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You’ve plotted. You’ve planned. You’ve dreamed all about your beautiful baby. Now there’s just one thing in your way: labor. Like a winding road that weaves into the horizon, labor looms, full of uncertainty. Will the ride be poetic or painful?
The honest answer is both. No one will say that labor is pure, pain-free bliss. It does hurt. Sometimes a lot. But women everywhere will say that you can handle the pain.
Today, more than ever, there are many ways to manage labor pain, from time-outs in a bubbling Jacuzzi to new medications like the walking epidural. Many women try different techniques during labor as they decide what works for them and what doesn’t, says Joy Hawkins, M.D., director of obstetrical anesthesiology at the University of Colorado Health Sciences Center in Denver. There’s no single right approach, Hawkins adds. What’s right is what works for you at the moment.
Help for the hurt
The most common route to pain relief is an epidural — a small catheter that an anesthesiologist inserts in the epidural space in your lower back. Through this catheter, the anesthesiologist administers a local anesthetic with a narcotic drug, which numbs the lower part of your body enough to ease the pain while leaving you able to push during the last stage of labor. Researchers say today’s epidurals are safe, with little risk of complications.
Many women find that an epidural brings a welcome break during labor. For Jamie Spencer of Boston, who had her son, Tom, in 1998, the epidural allowed her to rest and gather her energies for the birth.
But epidurals aren’t perfect. First, they take 10–15 minutes to work, which can seem like a long time when you’re in labor. There is also a slight risk of getting a “spinal headache” from the medication. Finally, some women say they’d rather be able to walk around during labor than lie in bed with numb legs.
That’s where the new combined spinal-epidural, commonly known as the walking epidural, comes in. The traditional epidural numbs your midsection — and your legs, too. With a walking epidural, the anesthesiologist uses the same type of catheter but instead typically injects a narcotic such as fentanyl into the spinal fluid, says Joseph Meyer Jr., M.D., Ph.D., an anesthesiologist in Columbia, Mo. This offers pain relief without numbness, usually for about two hours. During this time, you can walk around. Later in labor, as the medication wanes and pain intensifies, you still can receive the usual local anesthetic, in the same catheter, and then stay in bed.
The walking epidural debuted in the United States approximately seven years ago and, while still new, is gaining popularity. One fan is David Birnbach, M.D., director of obstetric anesthesiology at St. Luke’s-Roosevelt Hospital Center in New York City. He believes that since a walking epidural blocks the pain but still allows a woman to get up and walk around, it gives her a greater sense of self-control. Still, some hospitals have yet to embrace the walking epidural, possibly for liability reasons. When Spencer asked a Boston hospital about the possibility of using the technique, for example, she was told that the risk of falling was too high.
Aside from an epidural, drugs given by injection or intravenously, such as Demerol or Stadol, can help ease pain during labor. However, use of these drugs can be complicated, according to Birnbach, because too much medication can make a woman sleepy or nauseated, while too little may leave her in pain. Sometimes the drugs also depress a baby’s heart and respiratory rates, which makes doctors wary, he adds.