Pain Management During Labor and Delivery
There are several options—both natural and medical—to manage labor pain. Most women use a combination of methods. It is difficult to predict how you will feel during labor. You should explore all your options ahead of time. Talk with your partner and doctor about your choices. It is difficult for women to know exactly what to expect from labor pain. Even women who have had babies before often forget what to expect. Luckily, there are many safe options for pain management.
Natural Means of Pain Control TOP
Natural childbirth is a group of non-drug methods of coping with labor and birth. The Lamaze method, hypnobirthing, or the Bradley method are a few options. They may use focused breathing, distraction, massage, mental imagery, and other relaxation tools to help manage reaction to pain. Acupressure may also offer natural pain relief during labor.
Many women benefit from a support person other than their partner during labor. This may be a doula, nurse, nurse midwife, or childbirth educator. Their job is to ease stress or worry through labor and delivery. They may offer massage, calming words, or whatever else you need. The support person can also talk to your medical team for you. Meet with your support person before due date to talk about your labor and delivery needs if possible.
Medical Means of Pain Control TOP
Pain medications are helpful for many women in labor. Some pain medications reduce pain while others end it. Most women are still able to feel sensations like pressure even when pain in blocked.
Pain Relievers (Analgesics or Narcotics)
Pain relievers can reduce your pain. You may receive a pain reliever as a shot in a muscle or through an IV. You may get more than one dose. These drugs may cause nausea and sleepiness. They may also slow the progress of labor.
Opioids may cause the baby to be extra sleepy when born. A sleepy baby may have a harder time taking first breaths and adjusting to new world. This effect is greatest when given too near to delivery. Your doctor will give a pain reliever several hours before birth is expected to avoid a sleepy newborn. An overly sleepy baby can be treated with oxygen or medicine if needed.
Regional Anesthesia (Epidural and Nerve Block)
An epidural is the most common form of anesthesia used for delivery. It can be used for a vaginal delivery or a C-section. An anesthesiologist will give the medicine when active labor begins. A small tube is inserted into the lower back. It rests in the space near the spinal canal. Medicine is passed through the catheter into the space. The medicine will numb the body and block pain from the belly button to the toes. An epidural can be used for pain relief throughout the labor and birth process. The baby should not be affected by the medication in an epidural.
Epidural Injection© Nucleus Medical Media, Inc. |
Some issues with epidural include:
- Labor can takes longer with an epidural—higher doses can also decrease your ability to push
- Increased need for a forceps delivery or c-section
- May lower the mother’s blood pressure
- Less common side effects can include severe headache after delivery, difficulty urinating or walking after delivery, and fever
The amount of medication you are given, and the amount that you feel, can be changed. For example, the medication may be lowered just before delivery. This will let you feel the contractions better and push along with them.
Spinal anesthesia is similar to an epidural. Like an epidural, it is given in the back. It numbs the body from the belly button to the toes. The medication is injected in one dose directly into the spinal fluid. Spinal anesthesia acts quickly and women get almost instant relief. Repeat doses cannot be given easily. Spinal anesthesia is most often used for c-sections or in combination with epidurals.
Nerve blocks are a form of local anesthesia. A pudendal block is an injection given into the vaginal wall. It numbs the area at the bottom of the pelves called the perineum. It is given just before delivery, to quickly reduce pain. The effects last about one hour.
Local anesthesia may be used if other forms of anesthesia were not used. It may be needed if there is a tear or episiotomy that must be repaired after delivery. Medicine is injected in the area that will be sewn. The effect lasts for about one hour.
RESOURCES:
Office on Women's Health
https://www.womenshealth.gov
The American Congress of Obstetricians and Gynecologists
http://www.acog.org
CANADIAN RESOURCES:
The Society of Obstetricians and Gynaecologists of Canada
https://sogc.org
Women's Health Matters
http://www.womenshealthmatters.ca
REFERENCES:
Alternative relaxation techniques. American Pregnancy Association website. Available at:
...(Click grey area to select URL)
Updated August 2015. Accessed January 30, 2017.
Comfort measures (pharmacologic) during labor. EBSCO DynaMed Plus website. Available at: http://www.dynamed.com/topics/dmp~AN~T116857/Comfort-measures-pharmacologic-during-labor. Updated November 18, 2014. Accessed January 30, 2017.
Dealing with pain during childbirth. Kids Health—Nemours Foundation website. Available at:
...(Click grey area to select URL)
Updated April 2014. Accessed January 30, 2017.
Management of routine labor. EBSCO DynaMed Plus website. Available at: http://www.dynamed.com/topics/dmp~AN~T905272/Management-of-routine-labor. Updated October 27, 2016. Accessed January 30, 2017.
Medications for pain relief during labor and delivery. The American College of Obstetricians and Gynecologists website. Available at:
...(Click grey area to select URL)
Updated March 2014. Accessed January 30, 2017.
Using narcotics for pain relief during childbirth. American Pregnancy Association website. Available at:
...(Click grey area to select URL)
Updated August 2015. Accessed January 30, 2017.
4/29/2011 DynaMed's Systematic Literature Surveillance http://www.dynamed.com/topics/dmp~AN~T114734/Comfort-measures-nonpharmacologic-during-labor: Hjelmstedt A, Shenoy ST, Stener-Victorin E, et al. Acupressure to reduce labor pain: a randomized controlled trial. Acta Obstet Gynecol Scand. 2010;89(11):1453-1459.
Last reviewed January 2017 by Andrea Chisholm, MD
Last Updated: 3/15/2015