Pain Management For Labour

Evidence Based Birth Podcast

Why this podcast?
I have long been a huge fan of the Evidence Based Birth website. I know that it’s a go-to place for both doulas and their clients. It’s founder, Rebecca Dekker, is a nurse who also has a PhD. This combination means not only does she have the medical knowledge but she knows how to carry out good research too!

In 2012, Rebecca created Evidence Based Birth as a non-biased source of information because she believes in –

“putting the evidence back in the hands of the people who need it the most: birthing people and their families.”

On the website, you can find evidence-based but easy to understand articles covering such topics as due dates, breech babies, big babies, failure to progress, water birth, IV fluids and premature rupture of membranes.

I really cannot recommend this site enough. It’s such an incredible resource for your informed decision making.

And now there’s a podcast!

How does it look?
It’s still pretty new, with only eight episodes so far. What a fantastic opportunity to join Rebecca right at the beginning of this journey!
Episodes tend to be between five and fifteen minutes, so very accessible even to those of us who are super busy.

The first three are general introductions to evidence-based care and the other five have covered –

– Waterbirth and The Newborn Microbiome
– Prenatal Vaginal Exams
– Pros and Cons of Membrane Sweeping
– Placenta Encapsulation &
– Overview of Pain Management During Labour

Why this episode?
This episode about pain management during labour is the jumping off point for a series of upcoming episodes covering the evidence surrounding both medical and non-medical pain management options.

Rebecca introduces the two different tracks as well as a couple of super interesting theories. I think it’s a great one to listen to before going ahead with the others in the series.

Who should listen to this episode?
All expecting mums and their partners. This topic seems to be something that many people think about during their pregnancy.
Whether you are sure you want no drugs, all the drugs or are totally undecided, this episode, and, I’m sure, the ones that follow, will be really helpful in your decision-making process.

 The episode
As a doula, I don’t tend to use the word ‘pain’ very often. I refer to sensations, power and intensity, but pain? Not so much.
Pain is, for most people, a pretty negative word and it doesn’t make complete sense to me to use it to describe the sensations of labour and birth.

In general, pain is a warning sign that something is wrong. It’s your brain telling you that you need to step away from the fire, get a broken bone set or stop the bleeding from the cut to your head.

The sensations of labour, however, are a sign that things are going exactly as they should be. You want your surges to get longer, stronger and closer together because that means your labour is progressing smoothly and that you are on your way to meeting your baby.

The feeling that accompanies a powerful surge is not a warning that something is wrong but rather a sign that everything is right.

Pain v Suffering
The one time I do bring up pain with my clients is when I talk about the difference between pain and suffering. I was really happy to hear Rebecca refer to this too.

You can experience pain, the physical sensation of pain, but that is different from suffering.

Think of a marathon runner or an Olympic swimmer, they put their body through extreme regimes to reach their peak performance but would they say they were suffering? Probably not.

If you can think of the pain of labour purely as a physical sensation, one that you can work with using various methods mentioned later, then it will be less likely to overwhelm you.

The point at which you allow it to overwhelm you is, I believe, the point at which you begin to suffer. It is no longer simply an intense, powerful feeling, it is something you are trying to escape.

Rebecca goes further into this idea and talks about the idea that you could have a pain free labour and still experience suffering. You have the epidural and so are not experiencing physical pain but you are stuck in bed, perhaps your labour slows down, your partner may leave you for a while because they believe you are pain-free and therefore fine, you may feel alone.

Pain relief vs working with pain
Rebecca talks about the fact that many nurses and doctors favour pain relief in labour. They see no reason why, in these modern times, women should experience the sensations that accompany birth and they may find it hard to comprehend why someone would choose a medication-free birth.

They may also believe that the benefits of pain medication will always outweigh the risks.

Others believe strongly that the sensations women experience during labour are a normal part of the experience. More than that, they are necessary because they encourage you to move around and use different positions to find comfort. This, in turn, will help to keep your labour moving and your baby to move down.

I love that Rebecca said that because, although I know that moving and changing positions is incredibly important to the progress of labour, I just hadn’t thought that the sensations women in labour experience have this as one of their purposes. This really stood out for me.

Working with pain is far easier if you are in a calm environment where you feel safe and supported. If this is the case your body will also produce endorphins; natural pain relieving hormones which will support the birth process.

Pharmacological and non-pharmacological approaches to pain management
Basically, drug-based and non-drug based approaches. The episodes that will air in the coming weeks will examine both of these approaches in more detail as well as look at the various options that fall under each approach.

To give you an idea, the pharmacological approach would include things like epidurals, spinals, drugs administered through an IV and nitrous oxide. Non-pharmacological options include the use of warm water, movement, counter-pressure, massage and gate control theory.

Gate control theory
This theory suggests that if you can activate your nerves in a non-painful way at the same time that you experience pain, then those new signals will reach your brain instead of the pain signals.

Rebecca uses her regular and intense migraines as an example. If she eats a spoonful of ice cream the pain signals from the migraine are blocked from getting through because her body is so busy with the other sensations she is experiencing, ie. the sweet, creamy, cold ice cream.

I’ll let Rebecca take you through this theory in more detail because she knows just a little bit more about it than I do, but using a TENS machine is a good example of how this theory can be utilised to manage labour pain.

To wrap up
The episode goes on to cover The Central Nervous System Control Method of pain management, essentially controlling your own mind, as well as some of the evidence for the effectiveness of non-pharmacological methods.

I’m going to leave it here but definitely encourage you to check this episode out as well as the ones that follow.

Pain management during labour and birth is often a pretty big topic when you are expecting a baby and so I love that these episodes offer a super easy way to get informed about all the choices on offer.

I’d love to hear what you think of this podcast.

Until next time!

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By emilywills

Emily Wills is a doula based in Stockholm. She believes that birth can be a beautiful and empowering experience and started this blog as a way of sharing some really great podcasts. She is also a mother of three and an enthusiastic runner.

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