Pain Medication Options in the Hospital Setting

Pain Medication Options in the Hospital Setting From a Nurse’s Perspective

During labor, there are two options for pain medication in the hospital setting: IV medications and/or an epidural. Oral pain medications (pills) are usually only given in the postpartum period.

When you are admitted to a labor unit, your doctor or midwife initiates an Order Set. These are the same universal orders for each patient, with some choices that can be added on or removed. The option to have IV pain medication or an epidural if desired by patient is included in these orders. Your nurse, and occasionally your doctor, will work with you to discuss if and when these should be given.

IV Medication options during labor

First let’s talk about the IV medication options. There are two different IV medications that may be given for pain (please note medications may vary at different hospitals but these are pretty standard). One is called Stadol and one is called Fentanyl. They are small liquid doses that are administered through your IV site. There are usually half and full doses available, and you can usually repeat the dose again after a period of time. For example, Fentanyl may be ordered as 50mcg (micrograms) or 100mcg, every X hours, as needed for pain. And Stadol may be ordered as .5mg (milligrams) or 1mg, every X hours, as needed for pain. Both of them have a maximum amount that can be given. That means, if you’ve reached that amount, you can’t have anymore.

Benefits of IV medication

These IV pain meds can be helpful for taking the edge off. I tell patients they might knock the top off of the contraction mountain. The sensations are still there, but not as intense. Maybe mom will even get a short nap. She may be able to rest and regroup and get back in the game of coping with contractions. This is good for someone who is looking to avoid an epidural but is having a hard time. It’s nice to have something, and IV pain meds can be a useful tool in the “coping with labor” toolbox. The effect of these drugs in your system can last anywhere from 20 minutes to 60 minutes. On a side note, sometimes we see moms in triage having days of looooong early labor. We can give them these same IV pain meds, some IV hydration, some monitoring to watch baby during this, and usually they take a great nap. Often times they go home afterwards.  

Potential Side Effects of IV Medication administered during labor

IV medications go into your bloodstream. Therefore they cause systemic effects, like mental changes. They’re narcotic drugs. They may make you feel loopy and out of it. You may not have a lot of experience feeling loopy and out of it or tipsy (especially since you’ve been pregnant for 10 months!). You may not like the way this makes you feel at all. The good news to that is that these are short acting drugs, so the effects (both good and bad) will be over quickly.

Will Baby Feel the Effects?

Since the drugs are in your IV and bloodstream, that means they are also in baby’s bloodstream. You will have to be continuously monitored with the belts around your abdomen during the time these drugs are in effect – the monitors are listening to and graphing baby’s heart rate as well as your contraction pattern. They sedate you, but they also sedate baby. Baby’s heart rate pattern will appear similar to what it looks like when they are sleeping. We would not be able to administer these drugs to you if baby had recently shown us any reason to be concerned about their wellbeing. Baby’s usually metabolize these drugs faster than you, and we see baby’s sedation wear off relatively quickly on the monitor.

How Long Can You Wait to Get IV Meds?

We also would not want to give you these drugs if delivery was imminent (meaning 8cm or more dilated for a first time mom, or a second + time mom who is dilating quickly). We would not want baby to be born with these drugs still active in their system, since they may make their responses to extrauterine life not as vigorous. We want a baby alert and crying (hello apgar scores!), not sedated. To be clear, these two IV narcotic pain medications and their doses are chosen for their use in pregnant women because they are safe to cross placenta to baby’s bloodstream. That’s why they aren’t very awesome and magical and pain relieving for you (those would be IV pain med drugs such as Dilaudid or Morphine), because that has to be balanced with safety for baby as well.

Alternatives to IV meds

Of course, all non pharmacological pain relief options are alternatives to IV pain meds. Additionally, if you don’t like the idea of your baby being exposed to short acting narcotic pain meds in utero, an epidural is a great option (more on that next!).

Reality & My Opinion as an L&D Nurse

I usually see IV pain meds administered as sort of a prelude to an eventual epidural. I usually don’t see IV pain meds alone. If you’re looking for that sort of relief/release, you will usually eventually have an epidural. Patients ask for some IV pain meds after either exhausting all of the non pharmacological coping strategies the doula or I have suggested (shower, walking, swaying, hip squeezes, distraction, birth balls, calm voices, encouragement…), or as a means of prolonging the time until they get an epidural (“I want to be 6cm before I get an epidural”). Probably an equal amount of times people are happy with the effects and take a spacy nap, vs feeling like ‘yuck, I hate feeling this out of it.’ And, for what it’s worth, I prefer to use Fentanyl for my patients because there seems to be less of the yuck.  mama papa laboring

Epidural Relief during Labor

On to our next pharmacological method of pain relief: the epidural. Epidural is not the name of the drug; rather it is the name of a space in your spinal column. That’s where the small flexible tube that will administer medications is placed. Think of it like your IV: we use a needle to get a small flexible plastic tube into a place, and then we remove the needle and tape the small tube in place. Medication drips continuously into this space and numbs the pain sensations of the nerves below it. The drug cocktail that makes up an epidural is a mix of Fentanyl and Bupivacaine.

When a patient says “I want an epidural now,” it takes about 45 minutes from that statement until you start to feel relief. Let’s suppose you already have an IV. I start giving you a whole bag (one liter) of IV fluid really fast. I let the anesthesiologist know that you want an epidural. Where I work, there is always an anesthesiologist or a nurse anesthetist in the building. I get all the materials anesthesia needs to perform the procedure at your bedside. I help you cope with the contractions that keep coming, because usually these last ones feel really intense. Mentally you have decided on the epidural, so you are ready for these contractions to be over. They may not actually be stronger, but they feel stronger because your coping has lagged.

Procedure for administering an epidural

When anesthesia arrives at the bedside, we sit you up on the side of the bed with your legs dangling. We sit your support person down on a stool right in front of you to help squeeze your hands and talk to you and distract you and just generally be up close in awe of how tough you are. We discuss what’s going to happen. It’s all about positioning, so we coach you into the right position. Think of the cat pose in yoga, or pushing your lower back out in slouchy posture. Maybe a pillow helps you round over your belly, chin to chest, shoulders relaxed. Anesthesia cleans your back, places a sterile drape over your back, touches your bony spine to determine the spot they are going to place the epidural. They numb your skin with lidocaine – which burns! That’s usually the worst part. But everything burning and tingling is getting numb. After that you just feel touch.

Positioning for Getting an Epidural

We help you get in the ideal position with rounded back. Having a rounded back makes the spaces between the bones of your spine bigger. They use a needle (that large, long needle everyone talks about, but your eyes will never see it) between two of your lower vertebrae almost like a dart. Then they thread a long, soft, flexible skinny straw into the space, and pull the needle away. It takes just moments. The needle does not stay in your back. We test and make sure the tube is in the right place by giving a tiny bit of medication first. We would know instantly if it was in a wrong place such as a blood vessel. Your heart would race, you would have a metallic taste in your mouth and a ringing in your ears if this happened. I’ve seen it happen twice. The amount of the drug is so small those side effects are over almost immediately, and anesthesia fixes the placement of the catheter.

Do Epidural Meds go to Baby?

It’s important for us to determine that the tubing is in the right place because we only want the epidural to  be in the epidural space of your spinal column. That’s where the medication stays. The medication does not go in your blood stream, and does not go to your baby. I’m anticipating some comments here about studies and evidence to the contrary, but the point I’m making is that compared to IV pain meds, epidurals do not “drug” your baby at all. Your baby does not know you have an epidural, and your uterus doesn’t know you have an epidural.

Dosage of Epidurals

Then we tape the tube to your back really well and connect it to the pump that gives you medication constantly. Epidurals don’t run out—we continue the medication until it’s no longer needed. You are usually quite comfortable initially because you get a loading dose, and then afterwards you have a remote button that you can press and give yourself a little more. I tell my patients if they are ever making the wincing ouch face again, it’s time to press the button. The button is totally optional.

We lay you down flat to let the medicine settle evenly across your whole pelvis. The contractions fade away like a sunset, rather than a light switch. The first couple feel shorter (even though they’re not) and then eventually you don’t realize that you’re talking to me through a contraction without noticing. We monitor your blood pressure closely. We place a catheter in your bladder to drain urine since you can’t walk to the bathroom anymore. This does not usually hurt.

Moving Around After an Epidural?

Once you have an epidural you can no longer bear weight on your legs, and it’s not safe to stand up. I don’t know what people are talking about when they request “walking epidurals.” You are bed bound. You’re not totally numb in a panicky “I can’t feel my legs” way. You are able to help us change your position every hour or so from side to side. You don’t generally lay on your back for the same reasons we tell you not to do that when pregnant – bad for blood flow to uterus. I like to keep a peanut ball or a folded pillow in between your knees to keep your hips open. It’s important to remind your care team to do that if it’s not being done. Epidurals take away pain, not pressure, so you may still have awareness of your belly getting hard with contractions, and ideally you still feel vaginal and rectal pressure with contractions when it’s time to push. If you’re getting close to the time to push and you are really really numb, I’ll suggest not pressing the button for awhile.  epidural birth

Benefits of an epidural

You’re able to sleep. Many of the epidurals I am apart of are for therapeutic rest, and not for an inability to tolerate painful contractions. You’ve been awake for days or even just all night (especially with the long early labors that are notorious in so many first time moms), and the epidural is a valuable tool to allow rest, relaxation and regrouping for pushing and early parenting.

Maybe mentally you’re in your own way. Fear, anxiety, and interpreting pain as suffering send your body “fight or flight” messages. Adrenaline overpowers oxytocin, and can stall labor. You need to feel safe as an animal to give birth. Your body needs to relax in order to release, surrender, and dilate. Sometimes the relaxation of an epidural is exactly what that body needs to dilate.

You remain numb throughout the rest of dilating to 10cm and throughout the one, two or three hours it may take to push baby out (if you’re a first time mom) or the maybe 20 minutes of pushing if you’re a repeat mom. We turn off the epidural pump after the placenta is delivered and any possible repair to your perineum (aka stitches)  is completed. We take the tube itself out an hour or so later when we get you up to try walking to the bathroom. You might complain about the tape coming off your back and won’t notice the sensation of me pulling out the tiny tube.

Potential Side Effects of an Epidural

We need to monitor baby and contractions continuously, so you’ve got those belts on from now on. We also need to monitor your vitals pretty regularly (aka the annoying blood pressure cuff stays on, sorry). The most common side effect of an epidural is a blood pressure problem. It can drop low. We try to prevent this by giving you all that IV fluid first. If it drops it can make you feel sweaty, nauseous, light headed, and gross. That’s what low pressure feels like. But baby doesn’t like it because they’re used to the glub-glub-glub of your blood pressure chugging along nicely. If we see this we will intervene quickly to raise your blood pressure back up and correct baby’s response to it.

Let’s talk about the Cascade of Interventions. Yes, if your contractions space out from every 2-3 minutes to every 5-7 minutes, and your cervix pauses in its dilation progress, your doctor will recommend augmenting with some pitocin. That means giving you an IV version of the drug pitocin, which is modeled after your own hormone oxytocin, which causes uterine contractions. We would also suggest this to you if these same conditions were present in labor without an epidural, by the way. Yes, if you get an epidural in early labor, you will have an epidural for a long time (first time moms take about 1 hour to dilate 1cm…and we’re going to 10cm = 10 hours at least, usually 16-24 hours), and interventions will likely be offered to you.

when to call the doctor

Reality & My Opinion as an L&D Nurse

We don’t have “rules” about getting epidurals only after 4cm and only before 8cm, but ask your nurse or doula to help you cope with contractions until you’re in active labor. And once you have an epidural make sure you are turning from side to side every 1-2 hours, and keeping knees and hips open with peanut balls or pillows. If you have an epidural you will not be able to take advantage of gravity efficient birthing positions such as squatting, so it may take you some time to learn how to push, and you may push for one, two or three hours. My advice: use the mirror!

The same rules apply to interventions whether you have an epidural or not: always be an empowered and informed healthcare consumer. If an intervention is offered and discussed it is totally ok to ask:

  • What are the benefits?
  • What are the risks?
  • What are the alternatives?
  • What if we wait an hour?
  • What if we do nothing?

Other side effects to note in an effort at full disclosure: maybe it takes several tries to get it in the right spot, maybe it works better on one side of the body than the other, maybe there is a hot spot on your belly where you still feel discomfort, maybe you weren’t as numb as you wanted to be, maybe you’re too numb when it’s time to start pushing. Your nurse and anesthesia provider will work to troubleshoot these problems. Before they start placing an epidural you will need to sign a consent form whereupon are all other possible known risk factors and serious side effects of having an epidural. The only serious side effect I’ve seen in my career is when there is an error in placement and a couple days later (usually when you are still hospitalized on the postpartum unit), you end up suffering from a terrible postural headache. That means you are fine when laying down, but feel awful when sitting up. It has to do with the levels of fluid in your spinal column and gravity. It is treatable.

Reality & My Opinion as an L&D Nurse

I feel like patients with epidurals are divided between women who know they want an epidural eventually and it’s just a matter of when (my job is to help steer them towards being in active labor first); women who maybe want an epidural but are afraid and anxious about getting one (my job is education and emotional support); and women who are getting epidurals for therapeutic rest after fighting long hard battles with natural labor (my job is emotional support).

The ebb and flow of popularity for different trends in obstetrics is interesting over time. We are currently in a natural parenting surge, which is great. I sat down to write this article after breastfeeding my 3.5 year old. I get it. I just want people to remember that access to an epidural was once a women’s rights cause, and women marched in the streets demanding access to them. I completely reject the guilt, shame, and “mommy wars” hostilities that women place on each other for their childbirth and parenting choices, especially the choice to have an epidural or not. You do you! I did not have an epidural with either of my deliveries, but oh I was talking about it. I had put in some good hard time (naked, moaning, out of body experience), and if my midwife would have said “You’re 5cm” I would have said “Epidural.” Done. But it just so happened that she said “You’re 8cm” (and with second baby, “You’re 10cm”). The thought of being close to the end was reward enough to keep going, and soon after those babies were here. I may be biased, but I think most pregnant L&D nurses and obstetricians (at least all the ones I know) operate on a pretty similar and effective “Birth Plan” for their own deliveries: use whatever you need if you need it. No shame, no guilt!

This guest post was written by Maureen Hodges, BSN, RNC-OB, LCCE. Maureen has over ten years of Women & Children’s nursing experience. For the past seven years she has been a Labor & Delivery nurse at a very busy hospital in the Austin area. She teaches private, hospital, and online childbirth classes. She has two children, aged 1 and 3, and a husband who knows all her L&D pep talks verbatim from listening to her answer every pregnant woman’s questions at dinner parties, on airplanes, and on the phone in the middle of the night. She has attended the deliveries of everyone in her book club. She could not pick any of their vaginas out in a line up. You can find her on instagram at @empoweredbirthatx or on facebook at Empowered Birth Austin.

How to Be A More Mindful Mama

I took a class in college called “Mind Body Health.” It was fascinating. It was all about the immense power of the mind and how it actually influences our physical chemical processes. Our attitude and thoughts can determine how disease prone we are, our life expectancy, our moods, our relationships, and even career success.

The Power of Meditation

The professor told a story of his friend who had a pretty aggressive cancer. The doctor wanted to do some drastic surgeries, but she was really against it. Her white blood cell count was really low, and she believed that she could increase her count by doing meditation. Her doctor gave her a few weeks and said if it wasn’t at a certain point, he would have no other choice but the surgery. She said she’d work on it. And then she really worked hard. She meditated for a few hours every day and envisioned in as much detail as possible white blood cells being produced and flowing through her body. She went back at the designated time, and her numbers had increased dramatically. It still wasn’t at a level the doctor was comfortable with, but he was pretty impressed at the progress. She asked for an extension, and he agreed. Again she worked really hard at meditating and producing more cells. Again, when she returned, her count had drastically improved. This happened one more time and she was able to avoid the surgery.

The mind truly is a powerful tool, and I believe an untapped resource to our emotional and physical well being. There’s been countless studies on the benefits of mindfulness meditation. It improves overall physical health, reduces stress, improves relationships, and on and on.  Expecting mothers who meditate have less stress, less discomfort in pregnancy, and even shorter labors!

Mindfulness as Daily Self Care

As a mother, I have found mindfulness practices to be invaluable. I was first introduced to the power of meditation when I decided to study hypnobabies with my 3rd pregnancy.  I practiced every day for about 45 minutes. Positive affirmations like “I am strong, and I listen to my powerful body” started to become the common thoughts floating around my head. I started to really believe that I could have the birth I was envisioning, even down to how far dilated I would be when I arrived at the hospital. When I delivered my baby almost exactly as I had pictured it all those weeks, I knew there was something to this meditation thing.

Meditation In Hard Times

I was re-introduced to meditation and mindfulness through therapy as I was experiencing some major hiccups in my family relationships. Again, this simple practice produced amazing results.  I found myself more confident, filled with peace, filled with love and energy, even amidst emotional pain I was living with. My therapist told me that repetitive behaviors create routes in your brain and your brain will want to take the easiest route to get a signal where it needs to go.  So if I normally cope with stress by Netflix and ice cream binging (anyone?!), then in the future when I feel stressed, I will have strong cravings to open that freezer. If we can replace a negative reaction (yelling at the kids) with a positive one (doing a meditation) that route will start to become easier for our brain and we will crave THOSE behaviors more. Interesting, right?

sleep when baby sleeps

I have continued this practice and try to meditate several times a week. Just today after a rough morning with the kids (barking orders, drill-sergeant style, and constant threats until they were out the door—please tell me you have mornings like this!), I could feel the stress and tension inside my body. My heart was pounding, my shoulders were tight and high, my eyebrows were scowled, and my breathing was shallow. Instead of succumbing to this being a horrible day, I decided to do a quick stress reduction meditation. I got my preschooler set up with some toys and laid down with my phone and earbuds and did a 10 minute session. It completely worked. Deep breathing, focusing on the sensation of my breath, feeling every part of my body, being present in the moment, imagining all the negative energy flowing out of me…it all worked. The mood was just gone. I was able to get up and play with my daughter and start getting stuff done.  

Mamas everywhere can greatly benefit from this powerful practice!

Here’s a few resources to help get you started:

  1. Expectful—An app for pregnant mamas, and non-pregnant mamas as a way to connect with yourself and your babies. Free trial available.
  2. Headspace—mindfulness that moves you through training stages. They also have categories for a variety of situations: pregnancy, stress, sleep, work, etc. As little as 10 minutes a day. Plus the leader has a lovely British accent so it’s fun to listen to.
  3. Hypnobabies—I highly recommend this if you’re thinking about a natural unmedicated birth. Many women have very positive empowering experiences birthing their babies. At the very least, it’s a wonderful meditative practice that completely soothes body and mind and connects you to baby.

There you have it. The answer to a more peaceful you! Can I still pound a pint of Ben & Jerry’s while I watch 4 hours of Gilmore Girls?  YES! And sometimes I really enjoy it. But I’ve added in some other things too and the balance is coming!  Hang in there mamas. Happy meditating!

This post is written by Austyn Smith.

10 Things Labor & Delivery Nurses Want You to Know

 

  • We want to see your poop.
  • You’re getting an IV.
  • Take a class or a tour.
  • Your first labor & delivery is the longest.
  • Get a doula.
  • Let go of control.
  • It’s only one day.
  • Are you with the right doctor?
  • Say something.
  • How to thank us.

We want to see your poop.

Let’s get this one out of the way first because it’s my favorite. Everyone who comes into L&D to have a baby is worried about “pooping on the table.” They think that they are going to try and push a baby out, and the baby will stay inside their body, and instead a huge poop will come out and it will be mortifying. Wrong!

When you are completely dilated (10cm) the only thing holding your baby in is your pubic bone. Pushing is the act of bearing down to rock baby under your pubic bone and stretch/make space for your baby in your vagina. When you are doing a great job of pushing, if (big IF!) there happens to be stool (medical term for poop) in your rectum (medical term for butt) at that time (and maybe there isn’t because diarrhea sometimes happens in earlier labor), a little smear of poop might come out with pushing.

Nurses think this is a great sign that you are pushing effectively! We like to see this! We are usually quite good at keeping this discrete. I keep a “poop drape” towel tucked under your bottom and folded up to hide your bum. We change these towels often, and chances are you will have no idea if there was a little bit of poop or not. Ditto for any support people in the room at the time.

You’re getting an IV.

Please don’t write a birth plan that says “No IV unless medically necessary.” You’re all getting IV’s. Think of an IV like buckling your seatbelt when you get in a car. It’s for safety. It’s for just in case. There are people who say “telling moms they need IVs in case of emergency is hospital fear language and negative because it implies there may be emergencies.”

There are people who say “can’t you just start an IV if there’s an emergency?” These people have obviously never started an IV and have never been in a true medical emergency. It’s not always easy or quick to start IVs, so we like to place them soon after arrival to the hospital. An IV is a tiny plastic straw inside a blood vessel. The needle we use to get that straw under your skin doesn’t stay in! Lots of people fear IVs because they mistakenly believe a needle is going to stay inside them. Wrong, it comes right out immediately!

hospital birth IV

The straw (catheter) is connected to a small access port. We can connect that access port to a longer strand of tubing and use it to infuse fluids or medications. If the straw and port are not connected to the tubing, it’s called a “saline lock” or a “hep lock.” But the IV part remains the same. Please don’t write a birth plan that says you want a “saline lock instead of an IV.” That doesn’t make any sense. If you don’t need to be connected to fluid or medications, we will disconnect the long tubing so you will have more freedom of movement.

If you don’t think you need extra fluids and you aren’t requiring medication at the time, it’s always ok to ask for your IV to be saline locked. Requiring patients to have IV’s isn’t a thing that’s going to change anytime soon in the hospital setting. If this is really a big deal for you, look into giving birth at a birthing center or at home.

Take a class or a tour.

If you took a childbirth preparation class, you would have already heard that pooping pep talk, and heard that you’re getting and IV, and had the chance to ask a birth professional anything you wanted! Classes are amazing for lessening anxiety and fears, building confidence, empowering you to make informed decisions about your health care, even teaching you the anatomy basics. I started teaching classes because I couldn’t believe how many times I would be holding a woman’s dilating cervix in my fingers talking to her, and she had no idea what that was or its very important role in labor. Get informed!

At the very least, take the tour of the hospital’s birthing facilities. It’s packed with information, tips, and you get to ask the nurse leading the tour any and all questions about policy or procedure.

Your first delivery is the longest.

Your first labor and delivery usually takes the longest time of any pregnancy you will have. Be patient. Be more patient than you ever thought possible. It can take days or weeks for your cervix to soften, efface and start to dilate. Then it takes awhile to dilate to 4cm (awhile = hours or days). Then it takes about a centimeter an hour to go from 4cm to 10cm. And then it takes anywhere from 20 minutes to one, two, or three hours to push your baby out.

While we’re on the topic of things you should know: know that your doctor won’t come push with you until the very end, like the last several pushes. You could push with your nurse for two hours, and the doctor two pushes. Might as well tell you all of it: it might not even be your doctor. It might be one of your doctor’s partners.

The active labor portion of this whole experience (where contractions are strong and require all your coping attention) can start at any time of the day or night, so maybe you end up being awake for a long time. Even if you are planning on having an epidural, you must come prepared to cope with strong contractions. We will help you cope of course, but it’s naive to think it’s possible to feel nothing.

Many of the epidurals I help administer to patients are for exhaustion, not inability to handle pain. We call it “therapeutic rest” and is very common for first time moms.

Coincidentally, the time when most women think they want to try and have a baby without an epidural is the first time they are pregnant. It’s like if someone tried running for the first time and found out the course was a marathon. Some people might reasonably decide, well running isn’t for me. I sure would. The problem with this is that the second meeting of the running club is just a 3 mile loop around your neighborhood. Your second, third etc labors are much faster! Like, hours and hours faster! Once strong labor contractions start your cervix can dilate to 10cm very fast.

We joke that we don’t trust those moms for a minute. They could “go complete” (-ly dilated) at anytime and push that baby out in minutes. My point is, don’t beat yourself up if you thought about not getting an epidural with your first delivery and you ended up having one. Maybe try it with your next delivery, or…

Get a doula!

If you are a first time mom and your goal is to deliver epidural free in a hospital setting, think about getting a doula. When you are in the hospital, a doula and I aim to do basically the same thing for you, with one catch. The doula only has to do it for you. Sad but true, I may have another patient I am taking care of at the same time as you in the early part of your labors. Additionally, your doula usually starts caring for you at home in early labor. This can keep you home for a longer amount of time than if you were laboring alone.

Constant, reassuring, expert bedside support is crucial for managing natural labor. Doulas can be expensive. If you can’t afford one, make sure that when you first arrive as a patient in Labor & Delivery, you ask to speak to the charge nurse and request a nurse who loves working with natural labor patients (we all are capable of doing this, some just have a special passion for it). 

Let go of control.

There is a huge spectrum of normal in Labor & Delivery, and you can’t plan it all out in advance. You just can’t. Trust your support team and your providers to give you good advice and expertise, ask the right questions, and pay attention to your intuition. Breathe. Think of this as your initiation into parenthood. Anyone who’s been around kids knows “control” is not a word used to describe the experience of raising young children. More like: “SURRENDER”, “LET GO”, “WHAT WILL BE WILL BE”, “BE OPEN TO THE EXPERIENCE”, “RIDE THE WAVE.” Coincidentally those are great birth mantras. Another one of my favorites: “Let go or be dragged.” Breathe. It will be ok.

This is only one day.

Ok, maybe it’s two or three or four days, but your time being in labor and delivering a baby is relatively short. It can be an empowering, life changing, positive experience, but it is still only several days. Parents spend so much time preparing for (and worrying about) this portion of the experience (where you will have a constant bedside presence of a supportive L&D nurse or doula), and neglect preparing for the postpartum period (where you will be sleep deprived at home with another sleep deprived person as your companion and a confusing tiny new member of the family who you love in a terrifying way).

Labor is one experience. After your baby is born, breastfeeding is an experience that is going to happen every three hours for almost the next three months or longer. Breastfeeding is natural, but it doesn’t come naturally. Babies and moms have to learn those behaviors. Take a breastfeeding class; identify three friends who have breastfed successfully that you can text with questions; and get the name of a good lactation consultant in town. Most breastfeeding issues come up after you’ve been discharged from the hospital. Not breastfeeding? No judgment here, fed is best.

Make a postpartum care plan (great book). Put just as much effort into that care plan as your list of birth preferences. Identify a new moms group you can go to, an online community, or a postpartum doula service to come love on you at your house if needed. Make a plan for postpartum mom not being the person solely responsible for dealing with household chores, cleaning, cooking, laundry, etc. Make a plan to have friends drop off dinner. Key words: drop off. You’re not hosting people to dinner every night. Drop off food and leave, thanks. People who understand this are the best kind of people to include in your postpartum plans.

Be kind to yourself. Let your house be a mess. Just a total mess. The default position is on the couch with a baby skin to skin, feeding when needed, next episode on Netflix starting in 12 seconds. Be kind to your postpartum body. Don’t say mean things to it or think mean things about it. It’s beautiful. You’re beautiful. You just did a beautiful thing.

Postpartum depression is real. Postpartum anxiety is real. Weepy is normal. Feeling hormonal and overwhelmed is normal. It’s ok to feel like you should be so happy but you’re just not. If this lasts longer than three weeks or you have thoughts about harming yourself or baby call your doctor or midwife immediately and get an appointment to see them in person. If you feel traumatized by your birth experience, talk to someone. Partners and friends can help, but don’t be shy to talk with your providers. And ideally, if you were delivered by a different provider in that practice, make your follow up postpartum appointment with them. Maybe they can help you work through and process some decisions and emotions from that day. You’re not alone. Seek out postpartum mental health support group or alliances in your town.

when to call the doctor

Some of you are with the wrong doctor.

We scratch our heads over this one all the time. Let’s say Doctor A and her partners are the group at our hospital who have the highest volume of pain med free deliveries (what a lot of people call “natural” childbirth), and the lowest rates of interventions (inductions, C-sections etc). Doctor Z and her partners have the highest rate of epidural deliveries and highest rates of interventions, with all the other practices that deliver with us having A-Z variations in between.

It is always perplexing to us nurses when patients with goals and philosophies similar to Doctor A group (and usually quite adamant about their desires) show up but are patients of Doctor Z group. You’d be better matched with another doctor, but our hands are tied. When we are meeting you, you are already in labor or showing up for an induction. We can’t, and we shouldn’t, tell you then to switch doctors. We can only attempt to navigate you through the maze of possible interventions. This is a finely honed art of professional relationships between the doctor and the nurse.

Our job is to advocate for you and your preferences. Your job is to do your homework. Don’t just choose a doctor because they are popular or your friends go to them or they are already your doctor who’s been prescribing your birth control pills and doing Pap smears for a couple years. Spend some time thinking about your birth philosophies and preferences, ask friends about their births and their providers, and know that it’s ok to interview OB’s before choosing a practice.

choosing an ob

You’re the consumer. Say something!

If you have a bad experience in a hospital setting, say something. Not to your friends, not to the internet, say something to the hospital administrators themselves. All hospitals call you in the postpartum period for a follow up survey. This is your chance to tell us the things we got right, and what areas we need to improve. Be specific. If you didn’t get this call, or you didn’t realize you could speak so openly during that call, call the hospital back. Ask to speak to the unit manager or director. These days, patient voice and satisfaction is everything in health care. Almost to a frustrating degree, hospitals will listen to what patients say more than what the nurses say. Upset about some of practices you encountered in L&D that you don’t feel are evidence based medicine? Let them know.  

Here are some possible suggestions, wink wink: strict restrictions on eating and drinking in labor, nurse to patient ratios in labor, baby remaining skin to skin with you in the first hour of life, enough staff for breastfeeding support.

How to thank us…

We love to eat still-hot Tiff’s Treats cookie delivery and a baker’s dozen Einstein bagels and cream cheese, but we can live off a genuine thank you note for weeks. I still have every one I’ve ever received, and they are among my prized possessions. Oh, but if you’re going for food we also like breakfast tacos, pizza, coffee…

This guest post was written by Maureen Hodges BSN, RNC-OB, LCCE. Maureen has over ten years of Women & Children’s nursing experience. For the past seven years she has been a Labor & Delivery nurse at a very busy hospital in the Austin area. She teaches private, hospital, and online childbirth classes. She has two children, aged 1 and 3, and a husband who knows all her L&D pep talks verbatim from listening to her answer every pregnant woman’s questions at dinner parties, on airplanes, and on the phone in the middle of the night. She has attended the deliveries of everyone in her book club. She could not pick any of their vaginas out in a line up. You can find her online at @empoweredbirthatx or Empowered Birth Austin on Facebook.

Breastfeeding Tips & Setting Up a Nursing Station

Breastfeeding Tips, Setting up a Breastfeeding Station and How to Get Support

We hear that “breast is best” all the time—the news, the hospital, our doctors, our friends, and even that random lady in the organic foods aisle at the grocery store. Even our social media feeds are peppered with research articles telling us why breast is the right choice. That’s all well and good, of course we all want what’s best for our babies!  But it’s one thing to know what is best and another thing to know how to actually accomplish it. As a lactation consultant, I’m called to give specific advice for breastfeeding issues but I also get asked all the time what my top breastfeeding tips are—so here they are!

Top Breastfeeding Tips from a Lactation Consultant problems with breastfeeding

Take a breastfeeding class while you’re pregnant!

Prenatal education is a top indicator of breastfeeding success after baby arrives! When you know what to expect and what’s normal, you can prepare! If you don’t know what latching is or looks like or how often baby should breastfeed per day, it’s hard to succeed.

Have support.  

Women find support from all different sources—some women find the best support is their husband. He may never have breastfed before, but he can certainly help you and cheer you on no matter what! Other women find their friends or mothers who have breastfed to be their top supports. Either way, research shows that women who have support have more success in breastfeeding.

After baby arrives, make plans to make no plans!  

Skin-to-skin time is so important with a newborn. In the first couple of days after birth, keep your naked-in-a-diaper baby on your chest as much as you can! This can be easy in the hospital since it’s pretty private, other than the nurses who want to look under your gown all the time, anyway. Once you get home, you may have to make more of an effort to rest and keep baby close. Make sure your partner knows ahead of time it will be his job to take over the cleaning, cooking, and bringing home the bacon (literally and figuratively!) for a few weeks after baby arrives. I love this shirt for convenient skin to skin time—or this one that comes in plus sizes too!

breastfeeding skin to skin

Feed baby very frequently.  

I tell moms all the time during personalized consults that you can’t feed baby too much, only too little!  Follow baby’s lead: during those first few days after birth before your milk volume increases, baby’s tiny tummy will need to be filled often. If baby’s awake, turning his head, or fussy: put him to breast!  

Get help if you need it!  

Breastfeeding may be the best and seem like it should be “natural,” but that doesn’t mean it always comes naturally.  If you’re in pain, baby’s not feeding well, or something seems off—get help right away. There’s no shame at all asking an IBCLC for some personalized help.  In fact, research shows that IBCLCs increase the rates of women who start breastfeeding as well as the rate of women who breastfeed exclusively. If those are your goals and you don’t feel confident in your ability to meet them, call an IBCLC!

Setting Up a Breastfeeding Station

breastfeeding lifestyle photos

Now that we’ve gone over some great tips for meeting your breastfeeding goals, let’s talk practicality. Just like “breast is best” is only helpful when we know how to actually breastfeed, those breastfeeding tips are only helpful when we can actually fit breastfeeding into our lives! One of the best ways to accomplish this is to set up a breastfeeding station in your home.

If you anticipate that you’ll breastfeed your baby in many different rooms depending on the time of day, then create your station to be a basket that’s easily transportable. If you know you’ll always be sitting down in the nursery to feed your baby, then it can be a shelf or drawer near your chair. What should you fill this station with? Anything and everything that you think you might even need! This can vary some from mom to mom (are you a reader who will need your Kindle nearby, or do you prefer to binge watch a show on your tablet?).

Lots of Water 

Get a water bottle you can operate one-handed while you’re nursing, I recommend one with a straw because you will drink more. Some moms get very thirsty as soon as baby latches on. A straw type can be great so you don’t have to lean your head back and get off balance, disrupting that perfect latch. I always kept two water bottles or cups at my nursing station at all times because I would inevitably drain all of one and then baby falls asleep on you and you feel trapped and oh so thirsty!

Healthy Energy Snacks

Did you know breastfeeding moms burn an average of 500 extra calories per day? You’ll need to make that up somewhere, so portable snacks like granola bars (these are great if you are trying to limit sugar intake—turkey flavor is my fave!), a piece of fruit, or a simple sandwich can be great to keep close by in case baby is on a marathon nursing session.

Netflix and Chill

Whether it’s a book, your phone, the remote, a tablet, or a sleep mask to catch some zzz’s while baby nurses, you’ll want something. Babies eat very often, so you’ll be spending a lot of time feeding!

Nipple care supplies

If your latch is good, you shouldn’t have much more than transient soreness for the first week or two.  If your latch is painful, talk to an IBCLC and have some of these supplies on hand.  A good nipple cream can be very soothing.  Some moms love lanolin and some love simple coconut or olive oils from the kitchen.  If there are open wounds, something like All Purpose Nipple Ointment (a prescription) or Medihoney can help prevent infection and heal your nipples. A Milk Saver is great to catch extra milk on the other side when your milk lets down and breast pads are great to protect sore nipples.  

Baby care supplies

Babies often will poop during or after a feeding—it can’t come out if it didn’t go in, after all!  So have a diaper and wipes nearby.  In the same vein, veteran moms know that an extra outfit can be needed in this situation, too!  Also make sure you have burp cloths (I’m a a big fan of a stack of plain prefolds as they are super absorbent, cheap and have a million uses!). Burping can be messy and just in case some of that milk makes another appearance, you’ll be reaching for them. Baby nail clippers (obsessed with these!) can be a good idea, in case baby falls asleep or is just finally still enough for this surgery-like activity.

When You Need Breastfeeding Support

breastfeeding tips

We’ve gone over top tips to be successful with breastfeeding, in addition to practical ways to implement those tips, but what if you do everything you can and things don’t seem to be going well?  Ask for help!  The tip to have a support system wasn’t just lip service—it’s really important!  If things are hard now that you’ve been thrust into the trenches with a brand new, needy baby, some simple love, help, and attention from your partner, mom, or friend can be just what you need.  

If breastfeeding itself is the issue, ask an IBCLC for some help!  

Nipple pain isn’t normal outside of some soreness in the first few days.  If you’re in pain or baby isn’t gaining well, breastfeeding support by a professional can be the ticket to breastfeeding success. Lactation Link offers in-person consults in Utah and e-consults for anywhere else, or you can find an IBCLC in your area through ILCA.

If motherhood seems lonely, know that you’re not alone.

Even though you’re constantly around this new little person, it can feel very isolating.  Finding a local group like La Leche League can be the answer to getting out of the house and making some mom friends.

Breastfeeding is Possible!

Breastfeeding can seem overwhelming, but you don’t need to go into motherhood unprepared! A little education, support, and preparation can go a long way in helping you achieve your goals.  Next time you see “breast is best” online or in the news, now you can add “breastfeeding is possible” to it!

This guest post was written by Kristin Gourley, IBCLC. Kristin is a mother of 5 and one of the 3 International Board Certified Lactation Consultants with Lactation Link, a private practice offering breastfeeding support through breastfeeding video classes, blog, and online support forum. She also offers in-home (or hospital) lactation support services as well online lactation support services before and after baby is born. Lactation Link’s goal is to empower women through education to reach their goals, whatever they may be.  

Breastfeeding Roadblocks and Troubleshooting

Navigating Breastfeeding Roadblocks & Finding Solutions

If you spend any time reading about mothers’ breastfeeding experiences and it won’t be long at all before you see the phrase “breastfeeding journey”. This is a perfect metaphor for the reality of the breastfeeding relationship from start to finish. For both a road trip and a breastfeeding journey, many people research and prepare carefully before starting out. They begin with a destination and planned route in mind, but don’t really know exactly what they’ll encounter until they’re in the thick of things.

Whether on the road or the breastfeeding journey, surprises can pop up at any time.  These can be as mild as some extra bumps in the road, or as extreme as route closures and long detours. Roadblocks rarely end the trip altogether, but they often require persistence, patience, and a clear head– and sometimes the help of roadside assistance, or an IBCLC, to get back on track.

Common Breastfeeding Issues

Pain and Nipple Tenderness

Pain is one of the most common reasons mothers give for early weaning. While some nipple tenderness is normal at the beginning of feeds in the early postpartum period, severe pain and skin damage is NOT normal and should be seen as a sign that help is needed.

How can you tell when you should be concerned? Use the “30 second” rule. If your pain disappears within 30 seconds after latching, you can safely ignore it. If your pain lasts longer than that, gently insert your finger into the corner of your baby’s mouth to break the suction and unlatch baby, then try again. If you’re not able to get a latch that is comfortable for the majority of feeding session, your pain is severe, and/or you notice any damage to the nipple, you should seek help right away. 

Milk Supply

Concerns over milk supply are right up there with nipple pain as a top cause of early weaning. Neither babies nor breasts come with full/empty gauges, so it can be hard to know how much you’re making and how much baby is getting. You can be confident that your baby is getting just the right amount of your milk if he or she is growing and gaining well, and having plenty of wet and poopy diapers each day. After the first week, and for the first month or so, expect 5-6+ light colored and mild smelling wet diapers and 3-4+ poopy diapers. If your baby is gaining poorly and/or not having enough wet and dirty diapers, help from an IBCLC is a very good idea.

The best way to ensure that you’ll have an ample supply is to start breastfeeding within the first hour after birth and then whenever your baby shows feeding cues after that—generally 8-10 or more times per day. Milk volume works on a supply and demand principle—the more you demand it (by feeding or pumping), the more you’ll supply. Your breasts are always making milk. They’re never truly empty, so you don’t need to wait for them to feel full before you feed your baby. In fact, if you do, you might be telling your body to make less milk.

Medications While Breastfeeding

Breastfeeding mothers might worry that prescribed medications will pass through their milk and possibly hurt their babies. The Infant Risk Center at Texas Tech University Health Sciences Center is an excellent resource for information on the safety of medications in breastfeeding mothers.  If you’re worried about a medication, or have been told that you can’t breastfeed while taking a medication, you can call their hotline 806-352-2519 or visit www.infantrisk.com for the most up-to-date information.

pain while breastfeeding

Concerns with breastfeeding older babies

Sometimes, breastfeeding problems can pop up with older babies after breastfeeding has been going really well for a while. This can be especially worrying if you don’t know other moms who have breastfed past early infancy and worked through these common bumps in the breastfeeding journey. Joining a local breastfeeding support group is a great way to help you gain confidence in nursing your older baby, and maybe even make some new friends at the same time.

Teething & Breastfeeding

Yes, you can continue to breastfeed through teething and beyond! Many teething babies will nurse better if they get to chew on something cold first. You can also talk to your doctor about pain relief options for your teething baby. If you’re worried about those new little teeth being right next to your nipples, relax. Most babies’ teeth cause no problems at all for their mamas. When a baby is actively drinking, it’s actually impossible for her or him to bite. If your baby does bite, he or she is usually trying to resolve the discomfort of teething, or simply experimenting with new ways to use his or her mouth. Your baby doesn’t realize that it hurts you. You can teach your baby that biting mama isn’t ok by ending the feeding session and calmly, but firmly saying “No, no, no.”

Nursing Strikes

Sometimes older babies will start to refuse to feed at the breast. It is unlikely that a baby younger than a year old is actually self-weaning from the breast. If you can protect your milk supply and be patient, you can be confident that the refusal is almost certainly temporary. Most nursing strikes only last a day or two, but some can last up to a week or more. If your baby starts to refuse the breast, keep offering gently. The trick is to act like you don’t care whether or not baby latches, even though you probably care very much! Lots of skin to skin cuddle time can be very helpful in these situations. You could try nursing baby when he or she is very sleepy, or in a new position– maybe even standing up and walking around.

If the refusal goes on more than a few hours, you’ll need to express your milk. You can give this milk to baby by cup, spoon, or bottle. Older babies who have never taken a bottle may do better with a straw sippy, or even frozen breastmilk cubes in a silicone feeder. Don’t be afraid to reach out for help from an IBCLC when having issues breastfeeding an older baby. We don’t just help newborns, we love helping moms breastfeed babies of all ages!

With any trip, it’s a good idea to expect some bumps in the road. Give yourself some extra time to arrive at your destination and know how to get good help if you need it.  The journey can be hard sometimes, but it can also be beautiful. Happy travels!

Sources: Mohrbacher, N. (2010). Breastfeeding answers made simple: a guide for helping mothers. Amarillo, TX: Hale Publishing, L.P.

This guest post was written by Stephanie Hadfield. Stephanie Hadfield, IBCLC is a mother of 5 and one of the 3 International Board Certified Lactation Consultants with Lactation Link, a private practice offering breastfeeding support through breastfeeding video classes, blog, and online support forum. She also offers in-home (or hospital) lactation support services as well online lactation support services before and after baby is born. Lactation Link’s goal is to empower women through education to reach their goals, whatever they may be.   

The Value in Finding and Forming Your Mama Support System

Life with young children is a paradox.

Viewed from the outside, nothing is getting done. But the reality is that so much is happening, between mother and child as well as within the family. The exhaustion mothers feel isn’t just the result of sleep deprivation or stress—we are working in the most primal and beautiful sense of the word.

Settling Into Your Role as a Mom

how to make mom friends

And yet in the moment, even as you are giving everything of yourself to the baby who is your everything it can feel like you’re stagnating. The 200th diaper change feels no different than the first. Breastfeeding sessions blur into each other. And that cliched question is always there: “What does she do all day?”

The real, honest answer is that the day-to-day grind is this rollercoaster of beautiful highs and confusing lows. Becoming a mother is a capital-B big deal. Your body changes. Your mind changes. Your outlook changes. Your relationships change. Have a baby, and suddenly everything you’ve ever known may be called into question. You’re so in love with this tiny human who can’t give you anything but has given you everything.

The truth of it is that motherhood is something you can’t really know until you’re there living it. It’s a joy and a privilege and awe inspiring, but it can also be filled with guilt and boredom and self-doubt and even fear. Because of the contradictions people around you can sympathize but not empathize, wishing you the best but not understanding a whit of what you’re going through.

Find Comfort in a Support System of Other Moms

Having a support system made up of other mothers is key. Popular culture has created this fairy tale where having mom friends is about raucous wine nights and cutting loose but that depiction ignores something fundamental about friendships between moms. Motherhood is hard, and the only ones who know just how hard are mothers themselves.

Every family’s story is unique but the bond we all have with our babies makes it easy to find common ground in a community of mothers. It turns out the Mommy Wars were fought and won years ago, and the fight didn’t pit mom against mom but rather mothers as a whole against the isolation that has too often been a part of the motherhood experience. Mom friends, as a concept, made headlines not because it was trendy but because it was needed.

After all, there’s something both powerful and empowering about knowing that someone a block or a text or an email away has sat next to an isolette in a NICU or rocked a colicky baby at 3am or agonized about whether and how to vaccinate. Knowing that they, too, have wondered over and over again, “Am I a good enough mother?” and will continue to ask that question for a lifetime.

It Really Does Take a Village

None of us has all the answers and we may disagree on some of the most basic fundamentals of parenting but that doesn’t mean we don’t need one another. We need one another badly, especially in those lonely early days of caring for a newborn when every single day feels endless and then again when our children begin to pull away from us to begin the process of evolving into who they’re someday going to be.

When you surround yourself with a network of mothers who accept you for the mom you are, motherhood may not get easier—but it will get better. A network of supportive mom friends will laugh with you and more importantly cry with you even when the rest of the world feels like they just don’t get it. Mom friends believe you when you say, “This is bad,” and then cheer you on while you work toward the good. They will be the people who will be there for you at your worst and never stop seeing the best of you.

paternity leave

Someone Who’s Been There

Mom friends do all of that not just because they love you but because they have been there, too. That’s the true value of mom friends whether you’re living a life of diapers and nipple cream or trying to power through what feels like a rerun of the toddler years with your teens. As much as your partner cares about you, they’re never going to grasp the heights of joy or depths of pain that our children can inspire in us as moms simply by being.

When to Make Mom Friends

As to when the best time to build that network is, the logical answer is before you need it but the honest answer is whenever you need it. Some mothers are lucky enough to find and connect with a circle of supportive moms while pregnant but that’s not at all typical. Unfortunately most of us don’t realize how important mom friends are until we’re in the thick of motherhood, surprised at how tough it really is.

And it is tough. But never forget that we’re all in this together.

This guest post was written by Christa Terry. Christa is one of the founders of HelloMamas.com, an app for iOS and Android that helps local moms meet, communications director of Graham’s Foundation, and mom to two small but incredibly loud humans. Courtesy of Hello Mamas cofounder Meg Gerritson.