Travelling when you are pregnant

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Things Your Should Know About Traveling While Pregnant

There are some pregnancy and travel related concerns; however, the information below is provided to help make your trip the safest and most comfortable it can be.

Should You Travel at all During Your Pregnancy?

As long as there are no identified complications or concerns with your pregnancy, it is generally safe to travel at all times during your pregnancy. The ideal time to travel during pregnancy is the second trimester.  In most cases, you are past the morning sickness of the first trimester and several weeks from the third stage of pregnancy when you are more easily fatigued.

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Traveling By Air During Pregnancy

Whether you are going by car, bus, or train, it is generally safe to travel while you are pregnant; however, there are some things to consider that could make your trip safer and more comfortable.

  • It is essential to buckle-up every time you ride in a car. Make sure that you use both the lap and shoulder belts for the best protection of you and your baby.
  • Keep the air bags turned on. The safety benefits of the air bag outweigh any potential risk to you and your baby.
  • Buses tend to have narrow aisles and small restrooms. This mode of transportation can be more challenging.  The safest thing is to remain seated while the bus is moving. If you must use the restroom, make sure to hold on to the rail or seats to keep your balance.
  • Trains usually have more room to navigate and walk. The restrooms are usually small. It is essential to hold on to rails or seat backs while the train is moving.
  • Try to limit the amount of time you are cooped up in the car, bus, or train. Keep travel time around five to six hours.
  • Use rest stops to take short walks and to do stretches to keep the blood circulating.

 

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Is Air Travel During Pregnancy Safe?

Traveling by air is considered safe for women while they are pregnant; however, the following ideas might make your trip safer and more comfortable.

  • Most airlines allow pregnant women to travel through their eighth month. Traveling during the ninth month is usually allowed if there is permission from your health care provider.
  • Most airlines have narrow aisles and smaller bathrooms, which makes it more challenging to walk and more uncomfortable when using the restroom. Because of potential turbulence that could shake the plane, make sure you are holding on to the seat backs while navigating the aisle.
  • You may want to choose an aisle seat which will allow you to get up more easily to reach the restroom or just to stretch your legs and back.
  • Travel on major airlines with pressurized cabins and avoid smaller private planes. If you must ride in smaller planes, avoid altitudes above 7,000 feet.
  • Although doubtful, the risk of DVT can be further reduced by wearing compression stockings.

The Royal College of Obstetricians and Gynaecologists and the International Air Travel Association recommend that expecting mothers in an uncomplicated pregnancy avoid travel from the 37th week of pregnancy through birth.

Avoiding travel from 32 weeks through birth is recommended for women who have complicated pregnancies with risk factors for premature labor, such as mothers carrying multiples.

Risk factors that warrant travel considerations include the following:

  • Severe anemia
  • Cardiac disease
  • Respiratory disease
  • Recent hemorrhage
  • Current or recent bone fractures

Making Best of your Travels While Pregnant

  • Dress comfortably in loose cotton clothing and wear comfortable shoes.
  • Take your favorite pillow.
  • Plan for plenty of rest stops, restroom breaks and stretches.
  • Carry snack foods with you.
  • If you are traveling any distance, make sure to carry a copy of your prenatal records.
  • Wear your seatbelt and take other safety measures.
  • Enjoy the trip.
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Pregnant Women May Now Have a New Way to Limit Unhealthy Weight Gain

pregnancy-weight.jpgGaining too much weight during pregnancy is tied to an increased risk of complications for both mother and baby. However, some doctors are reluctant to recommend that pregnant women restrict their weight gain, in part due a lack of tools to help mothers do this safely.

But now, a new study finds that with the help of nutritional counseling and a smartphone app, pregnant women who are overweight or obese can safely restrict their weight gain in pregnancy.

In the study, women who were overweight or obese were assigned to follow a specific diet during pregnancy. The women received guidance from a nutritionist and used a smartphone app to log meals. At the end of the study period, these women had gained less weight than pregnant women in a control group who didn’t follow the diet. The women on the diet gained 4.5 lbs. (2 kilograms) less than the other women. What’s more, babies born to mothers in the diet group were not at increased risk of low birth rate or other problems.

It’s “very reassuring” that babies born to mothers who restricted their weight gain during pregnancy were not at increased risk for harm, said Dr. Saima Aftab, the medical director of the Fetal Care Center at Nicklaus Children’s Hospital in Miami, who was not involved in the study. Aftab added that doctors currently don’t have specific tools to help pregnant women restrict weight gain, and so the type of program in the study “may be a solution in the future.”

However, Aftab stressed that larger studies are needed to examine whether this approach ultimately leads to heathier pregnancies and healthier babies, because the current study wasn’t designed to answer those questions.

The study, from researchers at Northwestern University Feinberg School of Medicine in Chicago, was published Sept. 24 in the American Journal of Preventive Medicine.

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Extra weight in pregnancy

Women who are overweight or obese in pregnancy have a greater risk of pregnancy complications, including gestational diabetes and pregnancy-related high blood pressure, according to the Mayo Clinic. What’s more, women who are overweight and obese are also more likely than women at a healthy weight to gain too much weight during pregnancy, which puts them at risk of having larger babies. That factor can lead to problems with delivery as well as low blood sugar levels in the newborn. Babies that are born larger than average may also be at higher risk for obesity in childhood, the Mayo Clinic says.

Because of these risks, the National Academy of Medicine (NAM) recommends that overweight women gain 15 to 25 lbs. (7 to 11 kg) during pregnancy and obese women gain just 11 to 20 lbs. (5 to 9 kg). For comparison, women of healthy weight should gain 25 to 35 lbs. (11 to 16 kg) in pregnancy, the NAM says.

Still, nearly half of U.S. women gain too much weight in pregnancy, according to the Centers for Disease Control and Prevention.

In the new study, the researchers analyzed information from 281 women who were overweight or obese at the start of their pregnancies. The women were divided into two groups: an intervention group and a usual-care group.

The intervention group met with a nutritionist, who counseled the women on how to follow the DASH diet, which is high in fruits, vegetables, whole grains, nuts, fish and lean protein and low in salt, sugar and saturated fat. The goal of the diet was not to help the women lose weight but to restrict their weight gain in pregnancy to meet the NAM recommendations. Women in this group also used a smartphone app to record what they ate, and a nutritionist reviewed these logs to provide feedback. In addition, the women were given a pedometer and told to aim for at least 30 minutes of physical activity, such as walking, per day.

Women in the usual-care group were given general advice on nutrition and physical activity in pregnancy but did not receive coaching or use the smartphone app.

At 35 weeks of pregnancy, women in the intervention group had gained 22 lbs. (10 kg), on average, compared with 26 lbs. (12 kg) in the usual-care group. In addition, about 31 percent of those in the intervention group stayed within the NAM recommendations for weight gain in pregnancy, compared with just 15 percent in the usual-care group.

Babies born to mothers in the two groups had similar birth weights, on average, and were not at increased risk of neonatal problems, the study said.

The current study looked at whether the intervention worked and was safe, but the research wasn’t designed to look at whether women who followed the diet were at lower risk of pregnancy complications or had healthier babies, Aftab told Live Science. That’s why larger studies are still needed before a program like this could be recommended by doctors.

In addition, unexpectedly, obese mothers in the intervention group were more likely to need cesarean sections than women in the usual-care group. This finding could have been due to chance, but it’s another reason to take caution regarding the results and to conduct further studies, Aftab said.

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Childhood obesity risk

More studies are also needed to determine if the children born to mothers who restricted their weight gain in pregnancy have a lower risk of obesity themselves. The researchers said they plan to follow the children until they are at least 3 to 5 years old to help answer this question.

In addition, although women in the intervention group tended to eat a healthier diet than those in the usual-care group, women in the two groups had similar levels of physical activity. That’s because, even though women in the intervention group were encouraged to track their activity, they often did not and usually fell short of their exercise goals. The women reported time constraints, fatigue and work-life balance as barriers to meeting the physical activity goals, which shows that more efforts are needed to improve physical activity in this population, the researchers said.

 

Why Are Pregnant Women Told to Sleep on Their Left Side?

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Here’s something to expect when you’re expecting: hearing the phrase “Sleep while you can” repeated by every person you meet for 40 weeks.

For pregnant mothers, that’s easier said than done — especially if they’re fond of sleeping on their backs or bellies. Currently, many doctors tell pregnant women to sleep exclusively on their left sides at night. But why? What’s so bad about resting on the right or snoozing in a supine position?

Turns out, there’s a good medical reason for it, and it involves an unseen Tetris game happening inside every pregnant woman’s belly.

As a fetus grows larger and larger throughout gestation, it naturally begins to put more and more pressure on mama’s internal organs and blood vessels. It can be annoying or painful when the growing baby plops onto mama’s bladder or kicks her in the intestines. But comfort isn’t behind the prescription for left-side sleeping. According to Dr. Grace Pien, an assistant professor of medicine at the Johns Hopkins University School of Medicine, the crucial piece of the puzzle is the mother’s inferior vena cava (IVC), a large vein that runs along the right side of the spine and is responsible for returning blood from the bottom half of the body to the heart.

“If a pregnant woman is lying on her back, the fetus is more likely to compress the inferior vena cava, decreasing the amount of blood returned to the heart,” Pien told Live Science. “There’s not a lot of research comparing sleeping on the right and left side, but at least theoretically, you’d also have less potential compression of the IVC on your left side than on your right.”

Why is this compression bad? Less blood being pumped into the heart means less blood being pumped out of the heart — and that means a drop in blood pressure for mom, and a drop in blood oxygen content for both mom and baby. (Mom’s blood carries oxygen to the baby.) Most healthy women and fetuses should be able to compensate for a slight reduction in cardiac output, Pien said, but IVC compression can become a bigger risk for pregnant women who already have blood pressure problems or breathing complications.

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For example, pregnant women with asthma or sleep apnea (a condition in which breathing repeatedly starts and stops at night) may already have trouble delivering the optimal amount of oxygen to their bodies or their babies. When conditions like these are coupled with the reduced blood flow that comes from supine sleeping, the effects could magnify each other in a dangerous way.

“A number of studies have suggested that sleeping on one’s back during late pregnancy may be associated with a higher risk for stillbirth,” Pien said.

The evidence for this connection is mounting. Most recently, a study published earlier this year in BJOG: An International Journal of Obstetrics and Gynaecology found that women who had a stillbirth after 28 weeks gestation were 2.3 times as likely to have slept on their backs the night before the stillbirth than women with a healthy continuing pregnancy. Another study, published in the journal PLOS One in 2017, found supine sleeping was associated with a 3.7 times higher risk of stillbirth than is found overall. One limitation to keep in mind for studies like these — where people are asked to recall what they did in the past — is something called “recall bias.” With recall bias, women who had a bad outcome, such as a stillbirth, are more likely than women with a healthy pregnancy to rack their brains for anything they may have done to cause it.

These alarming trends have been repeated often enough that most doctors don’t hesitate to recommend that pregnant women avoid sleeping in the supine position. It is, as Pien put it, “a relatively easy, cost-free intervention” that can potentially prevent some very negative pregnancy outcomes.

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So, what — if anything — is wrong with sleeping on the right? That’s hard to say, as there haven’t been many studies specifically comparing left- and right-side sleeping during pregnancy. One study of 155 women, published in the journal The BMJ in 2011, did find a slightly increased risk of stillbirth in women who went to bed on their right rather than their left the night before they miscarried, but these results have not yet been repeated.

“I don’t think there’s clear evidence that sleeping on your right is worse than sleeping on your left,” Pien said. “If there’s a reason somebody is sleeping on their right because they’re more uncomfortable sleeping on their left, I don’t think there’s a reason not to do it.”

If you have an otherwise healthy pregnancy and absolutely can’t sleep on your left, rolling over to the right is probably nothing to worry about, Pien said. In fact, it might be better for you; not getting enough sleep may be much worse for pregnancy outcomes than the slight risk of IVC compression when lying on your right flank.

“Research suggests that pregnant women who are not getting enough sleep — less than 5 or 6 hours of sleep a night — probably are at increased risk for things like gestational diabetes, and potentially for things like preeclampsia,” Pien said. “Getting enough sleep is very important to pregnancy.”

Getting Pregnant After the Age of 35

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Getting pregnant after 35 is more common than ever. Between 1980 and 2004, the percentage of women 30 and older having their first baby more than tripled, from 8.6 to 25.4 percent, while the percentage of those aged 35 or older having their first baby jumped sixfold. And while few women had their first babies after age 40 in 1980, by 2006 they accounted for 2.2 percent of all first babies born in the United States. Though having a baby at any age is exciting, getting pregnant later in life comes with some challenges, from getting pregnant and staying pregnant to labor and delivery. The key is to do everything possible to reduce your risk of problems. Specifically:

  • Get in shape before you get pregnant. Make sure you’re at a healthy weight. Obese women, defined as women with a body mass index (BMI) of 30 or higher not only have a more difficult time getting pregnant, but are more likely to develop gestational diabetes, particularly if they’re older, and that, in turn, is more likely to lead to complications. Obesity also makes it less likely that fertility treatments will work. In fact, some fertility centers will not perform IVF on women over a certain weight.

 

  • Learn to control and manage the stress in your life before you try to get pregnant. There is convincing evidence that both acute stress (losing your job) and chronic stress (hating your job) can negatively affect your pregnancy and baby.

 

  • Begin taking a prenatal vitamin before you even consider getting pregnant. The supplement contains folic acid, which prevents neural tube defects like spina bifida. You don’t need a prescription.

 

  • Clean up your habits before you get pregnant. That means quitting smoking, staying out of smoke-filled rooms and cutting out the alcohol. You want your body as cleared of toxins as possible, both to increase your fertility and to provide the best possible home for a fertilized egg.

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  • Rest during your pregnancy. “Sleep is very healing,” said Dr. Luke. Even just putting your feet up for 45 minutes every afternoon can help by reducing excess fluids and improving blood flow to the baby. Sleep also helps your baby grow, she says. After all, children only grow during sleep, when growth hormone is released. She also recommends taking time out for yourself during pregnancy. “Listen to your body. Women usually think of themselves as last on the list, but when you’re pregnant, that has to end.”

Signs of Labor

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There’s no way to predict exactly when labor will start. And even when you notice early signs of labor, your baby’s birth could still be days or weeks away.

Your body actually starts preparing for labor as much as a month before you give birth, so you may begin to notice new symptoms as your due date approaches.

Here are some early signs of labor:

  • Your baby “drops.”If this is your first pregnancy, you may feel what’s known as “lightening” a few weeks before labor starts, meaning the baby now rests lower in your pelvis. You might feel less pressure just below your ribcage, making it easier to catch your breath.
  • You have more Braxton Hicks contractions.More frequent and intense Braxton Hicks contractions can signal pre-labor, which is when your cervix starts to thin and widen, and sets the stage for true labor. Some women experience menstrual-like cramps during this time.
  • Your cervix starts to change.In the days and weeks before delivery, changes in the connective tissue of your cervix make it soften and eventually thin and widen, or dilate. (If you’ve given birth before, your cervix is more likely to dilate a centimeter or two before labor starts, but keep in mind that even being 40 weeks pregnant with your first baby and 1 centimeter dilated is no guarantee that labor is imminent.) When you’re at or near your due date, your doctor or midwife may do a vaginal exam during your prenatal visit to see whether your cervix has started to change.
  • You pass your mucus plug or notice “bloody show.”If your cervix begins to efface significantly or dilate as you get close to labor, you may pass your mucus plug – the small amount of thickened mucus that has sealed off your cervical canal for the last nine months. The plug may come out in a lump all at one time or as an increased amount of vaginal discharge over the course of several days. The mucus may be tinged with brown, pink, or red blood, which is why it’s called “bloody show.” (Having sex or a vaginal exam can also disturb your mucus plug and result in some blood-tinged discharge, even when labor isn’t necessarily starting any time soon.)

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Signs that labor is imminent, if not already under way, include:

  • Your contractions become increasingly intense.Unlike Braxton-Hicks contractions, labor contractions grow stronger, longer, and more frequent as they cause your cervix to dilate.
  • Your water breaks.When the fluid-filled amniotic sac surrounding your baby ruptures, fluid leaks from your vagina. And whether it comes out in a large gush or a small trickle, this is a signal that it’s time to call your doctor or midwife.

Most women start having regular contractions before their water breaks, but in some cases, the water breaks first. When this happens, labor usually follows soon after.

Choosing a Midwife: What You Need to Know

3CE81C4B00000578-0-image-a-17_1486423679332Have you considered working with a midwife for your delivery but are confused about what that involves?

What’s the difference between working with a midwife and an obstetrician-gynecologist (OB-GYN)? 
Midwives typically allow for more time during office visits and spend more time with women in labor. In addition, our philosophy of care emphasizes pregnancy and birth as normal events. We strive to avoid unnecessary medical interventions and promote normal, physiologic birth. We share the decision making with the woman and her partner—educating both about options available for their care. We tailor our care to meet the particular needs of our patients. Our training includes continuous labor support and learning the many techniques that sustain women as they journey through labor naturally.

Many OB-GYNs are trained to attend high-risk deliveries. As a consequence of that training, they may overuse tests and interventions, such as labor induction and cesarean section. Often, they schedule only 5 to 10 minutes for routine prenatal visits for healthy women. With such a short time available for visits, it can be difficult to tailor the care to the particular needs of the woman and her family.

Unlike certified nurse-midwives and certified midwives, many OB-GYNs have little or no formal training in supporting a woman during natural childbirth. And with an already overcrowded health care system, many are unable to dedicate the time and attention women need to accomplish this type of birth.

What kind of training do midwives have?
Midwives are dedicated to providing you with the personalized health care experience you deserve. When looking for a midwife who will best meet your needs, it is important to understand the different options available to you in the United States.

Certified nurse-midwives (CNMs) and certified midwives (CMs) have advanced education in midwifery. A CNM is a registered nurse with a master’s or doctorate degree in midwifery. A CM has a bachelor’s degree with a master’s or doctorate in midwifery. Both CNMs and CMs graduate from a graduate-level midwifery education program accredited by the Accreditation Commission for Midwifery Education. And both CNMs and CMs provide general women’s health care throughout a woman’s lifespan. These services include general health checkups and physical exams; pregnancy, birth and postpartum care; well woman gynecologic care; and treatment of sexually transmitted infections.

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What is the difference between a midwife and a doula?
Doulas are trained to provide continuous support to women and their partners during labor and birth. They are an excellent addition to the labor team.
Unlike midwives, doulas are not health care providers and do not provide medical care. While they provide support during labor and birth, they do not deliver the baby or give health advice.

The combined midwife and doula team provides a wonderful array of care for a woman in labor. If a woman strongly desires a natural childbirth, choosing to have both a midwife and doula at the birth will provide her with uninterrupted labor support. Having a care team comprised of both a midwife and doula will allow you to experience the midwifery philosophy, which supports normal, physiologic birth. Together midwives and doulas create a supportive environment for woman-centered care.

What kind of women are best-suited for using a midwife during pregnancy?
Most midwives in the United States are health care providers who offer services to women of all ages and stages of life. While midwives care for women of all ages, we particularly focus on women with a low-risk pregnancies or births. However, some midwives care for women with moderate health risk factors, such as gestational diabetes, previous c-section or hypertension.

I recommended interviewing several providers before making a care decision. It’s important you understand your care provider’s philosophy to care and can see yourself having a long-term relationship with this provider.


What questions should I ask a midwife I’m considering working with?

When choosing a women’s health care provider, it’s important to know your full range of options so you can make an informed decision. Your health is too important to rely on other people’s recommendations or to just “go where you have always gone.” Your health care provider’s services and approach to care should match your unique goals and values. Asking potential providers questions about their education and type of care will help you decide who will best meet your needs.

Below are sample questions to ask women’s health care providers that may help you in making your decision:

  • What is your education background?
  • Are your services covered by my insurance?
  • Where do you attend births? In the hospital? Birth center? Home?
  • Who will you consult with if I have complications during my care with you?
  • What is your rate of intervention during birth, such as for c-sections or inductions?
  • What techniques do you offer to support women who want natural childbirth?
  • Are pain medications an option? If so, what are they? Are epidurals an option?

 

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Can midwives work in hospitals?
A common myth that the Our Moment of Truthinitiative aims to set straight is that midwives only deliver babies at home. The truth is that because many women who choose a midwife for their care wish to deliver their babies in a hospital, many hospitals in the United States offer an in-house midwifery service. In 2010 about 90 percent of births attended by midwives in the United States were in hospitals. And because midwives are dedicated to one-on-one care, many practice in more than one setting to help ensure that women have access to the range of services they need or desire and to allow for specific health considerations.

Can midwives provide pain medication or do you have to have a natural labor if you choose to work with a midwife?
Another common midwifery myth that Our Moment of Truth aims to debunk is that all women who choose to have a midwife will want natural childbirth.

Those women who do desire natural childbirth are wise to seek midwifery care, because our training involves continuous labor support—learning methods and techniques for supporting women throughout labor and birth. Each stage of natural labor has unique characteristics. As midwives, we use this knowledge to advise relaxation techniques that help women cope.

However, some women decide in advance or during the labor process that they would like to use pain medications or epidurals. In my practice, 45 percent of women choose to have an epidural.

CNMs and CMs strive to help women have the birth experience that they are seeking—whether it involves natural childbirth or pain medications. If women choose a hospital birth with a CNM or CM, they have all the options available to them. It really is the best of both worlds.

 

Pain Management Options

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Here’s the thing. Labor and delivery hurt. Any woman who tells you they don’t either had effective medication or has a poor memory. There are numerous medications and other options you can use, most of which are detailed below, to make you as comfortable as possible.

Narcotics (Demerol, morphine, Stadol, Fentanyl, Nubain)

Given by injection into the spinal cord or arm, IV or self-administered pump (depends on the drug). These medications help you relax and take the “edge” off the pain without interfering with pushing or slowing labor.

Depends on the drug, but may cause drowsiness or breathing difficulties in babies and nausea and vomiting in you. Nubain, Fentanyl, Stadol and morphine have minimal effects on the fetus unless used in a spinal block.

Epidural-Injection

Epidural

The most common form of anesthesia used during labor and delivery. An epidural is regional anesthesia that blocks pain to a particular part of the body; in this instance, nerves leading to the uterus. You need to have an IV started before you can receive an epidural, usually before active labor begins. The epidural is typically inserted when the cervix has dilated to four or five centimeters. An anesthesiologist or nurse anesthetist usually administers the epidural. You need to arch your back while sitting up or lying on your side. After cleaning and numbing the area, a needle is inserted into the area surrounding the spinal cord, a small tube or catheter is threaded through the needle into the space around the spinal cord (the epidural space). Then medication is given through the tube as needed.

May result in sudden blood pressure drop and, rarely, severe headache if there is any spinal fluid leakage. May slow labor and make pushing more difficult. May cause some breastfeeding or respiratory difficulties in babies.

Spinal block

When narcotics are injected directly into the spinal column. The pain relief lasts about two hours. They are rarely used these days given the availability of epidurals.

The medication crosses into the placenta and may affect the baby. May cause low blood pressure, problems pushing during labor and severe headache.

Pudendal block

An injection of a local anesthetic such as lidocaine into the pudendal canal in the pelvis to provide quick pain relief to the perineum, vulva and vagina as the baby moves through the birth canal. Typically used in the second stage of labor when you’re pushing, just before the baby is delivered.

May cross the placenta; slight risk of blood clot or infection.

Local anesthesia Primarily used at the end of labor to provide pain relief for an episiotomy (a cut in the perineum to make it easier for the baby to come out). May also be used after birth for pain relief from episiotomy or perineal tears. Given by injection into the specific area of pain.

Rare allergic reactions.

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Patterned breathing

This nonmedical approach uses breathing patterns to calm and relax you while providing a sense of control during contractions.

Must be practiced before labor

Relaxation techniques

Listening to soothing music, surrounding yourself with a scent that soothes and comforts you, having your partner massage, kneed or put pressure on various parts of your body and focusing on an item like a candle throughout the contraction can all help reduce the pain and the feeling of being out of control.