Pleasure travels faster along nerve pathways than pain. Pleasure or comfort also causes our bodies to produce elevated levels of our own endorphins or "feel-better" hormones. In this way, basic methods of comfort therapy can provide pain relief and also enhance the effectiveness of lower doses of pain medications, minimizing medication side effects for you and your baby.

Basic Methods of Comfort Therapy

Patterned Breathing: Like the techniques learned in childbirth preparation classes, these breathing techniques provide comfort and focus while enhancing labor progress. Breathing enhances oxygen flow to your baby and is also vital to the contracting uterus muscles.

Beverages: You should stay well hydrated while laboring. Laboring women may drink liquids and eat ice chips, while at other times intravenous (IV) fluids are used. You can still walk around with an IV if a rolling stand is used.

Moving: Moving around during labor is usually more comfortable than staying still and can help labor progress by the simple effects of gravity and the changing shape of the pelvis. It may also relieve pain by shifting pressure and allowing the baby to move--you may try sitting, kneeling, standing, lying down, getting on your hands and knees and walking. The birthing ball and bean bag chair can be helpful tools for varying position and activity. Ask your labor nurse if you wish to try them.

Water: The soothing effect of hydrotherapy--water!--is a boost for most laboring women. Whether lying in the bubbling water of the Jacuzzi tub or sitting on a shower stool using the hand-held shower massage, the combination of warmth, water pressure and sound is very comforting.

Heat and Cold: Heat can be applied by a hot water bottle or warm washcloths; cold can be applied by an ice bag, cold washcloth or bag of frozen peas. Using heat and cold on separate parts of the body at the same time can provide particularly effective pain relief; for example, cool forehead with warmth on the lower back. For maximum effect, change the heat and cold locations frequently, about every 20 minutes.

Massage: Stroking or rubbing the neck, shoulders, back, thighs, feet or hands. No fancy techniques are required. Receptors in the skin pick up the signal of touch and elevate endorphins. Bare skin receives the signal best. Unscented powder or lotion are helpful for massage.

Attention Focusing and Meditation: Fear and anxiety cause the release of stress hormones. You can ease these feelings by envisioning a pleasant scene or, at times, visualizing what is actually happening--the cervix opening, the baby moving down. Techniques learned in childbirth education classes teach you how to reduce fear, anxiety and pain.

The basic methods described above can also be helpful for pain you may experience after the birth of your baby.

Medical Interventions
The following comfort therapies are medical interventions that may be used in combination with the methods described above. Using the Basic Method of Comfort Therapy along with Medical Interventions may enhance the effectiveness of a lower dose of medication, which can lessen undesirable side effects for you and your baby.

Narcotic Analgesics: Narcotic analgesics (pain medicine), such as Stadol and Demerol, are usually given directly into an IV already in place. Effects are felt within two to four minutes and are often described as "taking the edge off" of pain. Narcotic analgesics do not restrict movement so you can stand, walk and shower during labor. You may feel relaxed and mildly drowsy. Labor may speed up, especially if it has been slowed due to tension and fear. At other times, there is a temporary slowing of progress. Doses may be repeated every couple of hours and effects on the baby such as respiratory depression are minimal.

Local Anesthesia: Your physician or midwife can inject a local anesthetic into your vagina or the area surrounding it to ease pain. These numbing medications usually affect a small area and are especially useful before an episiotomy or the repair of a laceration. It rarely affects the baby, and after it wears off, there are usually no lingering effects. The main limitation is that they do not relieve the pain of contractions during labor.

Pudendal Block: A pudendal block is given by the physician or midwife as an injection to block pain in the perineum. It does not lessen the pain of contractions. It is helpful for relieving the pain around the vagina and rectum as the baby descends through the birth canal, as well as numbing the area before an episiotomy. Pudendal block is considered one of the safest forms of anesthesia and serious side effects are rare.

Epidural Anesthesia: Epidural anesthesia involves the placement of a small catheter into the lower back by an anesthesiologist. A continuous infusion of medication is administered through the catheter to provide a constant level of anesthesia. Epidural anesthesia provides excellent pain relief but has some side effects. It may cause the mother's blood pressure to drop, which in turn may slow the baby's heartbeat. Usually preventive steps are taken to avoid this problem: before receiving the epidural, fluids are given through an IV and the woman is positioned on her side to improve circulation. Blood pressure and heart rate as well as the baby's heart rate are continuously monitored. It may be more difficult to push the baby through the birth canal as contractions are not intensely felt and the muscles of the pelvic floor are more relaxed. As a result, it may be necessary for your care provider to use a vacuum extractor or forceps to assist with delivery.

In rare cases, the muscles in the chest may be temporarily affected, causing breathing problems. Possible other side effects may include severe headache, dizziness or, rarely, seizures. Special precautions are taken to avoid these problems.

An epidural block, which is epidural anesthesia using a higher dosage of numbing medication, can be used for surgery.

Spinal Block: A spinal block is given as an injection into the lower block. No catheter is required because the medication is injected into the spinal fluid. Spinal blocks are most often used for Cesarean births or procedures where it is not necessary for the mother to help push her baby out. A spinal block numbs the lower half of the body, provides excellent relief from pain and starts working quickly.

It has the same side effects as epidural anesthesia.

General Anesthesia: General anesthetics are medications that cause a loss of consciousness. When used for childbirth, the mother is not awake during delivery. It is rarely used except for emergency Cesarean deliveries.

General anesthesia is given in one of two ways: through a face mask or injected through an IV line. It works very quickly and results in almost immediate loss of consciousness in the mother. If the mother's stomach is not empty before being given general anesthesia, she may vomit and breathe food and stomach acid into her lungs. To avoid this complication, she may be given an antacid before delivery. She may be asked by her care provider not to eat anything if the use of general anesthetic is known in advance.

After general anesthesia wears off, you will feel woozy and tired for several hours and likely will feel sick to your stomach. This feeling usually fades within a day. Your throat may be sore from the tube that was inserted to provide oxygen.

Frequently asked questions about epidural anesthesia:

Can I change my birth plan? Yes, you can change what it says in your birth plan. Your birth plan is important and is used as a guide for those caring for you. It can always be changed
When can I ask for an epidural? How soon will I get it? While the decision lies with each individual care provider, most will let you have an epidural when you are somewhere between three and five centimeters dilated. An anesthesiologist will usually get to you within 20 to 30 minutes. It takes a few minutes to get the epidural placed and another few minutes for you to feel relief.
Is there an anesthesiologist always in the hospital? Most of the time they are in the hospital 24 hours a day. If not, they are within 20 to 30 minutes and your nurse will call them in time to get here for you.
Will an epidural slow down my labor? An epidural may slow your labor. We may then give you Pitocin, a drug that makes your uterus contract.
Will I be able to move my legs? Some patients can move their legs; others cannot. It is the goal of anesthesia to relieve your pain and still allow you to have some movement.
Will I be able to get up and go to the bathroom? Your legs will not support you safely after you have an epidural, so you will not be able to get up. If your bladder fills before you deliver your baby, you will need to have a Foley catheter inserted to empty it.
Will I need an IV? Yes, an IV is required before receiving an epidural.
What other equipment will I need? You will have an IV and possibly a catheter. Your oxygen, blood pressure and heart rate will be monitored. A pump will run the continuous epidural. Your baby will be assessed continuously with a fetal monitor.
How long does the epidural last? Does it wear off before I have my baby? You will have a continuous infusion of the anesthesic to keep you comfortable. If you have an epidural for a long time, you may need to have the rate adjusted or an additional dose of medication given in order to keep you comfortable.
Can I choose to have an epidural at the last minute? You can ask to have an epidural late in your labor. Your nurse, doctor or midwife may tell you that if you have an epidural late in labor, it may not have time to take effect before your delivery. They may suggest other methods to help with pain relief. Factors the staff consider as they counsel you about late anesthesia include how rapidly your labor is progressing, whether this is your first baby and how far dilated your cervix is.

We are here to support your childbirth experience. Your personal beliefs, emotions and desires will play an important role in this experience. We strive to give the best care for you and your baby.