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Although many women over 35 end up having an epidural, there are multiple other options, and it's good to be informed about these and ask about them when you talk with your care provider. Types of pain relief range from complementary techniques like acupuncture to powerful narcotic drugs.

Tens

Transcutaneous electrical nerve stimulation (TENS) works by passing a tiny electric current through the skin. This current is believed to block pain messages from reaching your brain. It may also stimulate your brain to produce natural pain inhibitors, called endorphins. Tens devices are about the size of a small radio and are connected to electrodes placed on the skin, usually on your lower back. Electrical impulses result in a tingling sensation, which some women find annoying. The side effects of tens are usually no more than some skin irritation where the pads are stuck to the back. The electrical impulses do not affect the baby. Most studies of tens in labor have found it to be only mildly effective in reducing labor pain.

Acupuncture

Some women find acupuncture helpful in reducing labor pain. There are different theories as to how acupuncture works. In Western medicine, the hair fine needles placed in the skin are believed to stimulate larger nerve fibers, which then block nerve activity in the smaller fibers that transmit pain sensations. It may also release endorphins, the body's natural painkillers. There is conflicting evidence on just how effective acupuncture is in reducing labor pain. However, it does seem to reduce the chance that you will request epidural analgesia. If you feel strongly about avoiding an epidural, acupuncture may be helpful for you. However, you'll need to find a licensed practitioner who will be able to be with you during labor, and to check the regulations at your hospital.

Hypnosis

There is some evidence that women who are susceptible to hypnosis may be able to reduce the sensation of pain through hypnosis. Hypnosis is a state of deep relaxation and concentration and is something that you can learn to do yourself (in which case it is called autohypnosis). While hypnosis is not harmful. it is expensive and only effective in women who are most susceptible to hypnosis. It may also only have mild effects on labor pain. If you want to try hypnosis, you should start inquiring about classes early in pregnancy.

Subcutaneous Water Injections

In this technique a small amount of sterile water is injected under the skin in two to four spots in the lower back. The procedure seems to be helpful for women who experience labor pain in their backs, especially if it is given in the early stages of labor. In two studies, treatments were found to provide a small to moderate reduction in pain intensity for up to 45 minutes after the injections. This therapy is safe and can be given by your care provider and may provide some pain relief in early labor. However, there is no evidence so far that water injections decrease the use of epidural analgesia.

Narcotic Analgesia

Narcotic medications, such as morphine and nalbuphine, can be used in labor. They are given either as a shot or intravenously. Narcotics slightly take the edge off the pain, but do not completely relieve it. They have the disadvantage of often causing drowsiness and nausea. Narcotics are most likely to be given in the active stage of labor. Most women can tolerate pain better when they are pushing because they can be active, and are less likely to need narcotics. You also want to be at your most energetic and alert during this stage so that you can push effectively. Some women use narcotics only for labor pain, while others use this type of analgesia as a way to handle pain until they request epidural analgesia (which is frequently delayed until you are more than 4cm dilated). Narcotics affect your level of alertness, and this will take a while to wear off.

Choice Of Medication

Most narcotic drugs are equally effective and have similar side effects. However, there are some that are possibly worse than others for the baby. Make sure you understand what medications you are being given during labor. One particular narcotic drug, meperidine should be avoided. In the body, this drug is converted to a substance called normeperidine, which can stay in your baby's system for days and affect his or her ability to interact with others. Safer alternatives are nalbuphine and morphine, both of which are more quickly cleared from the baby's system. However they may still make your baby drowsy and affect the baby's heart rate patterns.

Since one of the side effects of narcotics is nausea, many care providers will automatically give you a sedative drug called promethazine together with your dose of narcotic. Although experiencing nausea is unpleasant, you may want to ask your care provider not to give you promethazine unless you develop nausea, since it will make you very drowsy with out easing pain.

Spinal Block

Spinal analgesia is often used to block pain during a cesarean delivery. Similar to an epidural, it will usually numb you to pain and light touch from the top of your belly down. It is unlike epidural analgesia in that a needle is placed in to the spinal fluid (rather than outside the spinal sac) and a small amount of local anesthetic is injected in to the fluid. Leaking of spinal fluid occurs with about 1 percent of spinals and can result in a bad headache. Spinal analgesia lasts only 1-2 hours and can't usually be readministered.

Pudendal Anesthesia

If you don't have an epidural or if your epidural is not working well (a rare occurrence), your care provider may need to numb your pelvic area for a forceps delivery or to repair a tear. A pudendal block numbs sensation in the pudendal nerve, which supplies feeling to the genitals and inner thigh. To place a pudendal block, your care provider will place his or her fingers inside your vagina to help guide the injection. A small amount of local anesthetic is injected beneath the vaginal wall.

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