Ask a Midwife: The Spectrum of Pain Management Options

Ask a Midwife is a new blog series from Adriatica Women’s Health. Hear directly from midwives on topics like reducing c-section risk, considering a VBAC, pregnancy in a pandemic, and more. This conversation about pain management options is with Liz Marley, a Certified Nurse Midwife who believes midwifery is about empowerment and advocacy for women.

Stephanie: This month I’m excited to discuss another hot topic with another passionate midwife. Liz, you wanted to discuss pain management options. Why is that?

Liz: I still have a lot of patients who don’t know all of their pain management options when utilizing a midwife, and there’s a slew of tools. Women might not know a midwife is even an option if they want an epidural. As midwives, we’re here to help facilitate the birth experience that’s right for you. Maybe you are high risk but you want labor support, or maybe you’re low risk but you know you want an epidural and the individualized care of a midwife. I want women like this to know a midwife is an option for them.

S: In my experiences giving birth, I felt my pain management options were to either white-knuckle through the pain or opt for an epidural. But you’re saying there’s a spectrum of pain management options. What are these options, and how is it different when you are the patient of a midwife?

E: I think the best thing that we do as midwives is offer labor support. Midwives believe natural childbirth works. Our bodies were designed to give birth, so for women who want natural childbirth, we have different tips and tricks to help manage the discomfort of labor. This includes positioning, massage and counterpressure. We use birth balls, stools and squat bars to help with different positions. We also have options for hydrotherapy. Some women prefer having the warmth of the shower and the tactile stimulation with the water hitting the skin. Some women prefer laboring in the tub with the weightlessness and buoyancy that you get sitting in a warm bath. There are so many tools and methods to try, and that’s a big part of the labor support a midwife provides.

S: I found the labor and delivery nurse to be the main presence and support during my labors. Are they usually trained to help with pain management in a similar way with positioning and massage?

E: Labor and delivery nurses may have training through their programs, or they may learn on the job. But nurses don’t always get the freedom or don’t have the ability to offer one-on-one full-time labor support. As midwives, we kind of gauge the needs of each woman and offer labor support and pain management based on what they need and want – and we’re fully present to make it happen.

S: Say you’re with a patient trying different positions, massage and hydrotherapy to ease pain, but they’re still struggling. Are there other options before heading straight to an epidural?

E: Absolutely. Sometimes women just need a break, and IV pain medicine can help take the edge off for a few hours. The common medications are Demerol, fentanyl and Stadol. While they don’t prevent pain, they help sedate the woman and give them a window to relax. This option is usually short-term. Another option that’s slowly coming back to labor and delivery is nitrous oxide. It’s patient-administered, so you take it as you need it.

S: Aside from managing pain, labor is exhausting mentally and physically. How do you help women who are depleted of energy and ready to throw in the towel?

E: Every woman will hit that point when they feel like they can’t do it anymore. Physically and mentally, they’re just done. We call that the transition term, and it’s usually when they’re close to the end. If I know they want natural childbirth, I encourage them to try something different before getting an epidural. There are many ways to support women so they can rest and relax between contractions, whether that’s leaning over the side of a bed, sitting on a bench in the shower, even supporting them in an upright position so they can completely let their muscles go. Oftentimes, women will fall asleep in that two-to-three-minute break between contractions.

S: It sounds like a midwife brings a wealth of knowledge to every childbirth experience and can tailor their support to the individual.

E: Midwives are passionate about labor support and especially passionate about facilitating the birth experience you want. I hope this has helped educate women on the many options for them.

Find out more about Liz Marley and Adriatica Women’s Health, and follow the discussion around women’s health on social media.