Pain management during childbirth is the partial treatment and a way of reducing any pain that a woman may experience during labor and delivery. The amount of pain a woman feels during labor depends partly on the size and position of her baby, the size of her pelvis, her emotions, the strength of the contractions, and her outlook. Tension increases pain during labor. Virtually all women worry about how they will cope with the pain of labor and delivery. Childbirth is different for each woman and predicting the amount of pain experienced during birth and delivery can not be certain.
History Prior to the 20th century, childbirth predominantly happened in the home, without access to any medical interventions for pain management. Childbirth was a leading cause of death for women, and many were fearful of the process, creating a large desire for pain management. But despite the demands of female patients, little relief was offered before the mid-19th century. Chemical anesthesia during labor was first introduced in 1847, receiving support from women and reluctance from physicians. Some doctors and religious authorities argued that pain relief in childbirth went contrary to God's choice to make childbirth painful; however, others specifically disputed this interpretation. Most opposition to anesthesia, though, was framed in terms of concern about its health consequences and physical effects on labour. Anesthesia's use was popularized in 1853 by Queen Victoria's decision to use chloroform for pain relief during the birth of her eighth child. The procedure became known to women as "chloroform à la reine" (in the style of the queen). In the early 20th century, a drug-induced state known as "twilight sleep" was developed by Carl Gauss and Bernhardt Kronig, two doctors in Freiburg, Germany. The procedure, especially when performed by untrained doctors, had a number of risks and side-effects. Its rise and fall coincided with both first-wave feminism and the anti-German sentiment that arose during World War I. In 1956, Pope Pius XII approved the use of painless childbirth. The 1960s saw the rise of epidural analgesics for pain management.
Preparation Preparation for childbirth can affect the amount of pain experienced during childbirth. It is possible to take a childbirth class, consult with those managing the pregnancy, and write down questions that can assist in getting the information that a woman needs to help manage pain. Additionally, pregnant women can alleviate concerns by having positive discussions about pregnancy with their friends and family. Positive context and associations with childbirth can help women perceive labour as a rewarding experience, which may reduce the amount of pain felt. On the other hand, interactions with friends and family can also create negative expectations for childbirth, which increases future labour pain. As a result, it is best to prepare by receiving positive and calming encouragement to induce positive expectations that will help modulate labour pain.
Non-pharmacological
Many methods help women to relax and make pain more manageable. A review of the effectiveness of non-medical approaches to pain relief found that water immersion, relaxation methods, and acupuncture relieved pain. These and other non-pharmacologic pain management options are further discussed below.
Breathing and relaxation techniques Relaxation methods may be helpful in reducing the risk of assisted vaginal births. Warm showers or baths Massage Many types of massage can be used during various stages of labor. Literature suggests light touch or stroke massage techniques may aid in the release of oxytocin, which may help stimulate contractions and facilitate cervical dilatation. Various types of massage may also help soothe and distract from the pain of labor. Warm or cold compresses, such as heat on lower back or cold washcloth on forehead Applying warm compresses, especially to the lower back area, while the cervix is dilating may help reduce pain during the first stage of labor and may even help to decrease the length of labor itself, however, the evidence supporting this is limited. Changing positions while in labor (stand, crouch, sit, walk, etc.) Use of a labor ball Using a labor ball during childbirth first began in the 1980s. It is best used during the first stage of labor. Evidence suggests using a birthing ball can facilitate pain relief by supporting the perineum and providing gentle stimulation to the area during cervical dilatation. It may also aid in fetal descent through various positioning exercises and with gravity. Listening to music Although little evidence supports music as an effective method in decreasing pain, it may provide a distraction or assist in creating a more positive birth experience which may ultimately decrease the chance of negative postpartum outcomes. Acupuncture The use of acupuncture may be associated with fewer assisted vaginal births and caesarean sections. Continuous supportive care of a loved one, hospital staff member, or doula The presence of a doula or support attendant may decrease the need for pharmacological pain control and increase the likelihood of spontaneous vaginal births as opposed to cesarean section. A positive support person may also assist in creating an environment leading to a more positive birth experience. Transcutaneous electrical nerve stimulation (TENS) have had additional research into their effectiveness and have shown marked effectiveness in reducing pain. Research has measured pain at 30 minutes interval after TENS therapy from between 30 and 120 minutes after TENS therapy and also from 2h to 24h post-delivery using the visual analog score. Those who underwent therapy had minimally increased pain scores, while those that didn't, had a significant amount of pain at over 9.5 compared to 6.02 for those who had undergone TENS therapy 2–24h after delivery. Other methods include hypnosis, biofeedback, sterile water injection, and aromatherapy; however, there are limited studies that demonstrate the effectiveness of in reducing pain during labor and delivery by using these methods.
Water and childbirth
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