Sunday, December 10, 2017

The Sensations of Labor: Morphine Rest

Welcome back to part II of my Sensations of Labor series! Some of you may be wondering why my first two posts are such high-intervention choices for managing the sensations associated with labor. It's a valid question! I strongly believe that when a situation isn't an emergency, a birthing person is best served by starting with the most minimal intervention possible, and escalating from there only as necessary. That said, while our culture certainly has a lot to do with this, and our culture will hopefully continue to change with time, over 90% of people giving birth in America receive an epidural. They've heard of them, and what they've heard is basically that they're magical and fix everything. Giving them the other side of that coin is going to be more helpful than comparing massage, warm water, TENS units, etc. to their magical concept of what an epidural is. I think dispelling the mystique around these medical pain relief options is an important first step to introducing non-medical pain relief techniques as valid alternatives. Also, and this is important, I DON'T THINK EPIDURALS ARE BAD. They are a valid choice for managing labor sensations. Knowing all the pros, and the cons, helps birthing people discern if they're the right choice for their birth, and prevents them from being blindsided by the cons if they choose to use one. Now, onto the 'morphine rest'!

I find that this is a pain relief option that many people aren't familiar with, but it definitely has its place as a tool for birth, so everyone should be aware of it. It can make the difference between getting an epidural (and all that entails), and not getting one in some cases, and can help avoid or resolve labor slowing down or stalling by providing the birthing person with needed rest (hence, the name).

A 'morphine rest' is a term for giving someone a course of iv opioid (or synthetic opioid)-based pain relief drugs (morphine being just one example of what may be given) to someone in labor, generally for the express purpose of giving that one a 'rest' from dealing with labor. The does of opioid given via IV is much higher than what would be given via the epidural, since it's being put into the blood stream, and not directly into the epidural space where it can immediately affect the relevant nerves.

Now I know what you're thinking: why in the world would anyone opt for a HIGHER dose of drugs?? Fair question! But dosage is only part of the picture. A morphine rest is often used for different situations than an epidural would be. Let's look at pros and cons:

Pros:

Sweet sleep! Particularly if you're having a very long and uncomfortable pre-labor or early labor, getting admitted to the hospital, and getting an epidural so early in the game may not be an option at all, or even if it is, you're much more likely to experience a slowing or stopping of labor if you're forced to stop moving so early on in the process. The drug will provide pain relief, and also make you very, very sleepy. A good night's rest can work wonders on speeding things up, and once the drugs wear off, you can be back on your feet, laboring how you choose! Since you'll be better rested later on when things continue to get more intense, you'll be less likely to choose an epidural out of exhaustion.

Stay home! Many doctors will allow you to return home after the drug is delivered via IV providing someone is there with you to take you home and keep an eye on you. This means you can receive significant medical pain relief, without committing to hospital admission, and delay being checked in until things have had a chance to progress to active labor, which doctors, midwives, and doulas all universally recommend!

Keep your options open! A morphine rest is temporary. The drugs wear off, and you're back to normal. You're allowed to be up about again if you're at the hospital, using any other coping mechanisms or position changes you wish. You can opt for an epidural later on if you wish, or switch to non-medical coping strategies. While epidurals can be turned down or off, the numbness persists long enough that most hospitals won't let you out of bed again, and they certainly won't let you go home.

Temporary relief for temporary discomfort! Are you experience terrible back labor, and are hoping the baby will turn given time and position changes? Does the doctor want to use a foley balloon to dilate you those first few centimeters and get things moving? Why opt for long-term pain relief for a short term procedure or situation?

Cons:

Drugged birthing person, drugged baby! Yes, your baby will experience the effects of this drug as well. These drugs are this dosage are not shown to cause any long term effects or issues, but many people are still not comfortable with their baby receiving this dose of these drugs. This option will not be offered if there's reason to think you'll have your baby in six hours or less, because it isn't safe for a newborn, who needs to be highly alert and stimulated to transition to breathing on their own etc., to be under the influence of opioids. If you have any reason to think this labor could go unusually fast, it likely won't be recommended to you, and it's a riskier choice. At the end of the day, this is always a calculated risk, as even a seemingly very slow labor can suddenly speed up and resolve very quickly.

Itchy Pukey! Itchiness, and nausea/vomiting are common side effects with opioids. Not everyone experiences them, but the higher the dose, the more likely they are, which is why you're much more likely to experience these side effects with a morphine rest than with an epidural.

Incomplete Pain Relief! IV opioids are less effective at reducing pain than the epidural. Depending on the severity of your discomfort, you may still experience significant pain. For labor contractions, this can mean not noticing the beginning or end of the contraction, but suddenly being struck by the peak. The element of surprise, and the lack of time to prepare and get into a breathing pattern can make contractions difficult to deal with, especially if you're sleeping, and are woken up by the intense sensations. If you're dealing with this, it's helpful to have a partner who notices how your breathing pattern or how you hold your body changes when a contraction starts, who can wake you up and get you into coping mode before the contraction peaks, and let you drift back off as the contraction ebbs away.

As you can see, this option is clearly not right for every birthing person, or every situation. It's one choice among many that can be beneficial in the right circumstances. Wouldn't it be cool if we thought of all birth interventions that way?? :-D See you next week for a discuss of nitrous oxide, aka, gas and air, or laughing gas!

Live Omily,
~Emily

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