Medications and non-medical techniques to help women during labor and delivery

For centuries — probably since the beginning of humankind — pregnant women have sought relief from the ‘discomfort’ of giving birth. A Scottish woman was famously hanged after daring to ask for pain relief while birthing twins in the late 16^th century. But it wasn’t until Queen Victoria breathed in chloroform to help ease the labor and delivery of her eighth (and final) child, Prince Leopold, in 1853 that pain management efforts began in earnest.

Today, laboring moms have many options available to them to help them navigate childbirth. Whether they want full-on medical interventions to tackle the pain or prefer to implement natural calming techniques, area doctors and hospitals will work with moms-to-be to help them have a safe and personalized birth experience.

Melissa Shaver is a registered nurse and the supervisor of Parent and Child Education at UPMC Pinnacle who sees women at all phases of their pregnancies. Classes include early pregnancy, childbirth, Lamaze and hypnobirthing. In UPMC Pinnacle’s early pregnancy classes, educators help women fewer than 16 weeks along in their pregnancies learn about healthy eating habits, reasons to call the obstetrician, and birth plans — such as where they want to deliver their child. They don’t delve into the specifics of labor or pain management.

“Women in the early pregnancy class are pretty much a clean slate,” Shaver says, explaining that they haven’t gotten much feedback from family or friends yet on just what to expect during labor. The educators at UPMC Pinnacle address that topic on the fourth night of the one-night-per-week, six-week childbirth class.

In general, there are two types of medications for pain relief during labor and delivery, according to the American College of Obstetricians and Gynecologists (ACOG): systemic analgesics and regional anesthetics. The former, which helps reduce a patient’s awareness of pain and can be calming, is typically administered via a shot or an IV line; the latter, which relieves much of the pain by blocking feeling, is delivered by a single shot or by a catheter in the lower back.

The preferred pain management intervention at UPMC Pinnacle is a regional anesthetic in the form of an epidural block (typically just referred to as an epidural), according to Shaver. It’s also the most popular form of pain management in the U.S. An anesthetic that an anesthesiologist administers directly into the epidural space of the spine through an inserted catheter, an epidural numbs the lower-half of the laboring mom’s body — including the uterus — relieving much of the pain and discomfort of the contractions.

There are some drawbacks with an epidural. Once administered, the mother is confined her to the bed, unable to walk. And while it can be given early in labor, an epidural can slow the laboring process down, says Shaver. She explains that a newly reintroduced pain management tool — inhaled nitrous oxide, or laughing gas — can help moms get a bit further in the labor process before they opt for the epidural.

Historically, nitrous oxide was commonly used by women in labor in the United States until the 1950s, when powerful anesthetics were introduced. The blend of inhaled nitrous oxide (50 percent) and oxygen (50 percent) is still commonly used in other countries, including Canada, Sweden, Australia, Finland and the United Kingdom.

According to an NPR report from Nov. 2016, only a few hospitals in the U.S. offered nitrous oxide to laboring women prior to the American College of Nurse Midwives recommending it in 2011 as a good option for their patients. UPMC Pinnacle was the first hospital system in the Central Pennsylvania region to have nitrous oxide available as a pain management alternative for women in labor, introducing it in early 2018. Patients self-administer the nitrous oxide on demand. Usually, laboring women will feel more relaxed with within 15 seconds. The pain will not completely disappear, but it will become more manageable.

“It takes the edge off, makes mom a little more relaxed,” Shaver says. Patient reviews of the nitrous oxide have been mixed, she adds. “Some moms really like it, and some don’t. That’s the beauty of it. They can use it or put it to the side of they want. They can also pick it up and use after the birth — say if the doctor needs to do some stitching.”

Other, non-medical techniques used by moms during labor include tubs for laboring — but not birthing — and showers complete with massaging showerheads. Wellspan, which does not currently offer nitrous oxide but has plans to in the future, according to Jonathan Griner, M.D., an obstetrician and gynecologist with WellSpan OB/GYN in Ephrata, also has tubs available.

“Laboring mothers have enjoyed the use of our new Whirlpool in addition to relaxation techniques such as breathing exercises and stretching,” says Griner, adding that epidurals remain a popular pain management intervention.

Both Shaver and Griner share that they don’t push any one type of labor or pain management approach with moms-to-be.

“We have found that women’s largest concern is about their level of comfort during labor so they can actively participate and fully experience the birthing process,” explains Griner. “We are receptive to the wants and desires of our patients and will manage their pain on their terms keeping safety in mind.”

WellSpan uses an intake process—which can be done in person or over the telephone—that includes a high-level overview of  pain management options, including epidurals, IV medications, as well as non-pharmacological options, including relaxation techniques, breathing exercises, and the Whirlpool.

Shaver says that she and her fellow educators focus on just that — education. She and her team present all laboring options for moms-to-be. “Having the education is going to take these pregnant women far. We want women to know what questions to ask their doctor, and to get more clarity with their practice. It’s all about how you manage your own labor.” In their hypnobirthing class, they talk about “trusting your own body. We don’t talk about intervention, but focus on relaxation techniques,” she explains.

As far as birth plans go, most women have at least an idea of what they want their birth experience to be by the time they enter their first childbirth class, according to Shaver.

“Some women have a birth plan they present. They’ll have an iPod or iPhone for music, scripts for hypnobirthing and meditation,” says Shaver. And during their admission to the hospital, we’ll go over a small birth plan [for women who don’t have a formal one]. We’ll ask them about things like delayed cord clamping.”

At WellSpan, patients enroll in an enhanced pregnancy educational app, Babyscripts, which doctors use to provide education material to their patients. At 31 weeks, according to Griner, a patient will receive a notification from the app to complete an optional birth plan that is located on WellSpan’s website.

“This is where our patient can list her birthing wishes, which is reviewed in detail at the time of her hospital admission,” says Griner.

As moms-to-be contemplate how they will approach their labor and delivery experiences, Shaver offers some guidance.

“We encourage pregnant women to take everyone else’s experience with a grain of salt,” she says. “Everyone is different. Your body is different, your baby is different, and your experiences laboring will be different. It’s more about how you manage your own labor.”

Leslie Penkunas is the former editor of Central Penn Parent.