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Pain relief during labor: Know your options
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Relieving pain with medication


10 questions to ask your obstetrician
10 questions to ask your obstetrician

  1. What types of childbirth-education classes are offered at the hospital?
  2. Will pain medication be offered to me, or will I have to ask for it?
  3. What pain-relief options does the hospital make available?
  4. Which ones am I eligible for?
  5. At what stages of labor can medication be given?
  6. What are the possible side effects of each type of medication?
  7. What are the effects on the baby?
  8. Will I still be able to move around?
  9. If I use medication, what are the chances that other interventions, such as Pitocin, forceps or vacuum extraction, will be necessary?
  10. If I need a cesarean section, what anesthesia will be used?

You’re pregnant and dreaming of the day you can hold your new baby in your arms. You’ve fixed up the nursery, and bought a few tiny outfits—the ones you just couldn’t resist. Only one thing stands between you and your dream come true: labor.

It’s only natural to worry about the pain of labor and how you’ll cope. Learning what to expect and understanding your options for pain relief will put your mind at ease and give you a comforting sense of control.

Perhaps the best-known method of managing labor pain is childbirth education. The most common programs are Lamaze, Bradley and Leboyer. Each has a slightly different philosophy but the same ultimate goal: a safe delivery for mother and baby.

None of these methods eliminates pain, but many women find that the breathing and relaxation exercises they learn in class enable them to cope with it.

One of the biggest advantages of attending childbirth-preparation classes—even if you’re certain you’ll want pain medication—is that you learn what to expect in each stage of labor. That removes a lot of stress and fear, which can heighten the sensation of pain.

Keep in mind, too, that for medical reasons your doctor may not always be able to give you the pain relief you ask for when you want it. If you know some pain-management techniques, you’ll be prepared.

Relieving pain with medication

Pain-relieving medications fall into two general categories. Analgesia relieves pain without total loss of sensation. Analgesics don’t always completely stop pain, but they blunt it. With anesthesia, all sensation is lost in specific areas of the body.

Here’s a list of pain medications commonly used to relieve women in labor:

SYSTEMIC ANALGESIA is often given by injection. Serious adverse effects are uncommon. Minor side effects include drowsiness and decreased ability to concentrate. Some women don’t like the lack of alertness they experience from such drugs, and, if given too close to delivery, the baby may be sleepy or “depressed” after birth.

PUDENDAL BLOCK, one of the safest forms of anesthesia, is injected through the vaginal wall. It’s used to relieve pain around the vagina and rectum as the baby descends through the birth canal. It’s also used to block pain while an episiotomy is performed. A disadvantage: It doesn’t work well for one in five patients.

EPIDURAL BLOCK is an increasingly popular anesthetic for vaginal as well as cesarean deliveries. Medication is injected into a small space outside the spinal cord compartment. The patient will be numb from the waist down, but mentally alert.

After the epidural needle is in place, a small tube (catheter) is inserted and the needle is withdrawn. This method allows the doctor to give more pain medication without another injection.

The medication can be allowed to wear off for delivery, or the patient can be re-dosed. Although many women are able to bear down effectively despite the anesthesia, some may become too numb to help push the baby through the birth canal. In such cases, it may be necessary for the doctor to use forceps or vacuum extraction (instruments that help guide the baby out of the birth canal).

An epidural block can slow the baby’s heartbeat. To prevent that, the mother is given fluids through a vein in her arm, and she’s positioned on her side to improve circulation.

Another risk: The spinal-cord cover might be punctured. That causes a severe, but treatable, headache. If the drug gets into a vein as it’s being injected it could cause dizziness or seizures, but such complications are very rare.

SPINAL BLOCK is an anesthetic given by injection into the spinal fluid. Like an epidural, it causes loss of feeling in the lower half of the body. Because it only lasts one or two hours and only can be given once during labor, a spinal block is best suited for pain relief at the time of delivery, especially if forceps or vacuum extraction is needed. A spinal block can cause some of the same side effects as an epidural.

Alternative methods of pain relief include hypnosis and acupuncture. These are effective for some patients who are highly motivated and go through special preparation and training.

Because not all methods of pain relief are suitable for all women, it’s a good idea not to make up your mind in advance that you’re going to stick to one method alone. That way, you won’t be disappointed if you have to change your course midstream.