Fetal monitors & pain relief during delivery

Chances are good that you’ll go through labor and delivery without any need for a fetal monitor for your baby or pain-relief medication for yourself. However, it’s a good idea to know in advance when and why these issues may arise.

Fetal monitoring

If your baby’s delivery is likely to be at greater risk than normal—for example if your blood pressure is high or if your baby will be delivered prematurely—the fetus most likely will be monitored. In fact some hospitals routinely monitor every labor continuously. Others use an intermittent system in which the baby is monitored during and after a contraction every 5 to 15 minutes, depending upon the stage of labor.

Monitoring can detect whether the baby is in distress and can measure the strength of your contractions to see whether they are of sufficient intensity for labor to proceed. The methods that are used to monitor your baby can be either of the following:

• External monitor. A beltlike device that is placed on your abdomen over the uterus to measure contractions.
• Internal monitor. An electrode attached to the unit also attaches to the baby’s scalp. Sometimes a catheter also is inserted into your uterus to measure the strength of contractions. This method is most often used in high-risk pregnancies.

Your pain-relief options

There will be pain, but there are many pain-relief options. Discuss them with your doctor and decide which ones you want to try. If breathing and massage techniques from childbirth classes aren’t enough, you can choose medication or drug-free pain control. There are four basic options to consider:

• Epidural. The most common anesthetic used in labor and delivery. The doctor threads a catheter through the vertebrae and into your lower back. Moderate doses of anesthetic are injected about once an hour. The anesthetic blocks both your motor and sensory fibers. The sensory nerves are easier to numb than the motor nerves, so you may, for example, be able to move your legs a little bit but you won’t feel them very well. So when it’s time to deliver, you can’t feel your contractions and don’t have a sense of when to push, which is a drawback.
• Continuous epidural. As with the epidural, a catheter is inserted, but only small amounts of anesthetic are administered by a pump so your nerve fibers are continuously bathed in anesthetic rather than overwhelmed with one large dose. As a result your sensory nerve fibers are blocked but not your motor nerve fibers, so you’re able to push.
• Walking epidural. This option allows you to remain mobile.
• Analgesics such as Demerol and Stadol. If you’re given either of these medications through an IV or as an injection, they can take the edge off the pain of contractions. Although they are narcotics, addiction is not a problem because the medications aren’t used for days at a time.

Drug-free pain control

In addition medication you also may consider the following:

• Hydrotherapy. If your hospital has a whirlpool spa, you can spend the most intense part of your labor letting the warm-water jets massage your aching back. The water allows you to relax and ride through the pain of your contractions. Many hospitals include spas in their maternity units for this very purpose. If your water has broken, you may not be able to take advantage of this therapy. Check with your doctor about any limitations.
• Self-hypnosis. This allows you to focus on a pleasant image while relaxing your body.