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INTRODUCTION

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The first twelve hours of my labor were easy. I had prepared well for my labor and all the tools I learned were really effective. However, at a certain point, I felt like I hit a wall and just couldn’t do it anymore. I just wanted to be done. I didn’t care about anything anymore, I was so tired and so uncomfortable. I told my nurse I was really having trouble and asked what else I could do and she didn’t pause for a moment before saying, “get an epidural.” In my state, I couldn’t come up with any of my own alternatives and my husband was half-asleep on his feet by this point, so I just went with it. But it didn’t feel good, it felt like I was weak or was just giving up or something. In the end, my baby was healthy and I know there are no prizes for having a natural birth, but I really did want that experience and was bummed it didn’t go that way. I wish someone had been able to help me in some other way besides just: here, take the drugs.

M. V., new mother

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Ineffective pain management is usually discussed in the context of pharmacologic methods of pain relief. However, women using nonpharmacologic methods of pain management in labor can also encounter periods of time when those tools become less effective and a mother who had previously been managing her labor well finds herself having difficulty coping. The typical medical response to this situation would simply be to offer pharmacologic pain relief. However, there are many alternatives that can be tried before abandoning the plan for an unmedicated birth. An understanding of some of the common patterns of uncontrolled pain can guide care providers and laboring women toward alternatives that may be the most helpful.

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COMMON PATTERNS OF PAIN OBSERVED IN NATURAL LABOR AND POSSIBLE SOLUTIONS

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Significant Back Pain

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“Back labor” is particularly difficult for women to manage with natural techniques. Some women predominantly feel contractions in their back, regardless of fetal position, but if a woman is complaining of strong back pain, a sunny-side up or occiput posterior baby is the usual culprit. In this position, the weight of the back of the baby’s head presses against the sacrum and creates intense discomfort. Alternative maternal positioning can help with both fetal rotation and pain relief, particularly forward-leaning positions.1 Most mothers find lying in the bed to be a nearly impossible position to maintain when they are suffering through a back labor. Massage is another option that mothers and their labor support team can try to reduce back pain. Generally, for this type of discomfort a higher pressure massage of the lower back, buttocks, and thighs is most helpful, though the pressure should always be modified for the mother’s comfort. Some women may prefer light ...

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