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Here’s an interesting bit of information you may like to know. Some researchers think that babies actually release a signal to the mother’s body that triggers labor. 

James W. Brann, MD

Your Pregnancy MD
Pregnancy Week Thirty Six

Pregnancy Week 36
Pregnancy Week 36

At 36 weeks pregnant, your uterus is rather “huge”. You may think that you can’t get any bigger, but keep in mind that you have four more weeks until your due date. Your belly will get larger in the next month. The capacity of a woman’s uterus and abdomen to stretch during pregnancy is truly a remarkable phenomenon. At no other time in your life will the body transform at such a rapid rate than in pregnancy.

Amazingly, while it takes nine months for the uterus to stretch to many times its normal size (from the size of a small pear to being able to hold a seven pound baby), by your six-week postpartum checkup your uterus will already be back to its normal pre-pregnancy size.

Your uterus continues to crowd your internal organs, and you may be ready for the day that your baby drops into your pelvis. For first time moms, “lightening,” or the descent of your baby into the pelvis usually occurs a few weeks before labor begins. Your baby might drop this week, or next, or the following week.

Your baby may drop into your pelvis this week, this is called lightening

Your baby may drop into your pelvis this week. This is called lightening, and it’s a normal occurrence in the final weeks of pregnancy. It’s a sign that your baby is getting ready to be born; however, it may be a few more weeks until your labor kicks into full swing.

After your baby drops, you’ll have less pressure in your abdomen, so you’ll be feeling relief from a few pregnancy symptoms – such as heartburn, shortness of breath, and rib pain and discomfort.

Unfortunately, once lightening occurs, you may start to waddle. Some women experience pelvic discomfort when they walk. Frequent urination is going to be a huge problem after your baby drops. Because your baby is taking up more space in your pelvic area, you may be running to the bathroom every five or ten minutes to empty your bladder. You may have the urge to urinate, even when your bladder is nearly empty.

Fortunately, this won’t last too long. Only four weeks to go until your baby is due!

Your Baby at 36 Weeks of Pregnancy

Your baby at 36 weeks of pregnancy.

By the time you reach pregnancy week 36 your baby is already about 5.8 pounds and may measure more than 18.6 inches long! Compared with the start of your pregnancy you might consider your little one a heavyweight champ at this point in time!

Mucous Plug

Another change you may have noticed is more vaginal discharge. The discharge may be increasing and even getting thicker. Don’t worry about the discharge – it’s absolutely normal. At this late stage in pregnancy, your mucus may be pink, red, or even brownish. Also, your discharge may be related to the fact that your mucus plug is starting to dislodge itself – a sign that labor is on its way.

True Labor Vs. Braxton Hicks Contractions

Perhaps the biggest question on most women’s minds during pregnancy is whether they will be able to identify true vs. false labor. The answer is tricky. Even experienced mothers sometimes have difficulty distinguishing between real labor and false labor. Chances are however once you are in true labor you will know it. It is however common for many women to experience false labor or pre-labor that feels like the real thing. Here are some tips for distinguishing between real and false labor.

Braxton-Hicks Contractions – False Labor

Braxton-Hicks contractions are your body’s way of preparing for labor and delivery. Most women experience Braxton-Hicks as menstrual like cramping or brief tightening in the lower abdomen. This feeling tends to be sporadic, meaning it comes and goes at various times. Braxton-Hicks  while common sometimes do result in discomfort or pain. This is part of the reason so many women have a difficult time distinguishing between false and true labor.

False labor contractions may occur regularly at 5 minute intervals, but generally only last about 30 seconds or so. It isn’t uncommon for women who have had children before to misinterpret Braxton-Hicks as the real thing and show up at the hospital, only to be sent home a short while later.

Here are some signs you may be in false labor:

  • Contractions are irregular.
  • Contractions don’t get closer together after a certain period of time.
  • Contractions are usually weak and don’t get stronger over time.
  • Contractions are usually felt in the front only instead of in the back.
  • Contractions may slow down or stop completely if you lay down, drink fluids or take a hot shower.

True labor pain is characterized by contractions that come regularly, gradually strengthen over time and do not go away if you change position.

When to GO to the Hospital: Video

Here are some signs of true labor:

  • Contractions usually last between four and six minutes apart and may last up to 60 seconds or more.
  • Contractions generally get stronger over time.
  • Vaginal pressure or back pain accompanies contractions.
  • Contractions continue to get stronger regardless of your position or whether you consume fluids.
  • Contractions are accompanied by a bloody show with the mucous plug.

Your water may also break during true labor. If in doubt, it never hurts to call your physician. Most doctors will recommend that if contractions occur regularly and last more than thirty seconds, you should try first drinking lots of fluids and lying down. If this doesn’t stop the contractions you may be in labor. You might avoid timing your contractions until they feel quite strong and are regular. Early labor, particularly for first time mothers, can last hours and hours, and you may find it tedious to time early contractions during labor.

Whenever in doubt it never hurts to get checked out. Don’t worry about feeling silly or embarrassed. Even the most experienced moms check into the hospital with false labor contractions. What’s more important is you make it to your doctor in time before it is too late. The very worst thing that can happen is you are sent home to labor on your own for a few more hours (or days if in false labor). Think of it this way, you’ll have plenty of fun stories to tell your family and children after you do go into labor and deliver your baby!

Vaginal Birth after Cesarean Delivery (VBAC)

What Every Mother Should Know about VBAC

Vaginal Birth after you had a Cesarean Birth

Women who have had a Cesarean delivery (C-section) in the past may wish to try a spontaneous vaginal birth. This is called a vaginal birth after Cesarean (VBAC) delivery.

In the past, women who had a Cesarean delivery were told not to attempt a vaginal birth for any later children. Studies have shown, however, that most women can safely try to have a vaginal birth if they have had a prior Cesarean delivery.

Who Should Not Try a VBAC Delivery?

A VBAC delivery may be dangerous for some women. Your doctor or midwife may recommend against a VBAC delivery under the following circumstances:

  • You have had more than one Cesarean delivery in the past.
  • Your uterine incision from a prior Cesarean delivery was vertical or T-shaped.
  • You or the baby have a health condition that makes vaginal birth dangerous.
  • You tried a VBAC delivery before and were unsuccessful (for instance, your uterus ruptured).
  • You do not plan to have access to emergency Cesarean delivery help if the trial of labor fails.
  • You are pregnant with multiples or the baby presents in a risky position when you go into labor.

What are the Risks of a VBAC Delivery?

Although most women can have a safe and successful VBAC delivery, problems may arise that make a repeat Cesarean delivery essential. If you decide to make a trial of labor after a Cesarean delivery (TOLAC), you should be aware of the risks you face. Some women experience the following problems with an attempted VBAC delivery:

  • During spontaneous labor, the uterus tears opens again at the place of the incision from the past Cesarean delivery. This makes an emergency repeat Cesarean delivery essential.
  • The labor is longer or more difficult than expected. In these cases, a repeat Cesarean delivery may be necessary for the health of the mother or baby.
  • It may be difficult to find a doctor or midwife who is willing to support the decision to try natural labor.

What are the Benefits of a VBAC Delivery?

What are the benefits of delivering vaginal, instead of by C-section
Vaginal Birth after C-section

A VBAC delivery can be intimidating, but there are many potential benefits to them. For instance, some women are disappointed with the childbirth experience when they deliver by Cesarean, and a VBAC delivery enables them to experience traditional labor and childbirth. Some of the other benefits of VBAC deliveries include:

  • Lower risks of postpartum infection, blood clots, and other complications that can arise from a major surgery (like Cesarean delivery).
  • Shorter hospital stay and recovery time for most women.
  • Increased likelihood of being able to deliver future children through vaginal birth.
  • The baby may have fewer breathing troubles at birth.
  • Vaginal birth may make breastfeeding easier for the mother and the baby.

What are the Alternatives to VBAC Delivery?

You can opt for a planned or elective Cesarean delivery if you do not elect VBAC
You can opt for a planned or elective Cesarean delivery if you do not elect VBAC

If you have had a Cesarean delivery in the past, you may not feel comfortable trying to have a VBAC delivery. If you choose not to attempt natural, spontaneous labor, you can opt for a planned or elective Cesarean delivery.

Planned Cesarean deliveries are less likely than emergency Cesarean deliveries to have complications for the mother or the baby. Women who do not plan to have another Cesarean but are unable to complete a VBAC delivery may need an emergency Cesarean delivery. Elective repeat Cesarean deliveries are common and are very safe. However, they still carry the risks and downsides of a major surgery.

How Successful are Attempts at VBAC Delivery?

Some women who attempt to give birth vaginally after having had a Cesarean delivery are unable to do so. As many as 20-40% of women with a prior Cesarean delivery are unsuccessful when they try to have a VBAC delivery. Problems with the old uterine incision, the health of the mother or baby, or the position of the baby can make a vaginal birth dangerous or impossible. Although this “failure” rate may seem high, it still means that up to 8 in 10 women are able to have a safe, successful vaginal delivery even after a past Cesarean delivery.

What Can You Do to Have a Successful VBAC Delivery?

f you attempt natural labor after a Cesarean delivery, your healthcare provider should work with you to prepare for the experience. You may be able to increase your chances of having a successful VBAC by taking care of your health problems (like diabetes or high blood pressure), staying healthy during pregnancy, communicating your wishes to your doctor or midwife, and allowing yourself time to heal from the Cesarean delivery before getting pregnant again.

These tips may also come in handy if you want to try spontaneous labor and have a successful VBAC delivery:

  • Let your obstetrician or midwife know as soon as you decide that you want to attempt natural labor. If he or she is not supportive, ask why (there may be strong medical reasons to avoid a VBAC). A supportive health professional may be essential to a successful VBAC delivery.
  • Arrange to give birth in a facility that has the proper monitoring equipment to keep you and your baby safe during labor and vaginal delivery.
  • Choose a hospital or birthing center that is able to provide a safe emergency Cesarean delivery if necessary.
  • Consider taking a childbirth class or hiring a birth coach to help prepare you for a vaginal delivery.
  • Follow a healthy diet and exercise regimen, according to the advice of your healthcare provider.

You Can Choose a Cesarean Birth to Avoid Labor

For many years, the number of babies born via Cesarean section deliveries has been increasing. Nearly 1 in 3 babies in the U.S. is now born via C-section, and most of these are for medical reasons. In some cases, though, women choose to have a C-section even if they have no medical need. These are called elective C-sections, or Cesarean deliveries on maternal request.

Medically Necessary C-Sections?

There are many reasons women have a C-section instead of a spontaneous vaginal birth. Medical reasons for C-sections include the following:

  • There is an emergency complication during labor.
  • The labor is very long or difficult and may become dangerous to the mom or baby.
  • The mother or baby has a reason that makes vaginal delivery unsafe such as, your baby is too big, your pelvis is too small or the baby is lying sideways or breech.
  • The mother has had a prior C-section and her physician feels it would be more risky to have a vaginal birth than a repeat C-section.

Why Do Some Women Request Elective C-Section Deliveries?

In addition to increasing numbers of medically necessary C-sections, women are increasingly requesting C-sections for non-medical reasons. Women may want elective C-sections for a variety of reasons, but the most common concerns are the following:

  • Women fear the pain and risks of a vaginal delivery.
  • Women want a sense of control over the due date and the process of childbirth.
  • Women wish to avoid the potential complications or side effects of a vaginal delivery (such as urinary incontinence).
  • Women have had a vaginal birth in the past that was very negative or unpleasant.

All of these concerns are normal and understandable. It is perfectly natural—especially for first-time moms—to feel anxious about giving birth. Many women find the idea of having a baby less stressful when they can plan the day and time in advance, and even arrange for family to be in town for the big day.

Sometimes, women have heard horror stories from friends or relatives who had a terrible childbirth experience. Still other moms know how common C-sections already are and just want to save themselves the trouble of having an emergency (or acute) C-section. Women who have given birth before may want to avoid repeating the pain or risk, especially if they had complications or a long labor.

What You Should Know (or Ask) About Elective C-Sections

If you are thinking about requesting a C-section and you have no medical need for your choice, take time to learn about the pros and cons before you decide. Always talk to a physician or midwife about your questions and concerns before scheduling an elective C-section. This helps make sure that you have all of the facts before you make up your mind.

After doing some research on your own, be sure to think about and discuss the following topics with an obstetrician or midwife:

  • What are your main reasons for wanting a C-section? Are you afraid of delivery, pain, or complications? Are there ways you could prepare for a vaginal birth to make it less intimidating?
  • Does your facility or insurance even provide elective C-sections? If so, what are the restrictions on timing or reimbursement?
  • What are your personal risks for major surgery? What can you expect in anesthesia and recovery time?
  • What are your personal risks for an unplanned C-section if you do not elect one in advance? Will your weight, health, or birth history put you at higher risk of a medically necessary C-section if you try to deliver vaginally?

Make sure your healthcare provider can answer all of these questions and any others you may have before trying to schedule an elective C-section. Many women may find that more information about what to expect from childbirth and the risks involved with major surgery may make an elective C-section less appealing.

In addition, most hospitals do not perform Cesarean deliveries on maternal request until the pregnancy has completed 39 weeks. Other hospitals may try to discourage elective C-sections whenever possible to avoid delivering a baby preterm, as some estimates of gestational age are incorrect (and preterm birth causes many problems for the baby’s health and development).

Elective C-Sections Vs. Vaginal Birth: Pros and Cons

Planned C-sections are usually safe surgeries. Women who undergo a planned Cesarean delivery are less likely to experience certain surgical complications, like infections or excessive blood loss, than women who have an emergency C-section. Despite the safety of this procedure in the U.S., an elective C-section is still major surgery. It carries serious risks, such as blood clots or organ injury, and some women may have a poor reaction to the anesthesia. Women who want to have more children may require a C-section for all future births.

Most women who undergo a C-section delivery also have longer recovery times than women who have a vaginal birth. They may spend more time in the hospital, have higher rates of infections postpartum, and experience more pain when they hold their babies or try to sleep.

On the other hand, women who give birth vaginally may be more likely to have urinary incontinence, which makes it harder to control the bladder. They may also suffer injuries to the pelvic floor or perineal tears (which are tears in the vaginal tissue). Vaginal birth is also typically a more painful process than elective C-sections, even when pain relief medications or injections are given.

Elective C-sections may prevent some pain and risk to the mother, and they may also spare her the pain or inconvenience of a long or complicated labor. When planned in advance, elective C-sections can normally prevent a baby from experiencing a lack of oxygen or an injury from the birth canal that a vaginal delivery can cause. Vaginal birth may offer the baby some benefits that a C-section cannot offer, however, such as exposure to helpful bacteria from the mother’s vaginal fluid. Some women may also find it easier to bond with their baby or successfully breastfeed after a vaginal birth. Long-term outcomes for children born from elective full-term C-sections do not differ from children born vaginally.

Requesting a C-Section: Making Your Decision

Before you decide on an elective C-section, try to get to the root of your concerns about vaginal birth. Taking a Lamaze class or talking with a birth coach may help relieve anxieties about vaginal birth and help you have a smooth vaginal delivery. If you decide to request a Cesarean delivery, be prepared to explain your reasons to a healthcare provider. Finally, remember that your childbirth method has to be a personal decision that you make for you and your baby. Each birth method has risks and rewards, so weigh your options carefully before making your decision.

Pain Relief Options during Labor and Delivery

Pain Relief options for labor
Controlling pain in early labor

You are most likely ready for this baby to be born. With your due date looming in less than a month, your thoughts are often drifting to your labor and delivery. If this is your first pregnancy, you may be nervous about the pain of childbirth.

To alleviate many of your fears, you should take some time this week to research your pain relief options. Call your hospital to see what they offer, and discuss this with your doctor or healthcare provider.

As you are doing your research, keep in mind that every woman experiences and tolerates pain very differently. Some women have a high pain threshold and only require focused breathing and relaxation techniques to get through their labor and delivery. Other women will require pain medication to help them cope.

Pain Relieving Drugs Available During Labor and Delivery

There are two categories of pain-relieving drugs: Analgesics and Anesthesia .

ANALGESICS:

These drugs offer pain relief without a total loss of feeling. They reduce your pain, but don’t always completely stop it.

Systemic analgesics are given as injections into one of your muscles or a vein. They lessen your pain and you will not lose consciousness. They affect your entire nervous system, rather than targeting a specific area.

Regional analgesics are often the most effective form of pain relief during labor and delivery. They include epidural blocks, spinal blocks, and combined spinal-epidural blocks.

With an epidural block, you will lose some feeling in the lower areas of the body, but you will stay alert and awake. You may receive an epidural block after your contractions begin, or later in your labor. An epidural block is given in your lower back. Pain relief typically begins ten to twenty minutes after the medicine has been injected.

During a spinal block, you will get an injection in the lower back to numb the lower half of your body. It offers good and immediate pain relief, but it only lasts for an hour or two.

ANESTHESIA:

These medications block all feeling and sensations, including pain. They also block muscle movement. If you receive local anesthesia, you will have numbness and loss of feeling in a small area. With general anesthesia, you will lose consciousness and feel no pain. In most cases, anesthesia is only used at the time of surgery.

Talk to Your Doctor About the Best Pain Relief Option

You should have a conversation with your doctor or healthcare provider about the best pain relief option for you. Make sure to learn about the pros and cons of each choice. Remember that although pain relief during labor and delivery is generally safe, it does come with some risks and side effects.

Is a Medicated Labor Right for You?

You may decide that a medicated labor and delivery is not right for you. You may want to attempt drug-free methods first. These include relaxation and breathing techniques, hypnosis, and acupuncture.

Keep in mind that even if you have made up your mind about a natural childbirth experience, it’s okay to change your mind at the last minute. Don’t feel disappointed if you decide to have a medicated labor and delivery. All that matters is that you deliver a healthy baby!

What happens when I get an epidural? Combined Spinal-Epidural

OK, the day you have been waiting for has finally come, you are in labor. You think the contractions are not “so terrible” as the nurse puts you in your labor room. But, wait the contractions are getting stronger and now you are wondering how strong will the contractions become.

At this point you are thinking about that prenatal class lecture that talked about the “breathing techniques” to help with the pain. So you give them a try with your partners help. You soon realize that the breathing is not helping, so you ask for your first dose of IV pain medications. The IV pain medication did not help either; in fact it just made you feel dizzy and you started to vomit.

The contractions now are unbearable and you want the pain to just stop. You want the contractions to stop hurting, now!  Remembering back to your prenatal classes, you recall using an epidural during the intense part of labor, but it would take 10 to 20 minutes to take effect. That would never do, “I want pain relief now”.

Sounds terrible, yes it is. I have heard this scenario over and over again from many laboring patients. Only if they knew that they could get immediate and continuous pain relief with a new anesthetic technique called a “CSE” or combination spinal/epidural anesthesia technique.

What is great about combined spinal-epidural analgesia (CSE)?

Combined walking spinal-epidural analgesia.
Epidural is the best pain relief for labor

The epidural and spinal analgesia combination is the most effective pain relief for labor and delivery today. The combined spinal-epidural analgesia (CSE), gives you the benefits of both.  The spinal anesthetic allows for a rapid onset (almost immediately) of pain relief and the epidural anesthetic allows for continuous pain relief throughout labor. This combined spinal (fast acting) and epidural (slower onset but greater control) anesthesia technique has led to exceptionally high levels of pain relief satisfaction.

The use of combined spinal and epidural anesthesia has risen for the past 10 years. Because of the advantages over the older single-shot spinal or epidural techniques that were limited by the duration of action and the inability to be adjusted for increasing pain.

The spinal anesthesia is easy to administer, rapid in its onset, and produces excellent pain control. The epidural, allows for smoother control of your changing pain perception.  Once the effects of the spinal anesthesia subside, the anesthesia received through the epidural portion takes over to relieve the pain. The epidural medication is regulated to provide the exact amount of pain relief desired until the baby is delivered.

How is the combined spinal-epidural analgesia (CSE) administered?

To administer a combined spinal/epidural anesthesia, a mother in labor is placed in a sitting position. Her back is cleaned and prepared with an antiseptic solution. The physician first inserts an epidural needle into the lower back.  Then, a long and fine spinal needle is inserted through the epidural needle until it reaches the fluid surrounding the spinal cord (cerebrospinal fluid). The anesthetic (pain medicine) is then administered through the spinal needle, resulting in immediate pain relief. The spinal needle is then withdrawn.

The next step is to insert the epidural catheter (thin tube) through the epidural needle; the catheter is fixed in place with tape. The epidural catheter is used to give you continuous infusions of anesthetic (pain medicine) for extend pain relief once the effect of the spinal pain medicine wears off.

Who can have a combined spinal-epidural?

The combined spinal/epidural anesthesia is indicated for all women who want rapid onset of pain relief, control over the amount of pain medicine they receive, and can be used for a scheduled cesarean sections.

What are the advantages of a combined spinal-epidural?

The increasing popularity of combined spinal/epidural anesthesia technique is attributable to its numerous advantages. The CSE allows rapid onset of surgical anesthesia, allows for continuous pain control during a long labor or surgery and pain relief after.  It also facilitates mobility (walking epidural), while controlling pain during early labor.

Overall, because of CSE technique’s faster pain-relieving effects with minimal discomforts and side effects, it has become the analgesic of choice with laboring patients.

What are the disadvantages of a combined spinal-epidural?

CSE may cause a sudden drop in blood pressure, which is similar to the side effect noted with other spinal and epidural techniques. If the blood pressure does drop, it is easily increased by turning you to the left side and administration of a drug to increase blood pressure (vasopressin). Decrease in blood pressure is a very common side effect.

Another disadvantage is the increased risk of a spinal headache, also known as postpartal puncture headache. The headache is relieved by lying flat and increasing caffeine intake. If the spinal headache is persistent a procedure can be done for immediate relief called a “blood patch”. The headache is a rare complication of CSE.

What are the effects on the baby of a combined spinal-epidural?

Virtually all medications administered during labor have the ability to cross the placental barrier and reach the baby. However, spinal and epidural anesthetics are less likely to cause side effects on the baby when compared to drugs delivered through an IV.

SUMMARY of the combined spinal-epidural?

  • CSE (combined spinal-epidural) has become the analgesic of choice with laboring patients.
  • CSE has immediate pain relief and continuous pain control throughout labor.
  • CSE is a patient controlled pain management technique that actively allows you to adjust the amount of pain medication you need.
  • The term “walking epidural” is commonly used to refer to CSE.
  • When compared to different classes of pain relievers CSE has the advantage of minimizing the likelihood of side effects.

How Can I Deal With the Pain of labor without an Epidural?

Pregnant women choose to manage labor pain associated with giving birth in different ways. I have patients that do not want any pain medicine, to women who would rather not feel one contraction.

There is not a universal way to manage labor pain that will works for everyone. The right type of pain management is a personalized decision between you and your physician. You need to research what labor pain control is available and talk to your physician about the one that is best for you.

Although, it is very helpful to discuss labor pain management ahead of time, you must realize that the best plans can always change. That is, because almost always your expectations of pain will be more or less than you thought.

You may choose to give birth without any pain control, “natural childbirth”. This means that you will not use any pain medications while in labor and giving birth. Instead, you will have to use breathing and relaxation techniques as well as other things to lessen the pain. Or, instead you may choose to use “labor pain medicines” to help ease the pain of giving birth.

The pain of labor and delivery is different for every woman.  The amount of pain you experience while laboring and giving birth is different for every woman. In fact, the intensity of the labor pain can be different between each one of your own births. The pain also depends on the size of your baby, the position of your baby and if this is your first delivery. The amount of discomfort also depends on if you are in the early part of labor or closer to giving birth.

You can do the following early in labor to control the pain:

  • Change your body position often; do not remain in one position for an extended period of time.
  • Use your relaxation or breathing techniques that you learned in your prenatal classes.
  • You find relief by taking showers or baths during the early part of labor.
  • Lower back pain can be reduced with a good old fashion lower back massage.
  • Use heat or cold packs on your lower back
  • Listen to soothing and relaxing music.
  • During early labor walking will give you some relief.
  • Make sure a support person stays with you to give support and reassurance.

You can use pain medication later in labor to control the pain:

Despite your best efforts, pain medicine may be needed to help with your labor pain. If you want to use medicines all you have to do is ask *. Doctors can order many different types of medicines to help decrease your pain in labor. These medications are used just to lessen the amount of pain you feel, but you will still feel pressure.

Pain medication can be given through your IV or as a shot – Opioid medicines are used in this way to lessen labor pain, but you will still feel discomfort at the peak of the contraction and pressure. The opioid medicines will cause nausea or vomiting and can make you feel sleepy. The baby will also be sleepy too, so these medicines are not used close to delivery.

Pain from Vaginal Tears and/or Episiotomy

The pain associated with an episiotomy and/or vaginal tear can be bothersome for weeks after giving birth. The pain can be so intense that patients do not hesitate to call in the middle of the night for help. Here are a few tips to help with the discomfort:

  • Application of ice packs helps, especially if there is swelling
  • Application of 5 percent topical lidocaine ointment
  • Take a “sitz” bath – a shallow tub of warm bath water twice a day
  • Take acetaminophen (Tylenol) or ibuprofen (Advil, Motrin)
  • Analgesics with codeine

Afterbirth Pains

Afterbirth pains are very common and occur frequently after giving birth. They are caused by strong contractions of the uterus. The pain is more of a problem for moms that have given birth before and that are nursing. Nursing will cause the release of a hormone called oxytocin which causes the uterus to contract strongly. The prolonged cramping of the uterus is similar to a strong menstrual cramp.

Afterbirth pains usually stop at the end of the first week after delivery. You can find considerable relief from the pain with short acting non-steroidal anti-inflammatory drugs (NSAIDs), such as ibuprofen (Advil or Motrin).

Being Prepared for Child Birth Considerably Reduces the Use of Pain Medicines

The fear of giving birth and being unprepared potentiates the amount of labor pain. If you are not fearful, and have confidence in your physician you will usually require less amounts of pain medicine. This was demonstrated by Read in his book (Childbirth without Fear. New York, Harper, 1944, p 192).

Lamaze (Lamaze F: Painless Childbirth: Psychoprophylactic Method. Chicago, Henry Regnery, 1970) concluded the pain of giving birth often can be decreased by teaching pregnant women relaxing breathing techniques and labor partners support techniques. His techniques reduced the use of pain medications need during child birth.

In conclusion, if you are motivated and prepare yourself for child birth, the associated labor pains has been shown to be reduced, and the actual time in labor is even shorter. In addition, having a supportive spouse or partner, a conscientious labor nurse, and a physician who you trust have all been found to be of considerable benefit in reducing your labor pain.

*The American College of Obstetricians and Gynecologists (2002)  with the American Society of Anesthesiologists re-stated their joint position “that a woman’s request for labor pain relief is sufficient medical indication for its provision”.

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