Pain relief, called analgesia, is an important consideration. Because everyone responds to pain differently, you should feel free to discuss options with your healthcare provider before delivery. Your options may include:
- No intervention;
- Spinal analgesia;
- Epidural anesthesia/analgesia;
- Combined spinal/epidural anesthesia; or
- General anesthesia.
Understanding the different options in advance will make it easier for you to decide once labor begins. Most providers believe that pain relief should be offered routinely for women in labor. Epidural anesthesia is extremely effective for pain relief, but sometimes may temporarily paralyze the patient from the waist down. Narcotics help to reduce the pain of labor, but may not be adequate to reduce the overall discomfort. Since it's impossible to predict how easy or difficult labor and delivery will be, it's a good idea to keep your options open.
It is often difficult to make important decisions in the midst of the exhilaration, fatigue, and pain that accompany delivery and the recovery period in the hospital. It is a good idea to think about your preferences for labor and delivery care in advance.
Episiotomy involves cutting the skin in the perineum (the space between the vagina and the anus) to prevent tearing during delivery. Episiotomies used to be routine for a woman's first delivery and common for subsequent deliveries.
Today, healthcare providers vary greatly in their use of episiotomies. Obstetric training once taught that episiotomies help protect the baby's head from the pressure of the birth canal and reduce future problems with urinary incontinence and pelvic relaxation. Current medical literature does not seem to support these conclusions. Episiotomies are more likely to extend and injure the anal sphincter muscles and rectum.
Currently, healthcare providers are performing fewer episiotomies. Two primary reasons for the procedure are:
- To help speed up the delivery of the baby; and
- To facilitate delivery if the skin around the vaginal opening is too tight to permit delivery of the baby's head.
Episiotomy can also aid delivery during shoulder dystocia or breech delivery.
Because the need for episiotomy at delivery cannot be predicted with certainty, it's a good idea to discuss this issue with your healthcare provider during prenatal visits.
Circumcision is the surgical removal of the foreskin of the penis. This procedure for male newborns has been commonplace in the United States for many years, and it has many cultural and religious roots in our society. Circumcision is an elective, irreversible, cosmetic procedure that is not done for any specific medical reason. Since it is a surgical procedure, it carries some risk of bleeding, infection, and scarring.
Current medical literature has not demonstrated any major health benefits from circumcision. Although circumcised men may have a reduced risk of penile cancer and urinary infections, these conditions are rare in men. Some recent research from Africa suggests that circumcised men may be less likely to transmit HIV (the virus that causes AIDS) to their female partners than uncircumcised men. However, there are still many unanswered questions that make these findings difficult to apply in the United States.
Circumcision of the newborn is a very personal decision for parents. It is a good idea to discuss circumcision with your healthcare provider during the course of prenatal care. You should also consider consulting a pediatrician for additional information.