Survey: Childbirth hurts but pain relief options make it manageable

Few things are more daunting for first-time moms than the prospect of childbirth. They wonder: Will my baby be OK? What will labor and delivery be like? How painful will it be, and can I handle it? Moms who have been there offer the low-down on labor and delivery and their message is comforting. Yes, childbirth is painful. But it's manageable. In fact, nearly half of first-time moms (46 percent) said the pain they experienced with their first child was better than they expected, according to a nationwide survey commissioned by the American Society of Anesthesiologists (ASA) in honor of Mother's Day.

The survey findings suggest that being proactive in managing pain with your physician anesthesiologist is important, whether laboring moms demand an epidural right away, choose other medical pain management methods, use complementary techniques only or opt for a combination. Nine out of 10 women said pain management was effective, no matter what method they chose.

But the survey also revealed that many first-time moms held some false beliefs about labor pain management before they experienced childbirth:

  • 74 percent thought you couldn't have an epidural after a certain time in labor (you can have one up until the baby's head begins emerging, known as crowning)
  • 44 percent feared pain at the epidural injection site would last for a prolonged time
  • 26 percent believed an epidural slows labor
  • Most concerning, 20 percent believed only one pain management option could be provided during labor and 16 percent thought about it but didn't know

Expectant mothers should work with their health care providers, including their physician anesthesiologist, to discuss what pain management methods may work best for them. They should talk to their physicians to find out who will administer their anesthesia if they decide to have pain medication during labor. Anesthesia care should be led by a physician anesthesiologist, a medical doctor specializing in anesthesia, pain and critical care medicine, who will work with all of the mother's physicians to develop and administer her pain management plan.

"First-time mothers need to know that a wide variety of options exist to manage pain, from epidural to massage, nitrous oxide to breathing techniques and that it's acceptable to change methods or use a combination during nearly every stage of labor," said ASA President James D. Grant, M.D., M.B.A., FASA. "But it's also important to be flexible, since it may be necessary to change pain management methods based on the labor process itself."

When it hurt most and what it was like

While slightly more than half said having contractions was the most painful aspect of delivery, about one in five noted pushing or post-delivery was most painful. Moms 18 to 39 were more likely to say post-delivery pain was the most painful aspect than those 40 and older. The most common description of the level of pain experienced was extreme menstrual cramps (45 percent), while 16 percent said it was like bad back pain and 15 percent compared it to a broken bone.

Health and safety are top of mind

It's no surprise that when choosing a pain relief option, nearly all mothers (99 percent) said the health and safety of themselves and the baby was an important factor in their decision. Not far behind was making sure the pain relief option didn't delay the labor process (86 percent) as well as being able to enjoy the labor and delivery experience (84 percent). But the importance of other factors diverged depending on the pain method chosen. Having no pain during labor was very or somewhat important to women who chose medical methods (epidural, medication delivered through an IV or injection, spinal block or nitrous oxide) only (79 percent) compared to women who opted for complementary methods (breathing, water birth, massage, visualization or hypnosis) only (37 percent). Being able to move around during labor was important to 90 percent of moms who only had complementary methods, while just 60 percent of moms who had medical methods only agreed.

So, what pain management did they choose?

While the epidural reigned supreme as the most common option, chosen by 73 percent, 40 percent of women used complementary methods. Additionally, pain management during labor and delivery may not be "one size fits all," with 31 percent having used both medical and complementary methods. More than half used medical methods only and 9 percent chose complementary methods only. Sixty-five percent of women who had medical options only said they were very effective in managing pain, while 39 percent who had complementary methods only said they were very effective.

And while nitrous oxide has received a lot of attention recently, the survey results suggest it's rarely used. Only 2 percent of moms had nitrous oxide, and none 40 and older or who lived in the Midwest used it to manage labor pain. Before childbirth, slightly more than 1 in 10 thought nitrous oxide relieved pain and 63 percent didn't think about it at all. "This suggests that despite the buzz, nitrous oxide may not be widely available yet, or that mothers aren't convinced it would be very helpful," said Dr. Grant.

In the future

If they were to give birth again, most moms would choose the pain management method, whether medical and/or complementary, they originally chose during their first childbirth, with the majority (60 percent) opting again for an epidural to manage their pain.

Women were split on the pain management advice they would give to first-time prospective moms – 21 percent would recommend getting an epidural as fast as possible, while 20 percent say try complementary methods first and if they don't work, try other options. However, 43 percent of mothers agree that choosing one's pain management method is a personal decision and you need to opt for those that work best for you.

The 10-question ORC International CARAVAN® Omnibus Survey was conducted online April 3-11 among 912 mothers (18 years or older) of children ages 0-8, whose first child was born either via vaginal childbirth or Cesarean section (C-section) after the onset of labor. Ultimately, 73 percent had a vaginal childbirth.

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