Updated March 05, 2015.

The pain of labor is something that deserves a healthy respect. I often encourage people in my classes to keep an open mind. This means that I encourage them to learn about relaxation, positioning, massage and techniques that do not require pain medications as well as medicinal techniques to help alleviate pain in labor including the epidural.

Women who have previously decided that they would like to use pain medications can use the other techniques until they are ready for pain medications.

For the women who choose not to use pain medications they will rely more heavily on the non-pharmocological management of pain including using water, the birth ball, etc. However, sometimes these women find that they have a challenging labor and that an epidural or other forms of pain relief is desired.

The problem happens when the mom-to-be wishing to go unmedicated hits transition typically. She's almost done. She's told us before the labor began we were to do whatever we could to prevent her from taking pain medication. And now she's asking for it. If a mother-to-be really wants to avoid pain medication there are some steps that we usually discuss well in advance of the birth to help ensure that this is really what she wants, including:

• Redouble your efforts.
  With all the labors I've been to, I've learned to hear a request for pain medication as what I'm doing isn't working. I will try something new and change her position. A lot of times this will help tremendously. You may have to do this continuously.

• Time for a check?
  Sometimes a sudden shift in how well she's dealing with labor has to do with a change in what she's doing. Since labor can also be a mental game, she may be thinking that she's not progressing. Sometimes a vaginal exam can tell her that her cervix is dilating or baby is coming down. Knowing that she is moving ahead can help her go on. If she's not progressing, it may also be time to reassess.
• Change the scenery.
  If you've been hanging out in the bathroom, try a walk down the hall. If you've been in bed, try using the birth ball. This can help prevent the mental stagnation that can come with staying in one place for a long time.
• Leprechaun
  No, I haven't lost my mind. The use of a code word can be beneficial when she's really ready for medication and isn't just trying to get you to make changes. You need to pick a word that she won't use in casual conversation. It is also important that your support team, including your practitioner, knows the code.

These techniques can be quite effective. However, it is imperative that you discuss them prior to labor. Some mothers may wish to use all of these techniques while others do not wish to use but one or two of them. Good communication can help you ensure that the laboring woman's wishes are met.