Pain Medication During Labor
Labor Induction
The truth about Inductions
Sometimes it is better to help get labor started. Our bodies aren’t perfect at knowing the right time and sometimes it’s better for babies not to have to rely on a placenta. After 39 weeks labor has few risks. It does increase pain/perception of pain because you are stuck in the hospital, tied to machines It is unpredictable. I can’t tell you if it is going to take 5 minutes or 5 days to get your body to start the labor process. All I can do is try and get labor started.
Why?
There are a number of reasons why we may decide to induce labor, including,
- you’re overdue. If there’s no sign of action from your uterus, your practitioner may induce you around 41-42 weeks, this is because after 42 weeks the placenta wears out and babies start to lose weight and get tired.
- There’s a complication. Sometimes conditions like preeclampsia, diabetes, gestational diabetes, issues with the placenta, or problems with amniotic fluid (low levels or infection) make it risky to continue the pregnancy.
- Your membranes ruptured. If your water has broken and contractions have not started on their own within 24 hours, your doctor may induce.
- Your baby isn’t thriving. If tests suggest your baby is mature enough to deliver, your practitioner may opt for induction.
- You live far from the hospital. You may be induced if you live far from where you’re delivering or have had previous short labor because there’s concern that you might not make it to the hospital or birthing center in time. Known as an elective induction, it should be scheduled at the place where you plan to deliver no earlier than 39 weeks.
How does labor induction work?
If you do end up needing to be induced, the process involves a number of steps, though you usually won’t go through all of them:
• Cervical ripening. Usually, your cervix will open up naturally on its own once you’re ready to go into labor. However if your cervix shows no signs of dilating and effacing (softening, opening, thinning) to allow your baby to leave the uterus and enter the birth canal, your practitioner will need to get the ripening rolling. She’ll usually do this by applying a topical form of the hormone prostaglandin (either a gel or a vaginal suppository) to your cervix. Your cervix will be checked after a few hours; often, this will be enough to get labor and contractions started. However if the prostaglandin is doing its work ripening the cervix but contractions haven’t started, the process continues on to the following steps. (Note that sometimes if you’ve had a C-section or other previous uterine surgery, you won’t be given prostaglandin to try to prevent uterine rupture. And in some cases, your practitioner may use a mechanical agent to ripen the cervix, such as a catheter with an inflatable balloon or graduated dilators, instead.)
• Rupturing the membrane. If your cervix has already begun to dilate and efface on its own but your water hasn’t broken, your practitioner might jump-start your contractions by artificially rupturing the membranes. In other words, she’ll break the bag of waters that surrounds your baby manually using an instrument that looks like a long crochet hook with a sharp tip. It might feel uncomfortable, but it shouldn’t be painful. This is one of the procedures that the new ACOG guidelines suggest may not be necessary for all women with low-risk pregnancies.
• Pitocin. If neither the prostaglandin gels nor the stripping nor rupturing of the membranes has brought on regular contractions within a couple of hours, your practitioner will slowly give you the medication Pitocin (a synthetic form of the naturally-occurring hormone oxytocin) via an IV to induce or augment contractions. When Pitocin is used, contractions — which usually start about 30 minutes later — are usually stronger, more regular, and more frequent than those where labor has begun naturally (though if this is your first baby, you won’t have anything to compare it with). If you’re considering an epidural, you might want to ask your practitioner about getting it started while you’re getting the Pitocin so it’s in place once labor does start.
The risks of labor induction
While in the majority of cases labor induction goes smoothly, complications sometimes arise. They include:
- Inductions increase pain because you are stuck in the hospital, and can’t move around naturally.
- Inductions are unpredictable, you might get stuck in the hospital for several days before we get labor started
- Fetal stress, we monitor the baby the whole time you are in labor and sometimes artificial contractions can stress the baby out. Studies have shown that babies do not have any long term risks/stress, but temporary fetal stress is stressful
- Increase stress on your body.
- Increase stress on your body.
- Bleeding after delivery
- Inductions do not increase the risk of cesarean section. Many studies have shown that earlier inductions do not increase this risk.
Do-it-yourself labor induction
While there are plenty of natural methods you can use to try to bring on labor (and plenty of old wives’ tales to go along with them), none of them have been shown to work more than placebo pills. After 39 weeks no matter what happens you will eventually go into labor on your own, and if you want to wait, and your baby is doing well….you can wait.
Labor and Hospital Bag
Come to the hospital when:
Contractions are ~5 minutes apart and painful for more than 1 hour.
You are leaking fluid, enough that it goes through your clothes
Use your best judgment, if you think you should be checked out……
When going into labor you can call ahead and we will be more ready for you. 503-842-4444
OB department if you have questions 503-815-2289
What should I bring with me to the hospital?
Hospital bags are mostly for creature comforts. Everything you need while you are in the hospital will be provided for you. If you show up without a hospital bag, you need not worry. Here are some things you may want to add.
- Going home
a. Comfortable clothes for you- not too tight, not to lose. You won’t be your pre-pregnancy size and you don’t be your 40-week size either
b. An outfit for the baby - Entertainment
a. Phones
b. Computers
c. Card games
d. A good book
e. Movies
f. Whatever you like to keep your mind occupied - Car seat
a. the only thing you are required to have to take a baby home - Camera
a. Make sure that someone other than the person having a baby knows how to use it
b. Make sure to talk about what you want/don’t want to be photographed - Insurance and ID card
a. At Tillamook Regional Medical Center we know who you are and have all your information already, but just in case something changed it’s good to have a backup.
b. You don’t need to pre-register, we have already done that for you.
Want a List?
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Exercise During Pregnancy
Exercise is good for you. It is good for the baby. Most experts recommend 20 minutes of moderate exercise through out your pregnancy.
In the first part of pregnancy you may be tired, or nauseated. As soon as you feel capable, make exercise a priority. Exercise during pregnancy may decrease your risk of excessive weight gain, diabetes, hypertension and cesarean sections.
If you feel to sore or tired, how about YOGA? Here are some videos to get you started.
If you feel unstable or short of breath; don’t do it.. You are responsible for your own health and safety.
Circumcision
Bleeding During Pregnancy
Back pain
Almost everyone has some back pain in pregnancy. Sometimes back pain is worse than other times. The good news is it usually goes away after delivery. In the meantime here are some things to do.
-Heat- Can help relax sore muscles, this can be done with rice packs, heating pads, tubs, or showers.
-Massage- you, your partner, or a professional can help massage some of the pain.
-Maternity belts- Following is some information on maternity belts. It is helpful to reposition the baby.
-Physical Therapy- we have a great physical therapist for back pain at Adventist Health Tillamook. If your back pain is really bad, do some physical therapy.
-It is OK to use bengay/ icy-hot/lotion to help sore muscles.
-Stretching/Yoga is very helpful. The following are some links for stretching in pregnancy and also some stretching.
https://www.youtube.com/watch?v=Sja4az8lnvc
Back pain during pregnancy isn’t surprising, but it still deserves attention. Consider seven ways to relieve back pain during pregnancy — from good posture and physical activity to complementary therapies.
By Mayo Clinic Staff
Back pain during pregnancy is a common complaint — and it’s no wonder. You’re gaining weight, your center of gravity changes, and your hormones are relaxing the ligaments in the joints of your pelvis. Often, however, you can prevent or ease back pain during pregnancy. Consider seven ways to give pregnancy back pain the boot.
As your baby grows, your center of gravity shifts forward. To avoid falling forward, you might compensate by leaning back — which can strain the muscles in your lower back and contribute to back pain during pregnancy. Keep these principles of good posture in mind:
• Stand up straight and tall.
• Hold your chest high.
• Keep your shoulders back and relaxed.
• Don’t lock your knees.
When you stand, use a comfortably wide stance for the best support. If you must stand for long periods of time, rest one foot on a low step stool — and take time for frequent breaks.
Good posture also means sitting with care. Choose a chair that supports your back, or place a small pillow behind your lower back.
Wear low-heeled — not flat — shoes with good arch support. Avoid high heels, which can further shift your balance forward and cause you to fall.
You might also consider wearing a maternity support belt. Although research on the effectiveness of maternity support belts is limited, some women find the additional support helpful.
When lifting a small object, squat down and lift with your legs. Don’t bend at the waist or lift with your back. It’s also important to know your limits. Ask for help if you need it.
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Sleep on your side, not your back. Keep one or both knees bent. Consider using pregnancy or support pillows between your bent knees, under your abdomen and behind your back.
While evidence to support their effectiveness is limited, massage or the application of a heating pad or ice pack to your back might help.
Regular physical activity can keep your back strong and might relieve back pain during pregnancy. With your health care provider’s OK, try gentle activities — such as walking or water exercise. A physical therapist also can show you stretches and exercises that might help.
You might also stretch your lower back. Rest on your hands and knees with your head in line with your back. Pull in your stomach, rounding your back slightly. Hold for several seconds, then relax your stomach and back — keeping your back as flat as possible. Gradually work up to 10 repetitions. Ask your health care provider about other stretching exercises, too.
Some research suggests that acupuncture might relieve back pain during pregnancy. Chiropractic treatment might provide comfort for some women as well. However, further research is needed. If you’re considering a complementary therapy, discuss it with your health care provider. Be sure to tell the chiropractor or acupuncturist that you are pregnant.
If you have severe back pain during pregnancy or back pain that lasts more than two weeks, talk to your health care provider. He or she might recommend medication such as acetaminophen (Tylenol, others) or other treatments.
Keep in mind that back pain during pregnancy might be a sign of preterm labor or a urinary tract infection. If you have back pain during pregnancy that’s accompanied by vaginal bleeding, fever or burning during urination, contact your health care provider right away.
Low Sexual Desire
This is a hard topic, but one most people can relate to. In relationships, we either have a high sex drive or low sex drive. Most couples don’t match 100% of the time.
Decrease sexual desire can be problematic, especially if it causes stress or anxiety and continues for more than 6 months. Decrease desire can also be problematic because there are SO MANY different causes. This is a problem that can be improved, or fixed, but there are no magic pills. -OK there are a few, but well get to that.
To start with, read this list and think about things that might be affecting your sex drive. Start changing some basic components of your life that aren’t working for you.
It probably isn’t one thing causing your desire to be elusive.
An incomplete list of possible culprits
- Sexual problems If you have pain during sex or don’t orgasm, that makes sex less exciting and can lead to long term decrease desire.
- Medical Problems If you are in pain, fatigued, or worried about your health, sex may be something you are not interested in.
- Medications Certain medications, especially antidepressants are known to decrease ones desire.
- Lifestyle habits Smoking marijuana or nicotine decreases blood flow, which may decrease arosal. A little alcohol may seem like a good idea to start, but to much will make sex less appealing for a variety of reasons.
- Fatigue If you are tired after your daily activities, you will likely not want to add one more thing onto your day.
- Menopause Hormone levels drop as we grow older. This can make you less interested in sex and cause vaginal dryness or other pain.
- Pregnancy If your feel fat and ugly during pregnancy, no wonder you don’t want to have sex. If you feel maternal, sex may also be unappealing. If your in pain every time you move, you probably don’t feel like sex.
- Emotional issues Stress, anxiety or depression definitely play a role in desire.
- Poor self image either about yourself or your partner, if you have gained weight the last thing you want to do is look at yourself naked. If your partner isn’t your ideal image, it may be leading to decrease desire.
- Low self-esteem
- Guilt
- History of physical or sexual abuse sex is only fun and enjoyable, when its fun and enjoyable.
- Previous negative sexual experiences If your partners have never really cared about your sexual experience, its hard to get excited about theirs.
- Lack of connection with your partner
- Relationship Conflicts In relationships this can be an issue for one person and not the other. We are two different beings after all.
- Trust issues
- Fear
Where to start
- Women need more foreplay to lubricate the vagina and relax the muscles. If you try and “push” through it might be self-defeating. You need to take a few extra minutes at the beginning. Don’t force yourself, but start over. Making sure your comfortable, or your desire will be less in the future.
- Use lubrication, It feels nice, smells good, and tastes good.
- Try to figure out your “ turn offs” and explain them to your partner. If your turn off is your partners turn on you will need to let them know. This may be hard, but if you are honest it will work in both of your best interest in the long run.
- Keep in mind your turn offs may not be an action. You need to dig deep on this one.
- Maybe you have pictures of your kids on your nightstand
- Perhaps that is the quilt your grandmother gave you for your wedding
- Maybe your nervous your dog is going to walk in on you and try and join
- Don’t let someone push you past your boundaries, but be open to suggestions.
- You need a vibrator. Even if you aren’t using it for enjoyment, it will help relax muscles, get blood flowing. You can use it on your own to try and get yourself ready or use it with your partner to increase the foreplay. Vibrators are a must especially if you find you are feeling dry or have pain of any kind.
- Pick a day so you don’t feel pushed at other times. This will free up some space and allow you to mentally have control. You can still change your mind, but you shouldn’t have to worry about sexual encounters. Sex doesn’t have to be spontaneous.
- Make it a mission to find something that sexually interest you, books or movies, that new vibrator…. If nothing does, its time to start over and find out what else may be playing a role in your lack of desire.
Less than magic – pills
Wellburtrin: This is an antidepressant that has been shown to help with sexual desire in some studies. This may be especially useful if you have some depression or anxiety.
Testosterone: If your menopausal estra-test is a great hormone replacement medication. If you are interested, talk to your doctor about the benefits and problems with this medication.
ADDYI: FDA has recently approved a medication for low sexual desire. As of 2021 it is a new drug and as such it is expensive. We have a hard time getting insurances to pay for it, but if you want to give it a try go to the website and talk directly with there doctors. This will be an online consult and they will send you a sample to see if Addyi is a good fix for you.
https://addyi.com/
Corona Virus and Adventist Health Tillamook
- This document is up to date as of October, 2021
- You can have only one person with you in labor as of 10/1/21. We hope this will increase in the near future.
- You can have one support person in the hospital, and you can bring one with you to clinic.
- You do not need to wear a mask while you are in labor.
- Your partner can not come with you if they have a fever.
- You will be tested for Corona-Virus when you arrive at the hospital, your partner will not.
- Your partner (s) must be over the age of 18. We still are not allowing children into the hospital unless they have medical needs.
Prevention for Pregnant Women
you might have heard this before…….
- Wash your hands
- Wear a mask
- Stay 6 feet away from people you don’t live with
- Do not go to group activities more than is needed for your mental and economic wellbeing
Common questions
If I am positive for Corona virus when I am in labor what happens?
Most experts are recommending that the baby is kept in another room. If you are breast feeding it is done with a shield, mask and gloves.
In the end this is your choice and it depend on how sick you are.
What if my husband/Partner has a fever?
Any visitor with a fever can not enter the hospital. Have a back up in mind.
What are common symptoms of covid and what do I do if I have those symptoms?
Common symptoms in pregnancy are fevers, Stomach upsets, generally not feeling good, many people are asymptomatic. If you have symptoms and are worried you were exposed, give us a call. If you have a primary exposure the health department will call you.
How many people can come with me to the hospital?
We are now allowing everyone to have two visitors when you are delivering a baby and after the baby is here.
It can be any two people. However, they can’t be under 18 yo, and if they have a fever, they can not come in.