You can ask for pain relief during labor. You should not feel pressured to choose a particular option by your partner, friends, family members, or health care professional. Only you know how you feel and how you handle pain. It is also OK to change your mind about which pain medication you want to use.
The use of pain medications does not make your labor “less natural.” It also does not increase the likelihood that you will have a cesarean birth. Pain relief medications can help you better cope with labor and delivery.
The medications used to relieve pain during labor and delivery have no long-term effects on the baby. They also have no effect on a child’s later development.
During one of your prenatal care visits, discuss your pain relief options with your obstetrician–gynecologist (ob-gyn). You do not need to make a decision about using medication until you are actually in labor. But it is a good idea to find out what types are available at your hospital or birthing center and think about your options before your labor starts.
Medical conditions that may affect your pain relief options include heart disease, certain blood disorders, liver disease, and previous spinal surgery. If you have one of these conditions, or if you have any questions about pain relief, you may be scheduled to meet with an anesthesiologist. You can do this before you go into labor or when you arrive at the hospital in labor.
In general, there are two types of pain relief methods:
Analgesia medications are called analgesics. Anesthesia medications are called anesthetics.
Pain relief medications can be either systemic, regional, or local. Systemic medications affect the entire body. Local medications affect only a small area of the body. Regional medications affect a region of the body, like the region below the waist.
Nonmedical pain relief approaches can be used alone or in addition to medications. Here are some ways to ease the discomfort you may feel during labor:
Systemic analgesia acts on the whole nervous system, rather than a specific area, to lessen pain. The medications used are known as opioids. These drugs reduce your awareness of pain and have a calming effect. They will not cause you to lose consciousness.
Systemic analgesics are usually given as a shot or through an intravenous (IV) line. This is a small tube that is placed into a vein through which medications or fluids are given.
Medication can be released into your IV line by a health care professional or when you press a button. The amount of medication you can give yourself is limited, so it is not possible to give yourself too much.
Side effects are minor and include itching, nausea, vomiting, feeling drowsy, or having trouble concentrating. A medication may be given to relieve nausea. High doses of systemic analgesics can cause you to have breathing problems.
Opioids can affect your baby’s breathing and heart rate for a short time. Your baby may be drowsy, which can make it harder for your baby to breastfeed in the first few hours after birth. You may not be able to get systemic analgesics within the hour before delivery.
Nitrous oxide, commonly known as “laughing gas,” is a tasteless and odorless gas used as a labor analgesic by some hospitals. It reduces anxiety and increases a feeling of well-being so that pain is easier to deal with. It does not numb pain.
Nitrous oxide is mixed with oxygen and inhaled through a mask. You hold the mask yourself and decide when to inhale. It works best when you begin inhaling 30 seconds before the start of a contraction.
Nitrous oxide is safe for you and your baby. You may feel dizzy or nauseous while inhaling nitrous oxide, but these sensations go away within a few minutes.
Local anesthesia is the use of drugs to prevent pain in a small area of the body. You may have already had local anesthesia if you have had a cavity filled at the dentist’s office.
The medication is injected into the area around the nerves that carry feeling to the vagina, vulva, and perineum. This is called a pudendal block. When used to relieve pain during childbirth, the medication is given just before delivery.
Local anesthesia is also used when an episiotomy needs to be done or when tissues need to be repaired after childbirth.
Rarely, there may be an allergic reaction to a local anesthetic, or you may have nerve or heart problems if the dose given is too high. Local anesthesia rarely affects the baby.
Local anesthesia is also used when an episiotomy needs to be done or when tissues need to be repaired after childbirth.
Regional analgesia and regional anesthesia act on a specific region of the body. During labor and delivery, they are used to lessen or block pain below the waist. These methods include the epidural block, spinal block, and combined spinal–epidural (CSE) block.
Typically, the medication includes an anesthetic that may be mixed with an opioid analgesic. The medication may be given as a single shot or through a thin tube (a catheter) placed in the lower back.
These techniques provide pain relief with few side effects.
An epidural block (also called “an epidural”) is the most common type of pain relief used for childbirth in the United States. In an epidural block, medication is given through a tube placed in the lower back.
For labor and vaginal delivery, a combination of analgesics and anesthetics may be used. You have some loss of feeling in the lower areas of your body, but you remain awake and alert. You should be able to bear down and push your baby through the birth canal.
For a cesarean birth, the dose of anesthetic may be increased. This causes loss of sensation in the lower half of your body.
An epidural also can be used for postpartum sterilization.
Typically, the medication includes an anesthetic that may be mixed with an opioid analgesic. The medication may be given as a single shot or through a thin tube (a catheter) placed in the lower back.
These techniques provide pain relief with few side effects.
An epidural may be given soon after your contractions start or later as your labor progresses. It is typically given by an anesthesiologist or other specialized health care professional.
Before the epidural is given, your skin is cleaned and local anesthesia is used to numb an area of your lower back. You sit or lie on your side with your back curved outward. You stay in this position until the procedure is completed.
A needle is inserted into a small area in your lower back. After the needle is placed, a thin tube is usually inserted through it, and then the needle is withdrawn. The tube stays behind, and medication then can be given as needed through the tube. You may be able to control the supply of medication yourself.
Pain relief should begin within 10 to 20 minutes after the medication has been started.
You can move with an epidural, but you may not be able to walk. Although an epidural block makes you more comfortable, you may still be aware of your contractions. You may also feel vaginal exams as labor progresses.
When opioids are used, itching is common. This itching can be treated with another medication. Other less common side effects related to opioids include nausea, vomiting, and breathing problems.
Less common side effects include the following:
Other side effects include shivering, difficulty emptying your bladder, and reactivation of cold sores (oral herpes).
Serious complications with epidurals are very rare and include the following:
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