November 2022

Labor Pain, What’s Your Best Strategy?

Imagine entering a Thai restaurant for the first time. Menu items in a foreign language may hint at ingredients, but guidance from an experienced diner could make all the difference. Someone to describe the dishes and make recommendations may save the day.

This scenario comes to mind when reviewing Henci Goer’s newest book, Labor Pain – What’s Your Best Strategy? Many people skip the pain relief menu and jump straight to the epidural because, doesn’t everyone get the epidural? Parents may be led to believe that an epidural as plan A is always the best choice. Glossed over details, confusing statistics, or feeling rushed at prenatal visits can make it difficult to understand all the options.

Expectant couples don’t always have time or access to in-depth exploration of the pros and cons of different pain relief options. Childbirth education classes used to cover this, but few expectant parents attend a full series of childbirth classes anymore. The effectiveness of doula support, position changes, massage, warm water therapy and other lower-tech options can’t be fully explored or appreciated in a brief conversation at a prenatal visit.
In just over 100 pages, Goer thoroughly explores pain relief in labor. Each pain coping option gets its own chapter explaining how and when it would be used, how well it works, and its advantages and disadvantages. She reviews options and circumstances that might make one choice a more comfortable fit than another.

The author acknowledges that there is no one right answer to coping with labor pain. Each person and their labor situation will be unique. Without making hard and fast recommendations, the book provides factual information in an easily digestible format to develop a personal strategy. Goer has a knack for explaining statistics, effectiveness, real-life situations, and offers chapters that take a deeper dive into the research if parents want more information.

Having a strategy in mind can help when plans change. A person hoping for an “all natural” birth might develop a dysfunctional labor that finds them considering an epidural. Someone else might arrive at the hospital with the plan of an epidural – right now – only to find the anesthesiologist is busy managing a cesarean and won’t be available right away. Knowing options and what to expect can help ease an otherwise stressful situation.

An epidural moves childbirth from a physiological process to a medically managed event that takes preparation to be safely administered. This means there’s always some delay in receiving an epidural once requested. IV fluids must be given before the epidural can be placed, continuous electronic fetal monitoring and frequent maternal blood pressure readings are required, and a urinary catheter is often necessary. Pitocin is also frequently needed to strengthen contractions. The longer an epidural is in place, the more likely it is that the laboring person will experience a fever requiring antibiotics (in case it’s a real infection and not just a side effect of the epidural.)

An informed patient will be able to roll with any delay and know how to cope until the epidural is available. An opioid injection, nitrous oxide (laughing gas), or a warm shower may be considered. Is the nitrous oxide unit readily available or does it take time to be ordered? Opioids might be readily available, but have some side effects and a possible cumulative effect if an epidural is added later. With this information, perhaps the choice is to get right into a warm shower, for some immediate pain relief with no side effects.

After some time in the shower, still considering the epidural, labor may slowly become more doable. Feeling like there is a rhythm and flow to the contractions instead of just pain, it now feels okay. The epidural is still an option, but perhaps as a plan B instead of Plan A. Maybe the next step is nitrous oxide. This is where the strategy part comes in.

Henci Goer’s book provides important information in a concise, nonjudgmental manner that stems from her expertise in working with both research and birthing families. Reading Labor Pain – What’s Your Best Strategy?, is like having that savvy diner at your side to review the menu in detail, with substitutions in mind. It may make the difference between a disappointing or satisfying experience.

Doulas, childbirth education –

Meet the Doulas – Nov 16, 7pm –

Labor Pain – What’s Your Best Strategy –

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