrous Oxide

Nitrous oxide is delivered as a blend of nitrous oxide and oxygen, through a mask that the labouring woman holds and self-administers through contractions. 

The Pros:

Nitrous Oxide is fast acting and wears off quickly. It can be used at any point in labor right up until the pushing phase, and doesn’t have an effect on the well being of baby. While you will still feel the pain, a lot of women find it helps them relax and reduce their perception of pain. 

The Cons:

Some women find that it makes them dizzy or nauseous. It doesn’t provide complete pain relief, and it isn’t always as effective as some hope for it to be. 

 

Fentanyl

Fentanyl is a narcotic medication that is administered through an IV and delivers pain relief that should be more effective than nitrous oxide. 

Pros: 

Fentanyl can be easily accessed in labor, and tends to be a stronger pain relief option. You are still able to be mobile and will hopefully find some rest and reliefduring and between contractions.

Cons: 

Narcotics dull the pain, but they don’t fully eliminate it. Fentanyl causes some women to be dizzy and nauseated. Narcotics also cross the placenta and can contribute to fetal distress or impact baby’s breathing after birth, especially if they are administered too close to delivery. 

 

Epidural

The epidural: administered by an anesthesiologist, who for many a labouring women, greatly resembles a knight in shining armour bringing sweet, sweet relief. An epidural is administered through a catheter placed in the epidural space in your lower bak, and can be delivered during the active labor and pushing phase. It is typically recommended to hold off on epidural use until you’ve reached 4cm dilation to ensure that labor is progressing well. 

The Pros: 

The epidural usually provides complete pain relief. This can be incredibly useful if the fear or struggle with the pain of contractions is causing tension or an inability to ‘let go’ in labor. If a labour is long and her body is growing tired, the epidural can allow for rest and prevent the need for a cesarean in some cases. 

The Cons: 

It isn’t always accessible. Depending on how busy the maternity floor is, or the availability of the anesthetist, it can take anywhere from 30 minutes to a few hours to access an epidural; be prepared to wait. 

Epidurals have a few unwanted, potential side effects, like a drop in blood pressure or the risk of developing an epidural fever. Epidurals can sometimes slow labor which can lead to the need for synthetic oxytocin (pitocin). Fetal distress due to the effects of the epidural are greater, and so is the incidence of vacuum delivery.

 

Curious to learn more information? Book a birth planning session with one of our doulas to discuss your options in more detail and feel prepared for your birth. We’d love to chat with you and help you understand your choices and make a plan that works for you!

 

The Only Guarantee Your Doula Can Offer...(hint: it's what really matters!)

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There’s hardly a doula fresh out of training that hasn’t shared some variation of these statistics that you see above, myself included. Shorter labor, reduction in caesarean birth, oxytocin, analgesia, and epidurals; all of these things are meant to illuminate the value of doulas. These numbers are meant to wow the masses of what it is we can offer to ‘improve’ birth out comes for our clients. It’s well meaning, but it’s time for a healthy dose of perspective.  

The Cocherane Review has one of the most recognized studies that speaks to the benefits of doula attended births and provides evidence for these claims (You can see the actual study with accurate facts and figures, here.) This study is an excellent compilation of research that does in fact illuminate the difference a doula can make for a birth, but the way these statistics are being shared in the birth world may be doing more harm than good. 

When I share with you the ways in which I may be able to ‘enhance’ your birth by preventing analgesia or epidurals, I’m assuming you want to give birth without medication.

When I tell you that studies show my presence may reduce the length of your labor, I may be setting you up to feel as though your long labor was the result of a broken body or some bad luck.

When I suggest that, with my help, you may be able to avoid a cesarean birth, I’m assuming that this isn’t an ideal option for you, whether by necessity or by choice.

Here’s the thing: there is no golden standard for an ideal birth.These statistics suggest differently. Each of these numbers represents a preference, a personal ideal. Too often there ends up being an unnecessary weight of guilt and disappointment that mothers carry when their birth doesn’t meet expectations either set by someone else’s standard or their own. 

Nobody should expect or hope that any of the issues on these lists are important to you– maybe they are, maybe they’re not. Your doulas job isn’t to try to provide you with some statistically ideal birth plan, our job is to offer unconditional support to you through the birth you end up having; through the choices you make and the outcomes beyond your control.

Neither you or I can determine the outcome of your birth. If I take on the burden of trying to measure up to a statistic, I may not only be setting myself up for failure, but I may actually prevent you from birthing the way you want to. Birth doesn’t always stick to the plan; the unpredictability of labor means that you need to be ready to be flexible, to change your mind without apology, to grieve the things you’d hoped for and lost, and then celebrate how incredible you are for bringing life into this world.

So what is relevant here? What’s the point doula support if it comes without the guarantee of the birth you’ve planned for? Studies have shown that a woman’s satisfaction with her birth isn’t a result of interventions, outcomes, or having things go as planned; it largely relies on how she was cared for, heard, and supported, and that is an outcome I can promise to deliver. So here’s a statistic I think is worth sharing:

 

 

Is A Doula Like A Midwife? ...and other FAQ's

I'll never forget my introduction to the word doula...

I went to visit a friend in the hospital after her long a difficult labour, and she introduced me to her doula. 

Her what???

She raved about this woman standing next to her, telling me all about the massages she gave in labour and the way she'd supported her through a very challenging birth. 

I left that day thinking a doula was a woman trained to give great massages in birth, and while that's certainly something that we do, there are so many other unanswered questions that have left many people a bit confused as to what it is we do. Allow us to clear up some of those wonderings by answering some of the most frequently asked questions:

 

Is a doula like a midwife?

Midwives are medically trained professionals who provide prenatal, birth, and postpartum care to women. Midwives often have hospital privileges, and like doulas offer care for both home and hospital birth. I don't know a midwife who hasn't gone into the profession with a passion and empathy for caring for women through pregnant and labour, but their primary role in birth is to ensure the safety of mother and baby, and this often requires a lot of their attention. 

A doula differs from a midwife in that she is not medically trained, but rather trained and experienced to provide physical and emotional support, with a knowledge of comfort techniques and the sole focus of attuning to your needs in labor.  Her priority is to hold the space for an environment that supports you in a way that the medical professionals caring for you often can't. While nurses, midwives and GP's care about their patients, the job they are doing is important and your safety is their number one priority. While a doula understands and can help you navigate the unfolding of your birth, she doesn't carry the responsibility of the medical components of birth; her eyes are on you as she intuitively responds to your needs, making you as comfortable and cared for as possible.

 

Are doulas trained to offer prenatal or childbirth advice?

A doula can and certainly does share information regarding pregnancy and birth. It’s important that any information she gives you or suggestions that may be made throughout your pregnancy, are reviewed and considered by your primary caregiver – your doctor, OBGYN or midwife. Doulas are not medically trained and do not (should not) claim to have the expertise to offer any sort of medical advice or perform any medical procedures including using a doppler for fetal monitoring, vaginal exams, or external palpitation to suggest babies positioning.  

 

What kind of training or certification is required for doulas?

The doula industry is not currently a government regulated industry, but there are definitely standards of professionalism that most doulas adhere to. Our doulas have taken a minimum of a  20 hour, in person workshop, and while pursuing certification, are required to complete a comprehensive exam, hands-on labour support, numerous client evaluations, and continual professional development to maintain certification. 

 

Can I access a doula for free? 

We believe that your doula holds immense value. While this work is extremely rewarding and it is an incredible honor to be welcomed as a support into a birth space, it is a line of work that requires huge commitment to being on call for weeks or months on end, meeting and conversing prenatally and postpartum, and providing continuous labour support, and our rates reflect that value. Maintaining certification usually requires annual fees and attending workshops and seminars. It is essential in this profession to continually keep up to date on new information and we want to give our clients our best through a personal commitment to learning and expanding our knowledge every day. We make payment plans available for our clients, and have a limited bursary fund for those who qualify for a reduced-fee for support. 

 

Won't a doula replace the role of my partner?

Not at all! Doula’s love birth partners and our priority is to help you both have the birth you imagine. We are there to support both the mother and her partner, because let’s face it, birth can leave you both exhausted, perplexed and out of sorts. We are experts in supporting women in labour and your partner is the expert on you; together we join forces and make a team that brings out the best in everyone. For the hands on partner, we can offer up suggestions for him to give you comfort and support while we meet your needs from another angle. Some partners will find birth emotionally overwhelming, physically exhausting, and others may lean on the side of squeamish. Having another trained support person there means the partner can be as involved as they can or want to be, while resting assured that your needs will be met to the fullest. We get to make sure you’re both fed and hydrated, that you find your voice to express your needs and desires in birth, and that you both feel confident and cared for going from start to finish.

 

Are doulas just for homebirth and unmedicated birth?

Doulas believe that birth is deeply personal. We have no preference for your birth place, nor do we hold any opinion on way you choose to bring life into this world. It is our greatest goal to offer support for all families, compassionately, without judgement or bias. We attend homebirths, hospital births and water births. We support women with epidurals and women who choose to manage their pain without intervention. While we believe information is essential to any decision through pregnancy and birth, we support you in every choice along the way because we believe that you know yourself better than anyone else!

 

Still wondering about what we do? Email us your questions or book a free consultation; we love to get to know new families to share about the work we do and how we could make your birth experience brighter.