8 Methods and Medications for Labor Pain Relief
Natural childbirth is not for everyone. You could have an exceptionally long labor or a low threshold for pain. Both are perfectly valid reasons for wanting some pain relief.
Whether you desire an unmedicated birth, an epidural as early as possible, or somewhere in between; you have all the resources available to support you in childbirth. It is important to become informed of all pain management options and choose what will be most empowering and satisfying for your birthing experience.
Related: 9 Natural Labor Pain Relief Techniques
Choosing the Best Labor Pain Relief Options for You
Pain management options that can be utilized throughout various stages of labor include non-medicinal, analgesia, and anesthesia. Non-medicinal pain management options include natural techniques to improve pain tolerance.
- Analgesia medications decrease the sensation of pain without losing all sensation and without loss of mobility. These include IV medication and nitrous oxide.
- Anesthesia medications decrease the sensation of pain while blocking most sensations, and cause a decrease or loss of mobility. Anesthesia includes epidurals and general anesthesia.
Non-Medicinal Labor Pain Relief Methods
There are plenty of non-medicinal/ natural pain relief options that can be utilized throughout labor or can be done with other medications to enhance comfort. Some non-medication options for labor pain relief include deep breathing techniques, acupuncture, and acupressure such as squeezing an item like a birthing comb during labor, or versions of aromatherapy.
Some of the methods can also be used to help with discomfort during the end of pregnancy. Most work by helping to promote relaxation, which releases a hormone in your body called Beta-Endorphins. Beta-endorphins naturally increase a person’s pain tolerance. The relaxation techniques are most effective if practiced prior to labor.
Pain Medication Options for Labor Pain Relief
These natural pain relief methods can be used by anyone, even those that plan to use an epidural. If you’re concerned about labor pain, it’s important to talk to your obstetrician or healthcare provider to develop the right birth plan for you early in your pregnancy to mitigate extra stress or anxiety about the birth process.
Analgesia
Analgesia may be a great option for those who desire pain medications, but are not keen to the idea of an epidural, or for those who plan to get an epidural but wish to wait until later in labor. Analgesia medications in labor typically are given through the IV, or inhaled if your place of birth provides nitrous oxide (laughing gas).
IV Pain Management (Intravenous)
The hospital usually has its own protocol to determine which IV pain medications are used during labor. These may include meperidine (Demerol®), morphine, fentanyl, butorphanol (Stadol®), and nalbuphine (Nubain®).
The decision of which medication will work best will also depend on which stage of labor you are in, and the progress of your labor. If a baby is born soon after exposure to analgesia, there may be issues with his or her breathing, heart rate, and breastfeeding.
Due to these risks, medications that cause significant drowsiness will likely be used if pain management is needed for a prolonged early labor/prodromal labor, and rest would be very beneficial for the mother. A medication that lasts for a shorter duration will be administered if you are closer to the end of labor to minimize side effects to the newborn.
Side Effects of Intravenous/Intramuscular (IV) Labor Pain Relief
Some may experience itching, nausea, vomiting, and drowsiness with IV analgesia. High doses of IV analgesics can impact your breathing. You will be monitored after the administration to be sure you are tolerating the effects.
Nitrous Oxide (Laughing Gas)
Nitrous oxide (commonly known as laughing gas) is an option provided for labor pain management at some hospitals and birth centers. Nitrous oxide is an odorless gas that reduces anxiety and improves general mood.
While it does not remove the pain, it increases a person’s tolerance to the pain and allows it to become more manageable. Nitrous oxide is self-administered by breathing in through a mask just prior to a contraction.
Side Effects of Nitrous Oxide During Labor
Nitrous oxide may cause some dizziness or nausea at the time of inhalation. The effect of nitrous oxide is short-acting and is safe for you and your baby.
Types of Anesthesia for Labor
Anesthesia in labor includes local anesthesia, general anesthesia, spinal blocks, and most commonly, epidurals.
Local Anesthesia
Local anesthesia helps to prevent pain in a smaller area of the body. This can be an injection to numb an area in the event that an episiotomy is needed, or before a repair is done. Another form of local anesthesia is known as a Pudendal block.
A Pudendal block is when an anesthetic is injected into the vagina, where the pudendal nerves are located, to reduce pain in the vagina and perineum just before the baby is born. The anesthetic has no effect on the baby and can be used with other medications and takes effect very quickly.
Epidural
Epidurals use an anesthetic medication and an analgesia medication through a tube/catheter in the lower back to decrease sensation and lessen or block pain felt below the waist (therefore blocking pain of contractions), while still feeling the urge to push.
Since epidurals decrease sensation and mobility, once an epidural is placed, you will need to remain in bed for the rest of labor, and a urinary catheter will be placed to keep your bladder empty.
If you are considering an epidural in labor, your provider can consult with the anesthesiologist/nurse anesthetist early in labor who will discuss this option with you, including benefits and risks, and take a brief medical history to ensure that it's safe for you. The anesthesiologist or nurse anesthetist will then be called later when you are ready for your epidural placement.
There are occasions when an epidural is not a good idea. These include cases where a woman has had spinal surgery or takes blood-thinning medication. Rarely, a woman may have an infection that could be exacerbated by an epidural.
The Epidural Procedure
Before starting the epidural, an IV will be inserted in the back of your hand or arm, and you'll be started on fluids. You're given fluids during an epidural to prevent your blood pressure from dropping. Your nurse will then help you into position for the epidural, which will either be sitting up with your legs over the side of the bed leaning forward or curled up on your side on the edge of the bed. The position may depend on the preference of the anesthesiologist.
- Your lower back will be cleaned with antiseptic and a drape placed over the rest of your back to reduce the risk of infection.
- Before the epidural needle is inserted, a local anesthetic will be given into the skin and surrounding tissues. This creates a numb patch to ensure that the insertion of the larger epidural needle is not painful.
- Since it's important for you to remain still during the procedure, the anesthesiologist will insert the epidural between your contractions. If that's too difficult, you should try to concentrate on your breathing and remain as still as possible until the procedure is completed.
- You'll feel a pushing sensation in your back while the anesthesiologist finds the small epidural space with the hollow needle. When the space is located, a tiny plastic tube (epidural catheter) will be fed into it through the needle.
- The epidural needle is then removed and the epidural catheter, which is secured onto your back with sticky tape, remains in the epidural space. The catheter remains in place until your baby is delivered. The catheter is thin, soft, and pliable, so it is perfectly safe to lie on it and move around.
- Once the epidural is in place, the anesthesiologist will give the first dose of medication through it with a syringe. Once they confirm that the epidural is in the right position and is working, all other doses can be given without another injection.
- Your blood pressure will be taken once the epidural is in place and monitored for the next half an hour or so, and then regularly thereafter.
- Once numb, your nurse inserts a urinary catheter to empty your bladder. This will stay in place until you are ready to push.
An anesthesiologist should be available 24 hours a day to manage any concerns or problems that may arise with the epidural.
Side Effects of an Epidural
There are a number of minor side effects that may occur from getting an epidural.
- Low Blood Pressure: The medication can cause blood pressure to fall, so this will be monitored. If it does fall, you'll be given fluids and medication, and subsequent doses may be reduced.
- Itching: It's common to experience itching with epidurals. The itch can be treated, but in most cases, it gets better on its own. If you develop an itch, a greater concentration of local anesthetic alone will be used.
- Shivering: Some may shiver with an epidural. This is even more common if a concentrated local anesthetic is used, as is the case for cesarean delivery (c-section).
- Fever: Epidural pain relief can cause a rise in temperature. If this occurs, you'll have a blood test to eliminate an infection, which can also cause your temperature to rise. You'll be given preventative antibiotics while waiting for the blood test results, and acetaminophen to bring your temperature back to normal.
- Difficulty pushing: Sometimes a strong epidural makes it challenging to engage pushing muscles, and will decrease pushing efforts. If this occurs, a mirror can be used so you can see when your pushing is moving the baby down, and the epidural dose may be turned down so you have the ability to push more effectively.
Potential Problems With Epidurals for Labor Pain Management
There can occasionally be problems with the effectiveness of an epidural.
1. Uneven pain relief
The anesthetic may not spread evenly in the epidural space, which may be caused by the epidural tube sitting on one side of the epidural space. That can mean that pain relief only occurs on one side of the body. If this occurs, the anesthesiologist will try to reposition the tube and give another dose of anesthetic. If that doesn't work, the only other solution is to redo the entire epidural.
2. Missed Segment
Occasionally, one spot can remain painful, usually in the groin area or low down in the front of the abdomen, which is referred to as a "missed segment." This results from a single nerve root not being coated with the local anesthetic.
Again, the anesthesiologist may reposition the tube. Sometimes, a stronger local anesthetic or an opioid is used to numb the area. If a persistent missed segment is too uncomfortable, the anesthesiologist may do a combined spinal-epidural block, known as a CSE.
3. Spinal Headache
Some women report a headache after an epidural, which can develop more than 24 hours after delivery. This headache is caused by a change in pressure around your spinal cord if a little spinal fluid leaked out.
This head pain can be described as throbbing and beginning in the front or back of the head. It is made worse by sitting up and moving around and is much improved by lying down.
The majority of the time, this resolves on its own. You will be encouraged to drink plenty of fluids and take oral pain medication such as acetaminophen. If the headache persists, a procedure will be done to help patch the hole and correct the pressure from the leak.
Spinal Block
A spinal block is very similar to an epidural, except the medication is injected into the fluid around the spinal column in a single shot, rather than having a catheter left in place. Spinal blocks work quickly, but only last for 1-2 hours so are used during cesarean sections where the timing is more predictable.
Spinal Block Procedure
The procedure for a spinal block is very similar to an epidural placement. However, the needle used is smaller than the needle used for an epidural, and there is one injection of medication, so no tube/catheter is placed at the spine.
Side Effects of a Spinal Block
The side effects of a spinal block are similar to the side effects of an epidural.
Combined Spinal Epidural (CSE)
A combined spinal epidural, or CSE involves both a spinal injection and putting an epidural in place. The spinal block helps for immediate pain relief, while the epidural place allows for continuous pain management. A CSE may allow for more maternal mobility than a standard epidural. Due to this CSEs were known as “walking epidurals”. However, walking is not allowed with a CSE due to safety concerns.
CSE Procedure
The procedure includes the procedure of a spinal block (single injection), followed by the procedure for an epidural placement to allow for continued pain management.
Side Effects of a Combined Spinal Epidural
The side effects of a CSE are similar to the side effects of an epidural.
General Anesthesia
General Anesthesia is when the woman is put to sleep, similar to how general surgeries are done elsewhere in a hospital. General anesthesia generally has higher risks than local anesthesia. General anesthesia is not typically used as the first line of pain management for birth and is generally used for emergency situations only.
General anesthesia may also be utilized in rare situations such as:
- A failure of other anesthesia attempts
- The mother has a blood clotting issue (making epidurals too risky)
- There is persistent fetal distress and an urgent cesarean is needed, without time for a spinal block
General Anesthesia Procedure
Receiving general anesthesia in labor usually begins with the administration of an oral antacid to help reduce stomach acid as a precaution in the event that any undigested food or liquids re-enter the mouth, as this can cause a rare but more concerning complication known as aspiration.
Next, an IV medication is administered or medication administered through a mask, which will put you to sleep. The anesthesiologist or nurse anesthetist will then insert a breaking tube in through your mouth to ensure you get enough oxygen during the time of the cesarean section.
During the procedure, the anesthesiologist or nurse anesthetist will be monitoring you closely to ensure your safety, while your ob provider will work with the rest of the team to complete the cesarean birth. The partner or support person can be with the baby while you are waking up in the recovery room. The baby will remain with you unless additional medical attention is needed.
Side Effects of General Anesthesia During Labor
- Drowsiness: The medications used during the procedure can cause drowsiness.
- Infant Drowsiness: General anesthesia may cause the baby to be born a bit drowsy, too. This usually does not cause any issues, but your baby and your baby’s breathing will be monitored to ensure he or she is adjusting well.
- Potential for delayed breastfeeding: It may be more difficult to initiate early breastfeeding after general anesthesia due to drowsiness and lethargy of both you and baby. If breastfeeding is desired, it can be beneficial to begin pumping to stimulate milk supply, and to hold baby skin-to-skin.
- Sore Throat: After the breathing tube is removed, you may have a sore throat. This does not require treatment and will go away on its own. Some find comfort with drinking cold beverages.
- Nausea/vomiting: This can be relieved with nausea medications or eating bland foods following birth.
- Delayed Pain: General anesthesia provides pain management during the procedure, but does not provide long-term pain relief. Pain medications will be needed as the anesthesia wears off. This is often given through an IV for a faster onset, and then with oral medications for a longer duration of pain control.
vThe Choice Is All Yours!
Resources are available for you to feel supported and empowered during your birth. Be sure to talk to your provider about what options are available, and any considerations that are specific to your care and needs.
