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Alternatives to an epidural

Posted Sep 29 2009 10:04pm
If you're not planning on an epidural, or cannot get an epidural, there are several other options available to you to help with pain management in labor.

Medications: ask your doctor/midwife or L&D nurse what medications are available at your hospital. Ask about how often you can get it, and what the side effects are. Some medications might include: stadol, nubain, morphine, demerol or fentanyl. Phenergan is a medication used sometimes to help prolong the effect of the pain medication. On my unit, we can give you stadol or stadol with phenergan. We rarely give nubain, though I used to give that a lot at a smaller hospital I used to work at. I've given morphine for labor pain relief with IUFD patients. I have never given demerol for labor pain, and have rarely given small doses of fentanyl IV.

Paracervical block: this can work wonderfully if the provider is skilled in this procedure! It is a local anesthetic that is injected into an area on the left and right sides of your cervix. Yes, it's an injection, so it stings and burns, but it works fantastic! It usually lasts for about an hour, and it can be repeated several times. The most common side effect is if it is accidentally injected too close to a blood vessel, it can cause fetal bradycardia (very slow heart rate). This is transient, and lasts about 10 minutes, and is NOT CAUSE FOR ALARM. I must stress that. I have seen it happen several times. It resolves after about 10 minutes, and the baby is fine. With a PC block, you retain the ability to move freely and be ambulatory, unlike with an epidural. (Side note: I hope to learn how to give paracervical blocks during my midwifery clinicals. The midwife I will be precepting with does them, and does an awesome job.)

Sterile water papules for injection: Sterile water is injected in several areas around the sacrum (lower back). It is thought that this helps block or disrupt the gate controls that tell your brain that you are feeling pain. Here is yet another link about sterile water papules. It appears to work best with back labor. We are not allowed to use this technique (yet!) in my unit, but I would love to implement it.

Methods of non-pharmaceutical pain relief include: use of jacuzzi/tub/shower, counter-pressure on the lower portion of the lumbar/sacrum, heat packs (disposable, electric, or rice packs), massage, acupressure, acupuncture, and hypnosis. There are a variety of breathing techniques and visualization techniques that work well too.

Please note: it's always good to plan ahead, and have several items in your 'bag of tricks' to help you cope with labor. Review them and practice with your partner(s) before labor hits. This way you're all on the same wavelength as to what to do when the contractions begin.
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