Latest / The Birth Lounge Podcast / Ep. 470: Pain Relief Options in the Hospital with Dr. Nicole Rankins [REAIR Ep. 227]

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Ep. 470: Pain Relief Options in the Hospital with Dr. Nicole Rankins [REAIR Ep. 227] · The Birth Lounge Podcast

So normally pain in our bodies is a signal that something's wrong.
0:03
It's like our body is.
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Sending us a signal to say, hey, this is not right.
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I need you to pay attention to this.
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Like I got to cut something's broken.
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Something's hurting.
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You need to pay attention to this, but pain during labor is different.
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It's actually pain.
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That's for a good cause.
It comes and goes at predictable intervals.
You know, that is going to end at some point and at the end of it is this beautiful thing.
Hello, guys, and welcome back to another episode of The Birth Lounge Podcast.
You guys, I know I say it every single week, but honestly, today's episode is one for the books.
I'm so stoked.
I was over the moon when we recorded this.
Now, listening to it play back during, um, the editing process has just made me even more excited.
This is probably one of the best episodes ever to be published on The Birth Lounge Podcast.
I'm so excited to be being joined by Dr.
Nicole Rankins, who is an OBGYN who truly understands consent and patient autonomy, and building a trusting, respectful relationship with her patients so that she can not only help them have positive birth experiences, but she can truly help them avoid birth trauma.
You know this is music to my ears, so I am not gonna waste any more of your time with my own chatter.
Without further ado, Dr.
Rankins, welcome to the show.
thank you so much for having me.
I'm excited to be here.
I'm very, very excited to have you.
I was just sharing.
With you that I followed you for a long time.
You're someone I look up to.
You are an obstetrician that truly believes in consent.
You really, really value the relationship that you have with your patients and your clients.
You are always talking about patient autonomy and having a really collaborative and respectful relationship.
I think it's important to talk about the perspective relationship between patient provider and that is our whole MO here at Tranquility by HeHe and the Birth Lounge.
And so this is a conversation that I think is long overdue.
I wanted to have a conversation with an obstetrician about the pain relief options that we have in hospital birth really transparently because I think a lot of women and birthers don't get that.
Unfortunately, it's very hard to find a transparent conversation where we can talk about.
Both the pros and the cons, but also the risk and the benefits.
And that's what people truly need to be able to make those informed choices about their labor so that they can feel good about their birth.
So absolutely.
Thanks for being here.
This is going to be a great conversation before we dive in.
I want to kind of set the stage for our listeners.
There are three main categories that we will cover today.
We're going to talk about an epidural, that's what most people are familiar with.
Then we're going to talk about IV medications.
And then we're going to go to a medication that you actually inhale, and it's called nitrous oxide.
It is not available everywhere, but we are seeing it start to be available in more places.
And so I'd like to cover it.
If it's not available in your, in your area, talk to your doctor about it.
Talk to your hospitals about it.
And you know, eventually it will make its way there.
So Dr.
Rankins, let's start with, maybe let's start with that fear of pain.
Let's talk about the pain in labor.
Fear makes that pain so much worse, right? Yeah.
It is, a lot of it is mental, but there is definitely some physical discomfort.
As an obstetrician, what do you say to people when they say, Dr.
Rankins, I am just so scared of the pain in labor, like, how am I going to do this? Sure.
Sure.
So the first thing I would say is that.
That's totally normal to be afraid of something, especially when you haven't experienced it before.
But I encourage people to think about the pain or discomfort during labor in a different way.
So normally pain in our bodies is a signal that something's wrong.
It's like our body is.
Sending us a signal to say, hey, this is not right.
I need you to pay attention to this.
Like I got to cut something's broken.
Something's hurting.
You need to pay attention to this, but pain during labor is different.
It's actually pain.
That's for a good cause.
It comes and goes at predictable intervals.
You know, that is going to end at some point and at the end of it is this beautiful thing.
You'll have your baby with you.
So it's important to think about pain in a different way.
So don't, you have to think of it as like, you know, it, there's a, it's a means to an end.
It's, it's going to end every time with each contraction, I'm getting closer and closer to meeting my baby.
So that's the first step to thinking about pain.
It's just to think about it in a different way.
And then the way to conquer that fear, which again, is totally normal.
It's totally normal to have a fear of something that you don't have an experience before is to learn your options, which is what we're talking about today.
I love it.
I'm a big believer of that same thing that the antidote to fear is just understand what options you have.
In that way.
It's.
It's not so much unknown, I think a lot of that fear of labor, and you nailed it, comes from never having experienced birth before, and so it all feels very unknown.
Not to say that if you are a second, third, fourth, fifth time parent out there, you're not feeling some sort of angst going into labor.
There will always be a piece of labor that is unpredictable or unknown, but the more that you do it, the more comfortable you get.
But for those people who...
And they don't want to do that pain and they say, okay, I know for a fact I'm an epidural girly.
What do we need to know about epidurals? I guess what, what would epidural 101 little crash course cover? Sure.
So the first thing that I would say is that even if you wanted an epidural, you still need to have some tools in your toolbox to manage pain without medication, because you're not going to get an epidural with the first contraction.
So an epidural takes time.
So you're going to be in labor for some time before you, before you get an epidural.
So definitely learn your options for managing pain without.
Medication just real briefly things like movement hydrotherapy or water are good options.
Massage, those are all great things, but know your options for that.
And then the other things that I would say about an epidural.
There are several important things to know.
So number one, it takes time.
Okay.
So it's not like I've had someone bless her heart call from the car.
And she's like, can y'all have my epidural ready when I get to the hospital, but it does not work like that.
It takes 30 to 45 minutes about roughly to get things together.
The anesthesiologist has to be there.
Sometimes we have to do blood work.
You have to get an IV.
So it does take some time to get an epidural.
So that's number one number two is that epidurals aren't always perfect for some people.
They may be one sided.
You'll get relief on one side more than another.
For some, for some people, they don't work at all and they need to be replaced.
And I think people aren't prepared for the possibility that the epidural is not going to necessarily work exactly like they want it.
To work, so most of them work fine.
I don't want you to go into it thinking that it's not going to work as most of them do work well, but know that.
It may be some tweaking and adjusting before you're able to get that epidural to, to feeling where you want it to feel.
That's also a good reason to have those unmedicated coping skills that you talked about earlier is if you have an epidural that doesn't work 100 percent or exactly what you had expected, you can You can pair them, right? You have the epidural.
It gives you, let's call it 90 percent relief.
You can make up that other 10 with your breathing strategies, your mindset work.
I love that.
Yeah, absolutely.
Yeah, definitely.
Definitely.
Definitely.
Also at epidural, you really actually don't want it to be where like you're completely numb where you can't feel anything.
It's actually best if you're still able to feel.
Something so you know where to push when the time comes, if you're completely dead numb and can't feel anything, it can be challenging to figure out the right way to push.
So you don't necessarily want it to like want to not feel anything at all.
It's actually good.
If you can feel something, the best epidurals are when you aren't feeling the contractions, but you still have some movement in your legs and you can still feel like that pelvic.
Pressure sensation to have a focal point to push and we're getting better at epidural so that people aren't quite so numb, but that's another thing in that I would say.
That's good too.
That's good to know.
I think a lot of people go in to an epidural, like getting an epidural with Expectations that may not be the best, whether they've picked it up from inaccurate information or the internet or movies or family and friends, I think it's really important to know kind of what is that perfect epidural, what are we going for, and having sensations with an epidural is not bad, it actually can play into your favor, it helps you push a little better, it helps your baby be able to navigate that pelvis, you to be able to move your body.
To make space in your pelvis.
Yeah.
Yeah.
Maybe not necessarily pushes long either.
And then there's some other things about an epidural that I think folks should know.
One is that they actually don't slow down your labor by very much.
Okay.
Studies show that an epidural may slow down your labor by a half hour or so.
So not a terribly long amount of time.
So don't worry that an epidural is going to like significantly slow down your labor and it's not going to stop your labor.
It's not going to cause you to have a cesarean birth.
They don't increase the risk of cesarean birth.
Again, they may slow down your labor a bit, but not substantially.
So.
And then another thing is that you should really be able to get an epidural whenever you want.
There shouldn't be any, you have to be a certain number of centimeters dilated in order to get an epidural and epidural should really be upon maternal request.
So upon the request of the person having the baby, it should make the decision about when they want that epidural.
Now, of course, there's like.
Risk and benefits and all of those kinds of things.
And some people actually don't like that sensation of not being able to feel their legs.
It kind of freaks them out a little bit.
So if you're worried about that, maybe you do want to wait longer to get an epidural, but you don't have to be a certain number of centimeters dilated in order to get an epidural.
You should be able to get it whenever you want.
That is awesome.
Okay.
So and I just want to hold space for people who I know that's not everyone's experience out there.
I know sometimes, you know, you arrive and you're told that you can't get it.
So if that was your experience.
I see you.
I do, I do recognize that unfortunately we don't have, we don't all get Dr.
Rankin's but that's how we have this podcast.
We're, we're working on it.
So I guess for people who have that imperfectly kind of placed epidural or their epidural just did not meet their expectations.
You mentioned replacing it.
Can we also titrate it up and down and then, you know, kind of adjust the placement without replacing it? What other options do we have in terms of maybe adjusting that if it is not great? Yeah, the anesthesiologist can adjust the location of it.
They can do what's called a bolus of medicine through the epidural.
So you get a big dose of medicine at once to try to help get the pain under control.
Some epidurals have buttons where you push the button and you give yourself A dose of medication through the epidural.
So there are some things that can be done.
That's definitely going to be under the anesthesiologist.
It's an anesthesiologist who puts in epidurals and anesthesiologists or certified registered nurse anesthetists.
And they're the ones who are going to manage the epidural and the things that go with the epidural, not your obstetrician.
Yeah.
Okay.
So anytime that we call back a doctor to adjust it and stuff, it will always be the anesthesiologist, not your OB.
Always.
Okay.
Yeah.
All right.
And in terms of people who I know we just talked about, it should always be maternal preference for people who were trying to decide the best time to get an epidural.
Is there data about when we should get an epidural in terms of like dilation or how far along we are in labor? No, you can really get it.
Now it's harder to place when you're completely dilated it, but you can get it up until the very end.
It may not have time to take effect and you know, or there may not be enough time, but if the baby is still high on your pelvis and you still have some pushing to do, you can get an epidural up until completely dilated.
I don't encourage folks to wait that long to do so, but you can get it really up until that up until the end.
Yeah, as long as you're able to kind of sit still, curve your back for a little bit and it's not, it's not a super quick placement, you guys.
It takes a minute or so, so you know, said figuratively, it takes a little bit or so.
So you do have to kind of stay still.
Exactly.
Dr.
Rankin, you talked about blood work before an epidural.
What is that for? Yeah, so the, the blood work that the anesthesiologist may or may not want, depending on what risk factors you have, is to know your platelet count.
Your platelets are what help our blood clot.
And if your platelet count is low, then putting an epidural And can be dangerous because it can cause what's called an epidural hematoma, which is a blood clot that forms around where the epidural is placed.
And that can be dangerous.
So some doctors may want to know that your platelet count is okay before an epidural is placed.
Got it.
Okay.
And what kind of I guess diagnosis would impact that? And so if your blood pressure issues, if you had high blood pressure during pregnancy and you're at risk for preeclampsia, a severe form of preeclampsia can lower your platelets if during the course of your pregnancy, because we usually check your blood count a couple of times if it was low.
Like around, we used to check it around the same time we do the diabetes test.
If it was low, then rechecking it later re rechecking it when you get to the hospital.
Some anesthesiologists might want to do, and every anesthesiologist is a little bit different.
There's some anesthesiologists who want it for every single person, regardless of their risk factors.
And then there are some who won't want it for most people.
So it really is going to be dependent on whatever anesthesiologist is there.
At the time you get your epi epidural placed.
And speaking of anesthesiologists being there, people should also know that sometimes the anesthesiologist is not in the hospital and they have to come from home depending on where, where you're giving birth and the the procedures at the hospital, there may not be an anesthesiologist in the hospital.
So that's going to add some additional time for you to get an epidural.
That's typically going to be during the nighttime hours.
So brush up on those unmedicated labor skills.
You guys, you need to know how to deal with contractions.
If you get into, you know, a situation where you thought you were going to have an epidural and maybe you're still waiting for it or it didn't work.
Okay, so I think my next question is about the lactated ringers that you get.
Everyone who gets a epidural is going to need fluids.
Talk to us about that.
Why do we have those? What are they for? Sure, so you get fluids to your IV because 1 of the side effects of an epidural is that it can drop your blood pressure.
And when you have and I should say the epidural mostly acts.
It doesn't like the medications don't cross the placenta.
They mostly.
Act like around the epidural space and in mom's body, they don't really cross the placenta.
So that's one of the benefits of an epidural, but those medicines can drop your blood pressure.
So we give you a bunch of fluids ahead of time to help keep your blood pressure up.
So that it, if it does drop that, it doesn't cause any significant issues or concerns for either you or for the baby.
Good.
Okay.
All right.
All right.
So in terms of risk, a couple of things that come to my mind that our team has kind of seen is a sore back, just seeing that not, I'm not talking chronic back pain.
That's not what I'm saying, but just a sore back at the site of you know, the, where your epidural was a couple of days after birth.
Sometimes people develop a headache.
Sometimes it makes you a little itchy.
You know, nausea, but who's to say that's from the epidural versus like being in transition, being in labor? What other things do we need to think about in terms of risk when it comes to epidurals? Because I know a lot of people do hold the fear of like, Oh no, we're going into my bag.
We're going into a very sensitive place in our body.
Sure.
There has to be risk associated with it.
So let's talk about those.
Yeah.
So like you said, the common things are risk or side effects or nausea itching, shivering is another one that people experience.
But there are some risks and honestly, these are better.
The anesthesiologist is going to be the one to explain the risk specifically of the procedure because they're the ones who place the risks are low.
There's a risk of injuring the spine.
Potentially, because, you know, you're near that area the spinal headache, like you talked about, or the epidural headache is another one that's a risk.
The blood pressure dropping is a risk.
It'll also maybe in the short term decrease your ability or success with breastfeeding.
That's only for a short term within the first few days after birth.
So.
That's not a significant factor or anything, but that is a possibility but there's a potential if you have the, the risk or higher if you have more complicated anatomy.
So, if you had like surgery done on your spine, or, yeah, if your spine is curved in some way, those are going to increase the risk of that needle hitting a place that they don't want the epidural needle to hit.
So those are the biggest risk.
The vast majority of people though, have an epidural without complications, but everything has risk involved and as long as you know the risk, then you can make an informed decision about what you want to do.
Yeah.
Every choice has risk.
It's just, what's what risk are you you know, comfortable with.
So the breastfeeding interference mainly comes from the extra fluids that we get and it just makes the breast kind of engorged.
Is that correct? Or does the narcotic, you know, actually no, actually, I'm not sure.
I, I'm not sure what the theory is.
I mean, that sounds reasonable about why it may be a possibility.
But I'm not sure what the exact mechanism is.
Okay.
And then that postural headache how would someone know what is normal versus what to call your doctor with, or anytime you have a headache in those first few days, postpartum, you should call your doctor.
Yeah, most of the time it's going to show up while you're still in the hospital.
So what we'll do is we'll have the anesthesiologist come see you, evaluate you.
It typically has some positional changes, like the headache changes with whether you're laying down or sitting up because the fluid in your spinal cord moves and it can affect the headache.
So the anesthesiologist will do an evaluation and see if they think that it is a spinal related headache or an epidural related headache.
Okay.
All right.
Okay.
My final question I think here is there are different types of epidural.
So we have an epidural.
We have a spinal and then we have a CSC, a combined spinal epidural.
What are the difference between these and when would we use each of them? Sure.
So a spinal is one shot.
So it's, you don't have a catheter that stays in.
So with an epidural, there's a catheter that's placed in the epidural space.
And the dura is like the sack that covers the spine.
So the epidural is a catheter placed in the epidural space and it's left there.
For the entirety of your labor.
So you can continue to get pain medication during your labor.
That's another thing people should know.
It doesn't run out like an epidural can't run out.
It can last for days actually.
So that epidural stays there.
The catheter is taped to your back.
It's connected to the epidural pump.
That, you know, hangs off your IV pole.
So that's an epidural, whereas a spinal goes in the different space.
And that is a one shot dose of medicine and it lasts for two to three hours, roughly.
So it's a one shot dose of medicine that lasts for two to three hours and then it wears off.
So that's something that we typically do for a planned cesarean birth.
When we don't need to leave the epidural in place, then the spinal is going to be better because it's just one shot.
The medicine wears off and then you're done.
Now, the combined spinal epidural is when they start with the single shot to get people comfortable right away.
And then they follow it with the epidural catheter after that.
So they do both of those in order to get people like immediate relief because the spinal works very pretty quickly to relieve pain.
And then After that they do the epidural.
Now it depends on the anesthesiologist about when they will do that or it depends on like the course of the labor.
Like if it's someone who's like really struggling with the contractions and maybe a CSE might be good because you're going to get better immediate relief.
A regular epidural is going to take 30 minutes to set up 20 to 30 minutes before you start feeling some relief.
Whereas with the CSE you'll feel it fairly quickly or the spinal.
So It really depends on the anesthesiologist as to whether or not that's what they do.
Cool.
Wow.
That was a great explanation.
All right.
That was, I feel so educated on epidurals.
Now, is there anything else we haven't covered? Actually, a few things.
So one, you have to have an IV when you have an epidural.
We didn't talk about that.
So you have to have an IV and be connected to an IV.
Typically you're going to, you're, It's going to be, it's going to be more challenging to change into different positions, but you can still change into different positions.
So don't think that you're going to necessarily be like, you shouldn't be stuck in the same position.
Your nurse should be helping you to change and move, but yes, it can be more challenging.
You can still, even though with an epidural do hands and knees, you can.
You know, be on your side.
So those things are a possibility with an epidural still.
Okay.
Now with an epidural, you cannot feel it.
It numbs everything from a certain level down.
One of the things that you can no longer feel is the sensation to empty your bladder.
So we do have to periodically empty your bladder with a catheter.
You shouldn't feel it.
But you will have to get your bladder emptied with a catheter.
And then also you typically are going to be on continuous monitoring when you have an epidural and not intermittent monitoring.
We typically do continuous monitoring.
And what else? I think Oh, the final thing is that epidurals can cause the, I talked about briefly how it can cause a drop in mom's blood pressure that can sometimes lead to a drop in the baby's heart rate as well.
And so right after the epidural, if mom's blood pressure is low and the baby's heart rate drops.
There's some physicians who will move a little bit quicker to a c section, when actually what we need to do, because the baby's heart rate is dropping, but what we need to do is fix the mother's blood pressure and then that will fix the baby's heart rate.
So sometimes There's some adjustment and things that need to be done if the blood pressure lowers in order to get the blood pressure back up and get the heart rate better.
And would that be like a medication fix or like a positional change? Yeah.
Yes.
Yeah, both.
Oh, okay.
Both.
Yeah.
Yeah.
So we try a medicine often called ephedrine, which helps to increase blood pressure and then position changes to help maybe with the babies on the court or anything like that.
So to help fix that.
Okay.
And as for the catheter, is there a benefit to either one, either placing a catheter and leaving it or doing that intermittent? I assume if you leave it, it's much harder to move around if your goal is to be mobile ish in the bed with an epidural.
It's actually not because it has a long tube.
It's still, there's plenty of motion for it, but it does increase the risk of urinary tract infections.
So we, if you leave the catheter in place, so we try to do, so we try to do just catheter, take it out, catheter, take it out.
Wow.
That surprises me.
I think my brain would think the more that we went in and out, the higher the risk of infections because of cervical checks.
I think it's like the opposite, right? Yes.
Okay.
Yes, but it's actually not true.
Actually, higher risk of infection by leaving a catheter in.
Okay, cool.
And how often are we emptying someone's bladder? Yeah, every four ish hours or so.
Okay, cool.
And I know I already said my final question, but eating and drinking with an epidural, what's the science say about this? You know, this is a controversial topic.
Probably unnecessarily so yeah, there's not a there's not a lot of of specific data that I'm aware of about eating and drinking with an epidural specifically eating and drinking during labor is more related to your risk of having complications during birth.
So really, if you're low risk, you should be able to eat and drink during well, I should take that back.
Everyone should be able to drink during labor.
Like, no one should ever be told that they can't have anything during labor or just ice chips or anything like that.
Like, everyone should be able to drink regardless of your risk.
And then low risk people.
Should also be able to eat.
Most people don't want to eat when they're in the throat, like the active part of labor.
Most people aren't actually terribly hungry, but I don't use epidural as a reason to say eat or don't eat.
And then in general, I say, don't eat anything that you don't feel comfortable that don't eat anything.
That would be like terrible if it came back up because like vomiting is really common.
And like, you are probably going to see that food again.
Yes.
Oh my goodness.
Okay, that really was my final question about epidurals.
Is there anything else before we move on to IV stuff? No, I don't think so.
Cool.
All right, so IV medications.
In my brain, I'm thinking Dilaudid, morphine, Dimerol, Stadol, Nubane.
Obviously, they're through an IV, so you need an IV.
What else do we need to know about IV medications? Yeah.
So it's really dependent on the hospital, what they have available and what the practitioners are comfortable with.
Like, right.
For example, for example, at our hospital right now, we don't have state all available.
We've used that before.
We don't have new vein available.
So it really is dependent on the hospital and what is available.
The other thing about IV pain medications, they will cross the placenta.
They will get to your baby.
So they are narcotic medications.
They will get to your baby.
Your baby will clear.
The narcotics from their system the same way we do, but it just takes babies longer.
So for that reason IV narcotics during labor should be limited.
They should be limited to maybe a couple of doses, maybe, maybe three doses.
And then once you're past a certain number of centimeters dilated, usually I say about six or so, you shouldn't get it anymore.
Because when the baby comes out, the baby may have some trouble breathing.
Yeah.
Because that's one of the biggest, yeah, that's one of the biggest side effects of narcotics.
So it's not something that you can continue to get over and over again, it really should be limited.
It can be great for in the early part of labor.
If you're having some difficulty, it can help be great to help you get some rest you know, get a little sleep, but it's not something that you can just like get over and over again.
It's more of a.
Two to three times or so during labor and also know that it is not nothing is going to be as effective as an epidural not like it's not.
So it's not going to be as effective as an epidural.
It's more kind of to help take the edge off.
So there are certain circumstances again, like I said, especially being the early part of labor when it can be very useful for sure.
But know that again, it's going to cross the placenta again, affect the baby.
You can't use it tons.
So those are the big.
Yeah.
We see it a lot with people who have very, very long labors and we get to the hospital and we're still kind of below that six to seven centimeter mark.
But we've been in labor for maybe a day or two already.
And that, that, that mom just needs a nap.
That's a really great place to, to use it.
Each of those medications, how long are they lasting? So we talked about how many doses we can have when we have a dose, how long is this going to stay with us? Good.
Yeah, great question.
So everyone metabolizes medications differently, but on average, you can expect to get two to three hours of relief from IV pain medicine.
Yeah.
So that's a nice nap and then you'll wake up and, you know, probably be further along cause labor's still happening in the background.
It doesn't stop labor.
So things are still happening.
So hopefully you wake up and you're, you're in more active labor for some people that may last even longer, but I would say on average two to three hours.
All right.
And if someone got that in early labor, you could then stack it with an epidural once that medication kind of weaned out of your system.
Absolutely.
Yeah.
Nice.
Okay.
Or sometimes, or sometimes it's nice to do if somebody is really struggling and it's going to be a while then, and we even know you're still going to get an epidural, then we can do that IV medicine right then to help kind of bring things down a little bit with as we're working on the epidural in the background.
Cool.
And do we need an anesthesiologist for the IV medications that can come from your OB? Yep.
Also a great question.
Yes.
No, you do not need that.
That's your, your OB can pres or your midwife can prescribe those.
Nice.
Midwi midwives and midwifery practices can too.
Okay, great.
All right.
In terms of risk and benefits, we kind of talked about the nap.
We talked about it going across the placenta, some respiratory distress for baby, maybe sometimes.
What else should we know? Yeah, those are the big things.
It can change the respiratory depression in while the baby's still inside in utero can cause the heart rate tracing to flatten a bit.
It doesn't have the nice squigglies that we like to see, but we anticipate that we know that that's going to happen.
So that's not necessarily a problem.
That's an expected side effect.
Yeah.
Okay.
And we, do we see itching like we do with an epidural? Oh, yes.
Also itching.
Yes.
Yes.
Okay.
Yes.
Potentially not everybody, but yes, you may have some itching with it.
Also.
Okay.
I think narcotics just kind of do that to people.
Yeah.
It's narcotics.
Yeah.
And some people have narcotics.
We'll take, get narcotics and then it may make them feel like loopy or like just out of it.
Or it really just depends.
Everybody again reacts to things differently.
Okay and these medications through the IV are a one time dose or they're also on a drip like an epidural or pitocin would be? One, one time dose.
One time.
So if someone had an, had an IV, they could get their medication and then have the IV taken out and go back to maybe a HEPLOC? Oh yeah, yeah, yeah.
It can, it can, it doesn't even have to be connected.
So it can, you can just get a HEPLOC, get the medicine through the HEPLOC and then just.
Keep the saline lock.
You don't have to be connected to IV fluids.
You don't have to have IV fluids to get the IV pain medication.
Okay, cool.
This is great.
Okay anything else we should know about IV meds? Electronic fetal monitoring.
We need to do that continuous with those two, right? Just for actually for a short period just to make sure the baby looks okay, but it doesn't have to be continuous.
Yeah, so we'll take people off the monitor as long as things look okay.
And this isn't in most hospitals.
It's only a few where you can get something that's called a remifentanil PCA, which is fentanyl, which is a specific type of narcotic.
Remifentanil is one.
It's, it's, It's metabolized very, very quickly.
So this is the only type of narcotic that you can actually use during the course of your whole labor because the narcotic is metabolized so fast that it gets in and out of your system quickly.
And it's almost called a PCA, which is patient controlled analgesia.
You can hit a button for it, but it requires some very specific monitoring.
Some very specific nursing care is not available at most hospitals.
But some hospitals are trying to get that as a an option for folks like it may be a great option for someone who can't get an epidural because they have like scoliosis or something like that, but then they can get this PCA that may help take off the edge with things.
Very cool.
And that's through an IV.
That's the one that'd be very cool.
Okay.
And it would not be available at hospitals because of staffing or availability of the medication.
More so for staffing because it's one, it has to be one to one nursing and, and you have to like monitor the oxygen levels.
It requires some specific monitoring things, but too often it's staffing.
Yeah.
Okay.
And most L and D units are what? 1 to 2? Most most are one to one, but sometimes they can be one to two.
Okay.
Yeah.
Wow.
Okay, cool IV medications Anything else about those that we need to know? Yeah, okay cool So the last option and this is also something that's not available everywhere and personally I love it.
I think it really You talked about the IV medications taken off the edge.
Nitrous oxide for me is that first step of taking off the edge, especially for someone in two cases.
I find it super helpful for someone who is spiraling and just needs an immediate, like kind of calm down or someone who is.
So, so close and just needs a little oomph to get them over the edge.
Both of these scenarios, our team has seen nitrous oxide work really well.
We've also seen people use it throughout their whole labor, so you can use it throughout.
Talk to us about nitrous oxide.
Yeah, so nitrous oxide is an inhaled gas.
It's a specific mixture of nitrogen and oxygen.
It's been used in European countries for decades and decades and decades, not so much here in the U.
S.
But what it is, it's an inhaled gas.
It's a little canister.
You control inhaling it yourself.
It does have to have specific like Things to make sure it's like released and all of this.
So it has, it's like a little specific machine that does it.
But the good, the good thing is that it doesn't affect your baby at all.
That we're aware of.
You can use it throughout your whole labor, as you mentioned.
And the side effects are very minimal.
For some people, they may feel loopy a little bit for some people.
It doesn't work very great, but the benefit as you can use it, you control it.
Again, it helps take the edge off.
And in addition to the circumstances that you mentioned, where it can be helpful, I think another circumstance where it's helpful is if for someone who didn't have an epidural or didn't.
Have any pain medicine if they're needing a repair, if they had a laceration or a tear, and it's going to take a little bit longer to repair than nitrous oxide and can also be helpful to help in addition to local anesthesia too.
But the two together can help kind of take, take things down when you're trying to do a repair after birth.
Yeah, guys, that is a fantastic recommendation.
So don't be afraid to ask for it.
If, if you're struggling with the repairs or you're like, I need a little bit, something more, you should ask your provider if nitrous oxide is available.
Okay.
If nitrous oxide is not available, what would be an additional option that someone might have access to for repairs? Yes, then fentanyl would be a good option in addition to always local anesthesia.
So always lidocaine in the area where we're, we're fixing, but in addition to that fentanyl, which is short, a short, the shortest acting narcotic will be the best option, but it is going to be a narcotic.
So you may be sleepy for a little bit right after you have your baby.
So you have to weigh the risks and benefits of that.
Yeah.
Okay.
And is that through that's an IV or just an injection? Through an IV.
Through an IV.
Okay.
All right.
If we, if we give, if we give injections, like muscular injections of narcotic medicines, those are gonna last a long time.
It takes a, they like kind of slowly get released in your system.
So for quick things, it's always going to be through your IV.
Okay.
That's really good to know.
One of the things I love about nitrous oxide is how quickly it gets in your system, but on the same token.
How quickly it gets out of your system.
So you guys, you're going to hold this mask up to your face, breathe in and out of the same mask.
Or sometimes it's like a little duckbill thing that you bite on.
But you breathe in and out of the same apparatus.
And once you take it away from your face, 10 to 15 seconds later, you're kind of back to, and you're feeling, you're feeling back.
And it, it also doesn't make you as Loopy as like laughing gas, people say it's much more of like a body relaxation.
Definitely.
Definitely.
And then the other things are that because you're not quite so, whatever, you can still move with it.
You can still be mobile and it does not require continuous monitoring.
So you don't, you still don't have to be on the monitor either.
That's nice.
What about being off of the bed? Can you be on a birth ball? Can you use it in the tub? Can you be standing up? Correct.
Yes.
All of those things.
Nice.
Yep.
Yep.
Cool.
Okay.
I love this.
Anything else about nitrous oxide that we need to know? I don't think so.
Other than we talked about how it's not always available at every hospital.
That's probably the biggest rate limiting step.
Yeah.
Yeah, yeah, I'm very hopeful that it becomes kind of standard across hospitals, but I know we may have a little bit before we get there.
Yeah, medicine takes time.
So it does unfortunately.
Hopefully that's not my great great grandkids come.
Nitrous oxide might be in all the hospitals.
Oh my goodness, Dr.
Rankin, this has been really, really fantastic.
Were there any other pain relief options medical pain relief options that we didn't mention that people might want to ask their provider about? Nope.
I don't think so.
I think those are, Oh, you know, there is one more that's not, and I don't know much about this.
It's not medical per se, a TENS machine.
Oh, I have seen.
Yeah, yeah, yeah.
I've seen, I know it's used more in Canada, someplace in Europe, but a TENS machine is another option for using, for helping relief with pain.
You have to have like, Place the things in specific places.
I don't know a ton about it, but that's another option too.
I love a good tens unit.
Okay, You're an obstetrician that knows a lot about unmedicated labor.
So give us your top three Unmedicated labor coping strategies.
What do you love to suggest to patients? Yeah.
People are going to hate this because the biggest, the, the, the, the most important one is your breath.
Oh yes.
Because when you are consciously focusing on your breathing and slowing it down and it, it.
It forces you to slow things down.
This is something that we can do even when we're in our lives and we're upset.
A slow count to five in slow count to five out.
It's just gonna really help.
So breathing is really, really, really important.
And a lot of that, again, it's like, it was like you were alluding to is connecting to your mindset.
And just how you're thinking about and approaching in your mind that, that this is what you're going to get through.
One contraction, get through that one, rest, and you're going to get through the next contraction, get through that one, take it one contraction at a time, one contraction at a time.
That's when people say they get into sort of like labor land and they didn't realize like how long it's been.
And that's because you're focusing on, I'm going to get through this contraction, then the next one, then the next one.
So breathing, focusing on one contraction at a time, and then movement can be so helpful, whether it's lunges, whether it's the birthing ball, whether it's squatting, whether it's leaning movement would be another great option as well.
And then I'll throw in one last one, of course, water.
So therapy, shower or bathtub can help too.
Yeah.
Oh my goodness.
I love that.
All right, you guys.
I hope we're all walking away.
Oh, and wait, I gotta say, no, no, yeah, go for it.
A doula is going to be exceptionally helpful, well trained doula will be very helpful to help you get through with unmedicated birth for sure.
Yeah, absolutely.
Or medicated or planned C section, you guys, doulas will help you just stay educated throughout the whole way.
Yeah.
Yep.
Absolutely.
Yeah.
This is amazing.
Okay.
This has been so much fun.
I know people are walking away with so much more information than they came to the conversation with.
You've got some really amazing resources online.
Where can people connect with you and where can they find those resources to continue to learn from you? Sure.
So if you want a summary of all of these pain management options that we talked about, I have a guide that you can get.
You can grab it on my website.
It's dr.
Nicole, Rankin's.
com forward slash pain.
That should get it for you.
And on my website, I have tons of other free resources.
And things like what to pack for the hospital, prenatal test, all of that stuff.
So that's Dr.
Nicole Rankins.
com.
Also check out my podcast all about pregnancy and birth.
That is my, my baby.
I love my podcast where you can interview folks.
We do birth stories.
I talk about topics.
So all about pregnancy on birth and all the major podcast platforms.
We're almost at 2 million downloads, which is Crazy to believe.
And then, yes.
And then social media, my favorite platform is Instagram.
So I'm on Instagram.
I'm actually everywhere at Dr.
Nicole Rankins, but follow me on Instagram there.
I'm also on TikTok too, but not as much, but Instagram for sure at Dr.
Nicole Rankins, where you can get more information from me there.
That is awesome.
Alright, you guys definitely go follow her.
It is it's a really great page to follow because I feel like she is the OB that we all want.
She's that OB that we go and feel safe in her care and when we leave we feel warm and fuzzy feeling heard and supported and like when we show up in labor, we're gonna be listened to and respected.
So go follow Dr.
Rankins.
She is a wonderful So it's, it's a really exciting light to what we all strive to have in the virtual.
Oh my goodness, yeah, I didn't, I didn't pay her to say this, I promise.
Thank you, you're so, you're so kind.
Not at all.
I feel like it you know, if we don't know that it exists out there, it's really hard for us to imagine that we can have that kind of care.
And so I think you do a great job of explaining what that collaborative or respectful relationship between a patient provider can look like and should look like.
And I hope that it inspires a lot of people to go out and seek that kind of care.
Cause that's what we all deserve.
Yeah, because absolutely, absolutely deserve it.
And I will say I'm not a unicorn in that regard.
There are other OBs who practice similarly to me.
You just have to find them.
And I think that's what we're both about is, you know, helping people know the questions and things to ask so they can.
Find that provider who's really passionate about about serving them.
So yeah, don't be afraid to dig you guys and go back and listen to past episodes with OBGYNs on the birth lounge podcast.
I have a I guess I prioritize trying to highlight OBs that do care consensually for their their patients and really value that Relationship with their patients and clients.
So alright you guys until next time.
Bye Hey, before you go, I wanted to let you know that the doors to the birth lounge are officially open.
You can join the birth lounge at thebirthlounge.
com to find the best childbirth education on the internet.
It is comprehensive care.
There is no agenda.
I'm truly stepping you through.
any birth plan that you want to make, whatever feels good to you.
Because just like Dr.
Rankins, my goal is not to help you have one type of birth over the other.
Instead, I want to help you have a birth free of birth trauma, because I know that that sets you up for a lifetime of success.
So much birth trauma is avoidable and it can actually be avoided in your labor if you do specific things or if you avoid.
certain things.
I want to teach you what those certain things are.
We know that you cannot plan out how your birth is going to go, but you absolutely can be prepared.
And that means being prepared for anything that comes your way.
So inside the birth lounge, I am going to teach you unmedicated childbirth coping mechanisms, but I'm also going to talk to you about medicinal options.
I also want you to I want you to understand what normal physiological labor looks like so that you know what's normal, but I also want you to understand what's abnormal.
So I'm going to teach you the common complications that sometimes pop up or the roadblocks or pivots that people encounter during the birth process.
I also am going to teach your partner everything that they need to know to be helpful during labor.
And I mean everything.
actually be helpful.
Not just sit on the couch and say, you're doing a great job, babe.
I'm going to teach them pain relief strategies, how to advocate for your goals, how to offer you options, and how to truly take care of you in labor so that again, you can avoid birth trauma.
Join the birth lounge at thebirthlounge.
com to have an informed labor where you feel confident navigating hospital policy and advocating for your goals.
Again, that is thebirthlounge.
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Thank you so much for tuning in today.
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