If you’ve got a bun in the oven, you’re probably wondering:
What are my pain management options in labor?
This is part one of a two-part series on pain relief options in labor. You can find Pain Management Options for Labor – Part 2: Comfort Measures here.
We all know labor can be intense and, as many report it, painful. The thought of pain in childbirth is enough to send some people into full-blown denial or anxiety attacks.
So what do you do? How do you manage? What options are there to help you stay calm, focused, and ease pain throughout labor? Is it really possible for labor to not suck? Good news, there are so many ways you can make labor manageable – even enjoyable!
Generally, labor comfort measures and pain management options fall into two categories: drug and non-drug. Pharmacologic (or drug) pain management is used in the hospital setting, and the availability of certain drugs can vary from hospital to hospital. It’s always a good idea to ask about availability at your facility ahead of time if you’re wanting to use specific pain medication.
Non-drug comfort measures can be used in both hospital settings and out-of-hospital (or community) birth settings. A good childbirth class will teach you how to use these non-drug options.
You may have heard of some of these ways to cope with labor pain, and some might be totally new to you, so let’s walk through common drug and non-drug options together!
Drug Pain Relief Options for Labor and Delivery
There’s a rather extensive list of drug options available to people in labor, and each one works differently to achieve the same outcome: managing pain. Let’s break down some of the common drug comfort measures for pain management in labor.
- Local Anesthesia: Anesthesia methods that are used to bring quick pain relief to a small, isolated area of the body.
- Lidocaine: Not typically used for labor pain relief, but for pain relief during repairs of any lacerations (tears) that may have happened during the birth. Lidocaine is also used when epidurals are being administered, to numb the spinal area before the epidural catheter is placed.
- Pudendal Nerve Block: This option is not as common, but pudendal blocks can be given just before the delivery of the baby to dull or numb sensation in the perineum, vulva, and vagina.
- Narcotic Analgesics (IV Pain Medications): These medications are administered through an IV and work to reduce your awareness of pain and have a dulling effect during labor and delivery. Common IV pain medications used in labor may vary by facility and provider preference, but generally include:
- Morphine
- Stadol
- Fentanyl
- Nubain
- Demerol
- Nitrous Oxide: This is a tasteless, odorless gas that reduces anxiety to make pain easier to deal with. (You may have seen or experienced nitrous oxide, or laughing gas, at a dental office.) This gas is mixed with oxygen and inhaled through a mask controlled by the patient. Nitrous Oxide users will have control over when the gas is inhaled, but typically at the start of a contraction and throughout the contraction is the most beneficial.
- Epidural Anesthesia: The most common type of pain relief used in the United States (about 60% of people in labor), epidurals are often a combination of analgesics and anesthetics administered through a small tube placed in the lower back via a needle, which delivers the medication to the spinal column. The epidural causes some loss of feeling in the lower half of the body to ease pain and can be continuously administered throughout labor and delivery or bolused in the event that a surgical birth is required.
- Spinal Block: Very similar to the epidural, a spinal block is a regional anesthesia and is administered one time via a single shot into the fluid surrounding the spinal cord. This method brings quick pain relief, but often wears off after an hour or two. It is commonly used for cesarean births.
- Combined Spinal-Epidural Block: This unique option has the benefits of both an epidural and spinal block. It brings the rapid and comprehensive pain relief of the spinal block, but also the continuous pain relief of the epidural.
- General Anesthesia: Used in the case of an emergency Cesarean when expediting the birth is a high priority, or when a mother is not a candidate for an epidural, spinal, or spinal-epidural, or when a mother prefers not to be awake during the surgery for any reason.
Each of these drugs come with benefits and risks. The highest benefit is typically immediate pain relief from labor and following therapeutic rest, which often allows a body under much stress to take a breather and simultaneously continue laboring.
As with use of any medication, especially powerful ones like opioids, the risks of use and potential side effects are worth noting. The risks range from mild and common, to rare and very serious. An estimated 12% of the population who receive labor epidurals will not get the pain relief they were hoping for, and this can be extremely distressing.
As the professional society of OBGYNs write, “Use of opioids in an epidural block increases the risk that your baby will experience a change in heart rate, breathing problems, drowsiness, reduced muscle tone, and reduced breastfeeding. These effects are short term. Less common side effects include the following: Decrease in your blood pressure, Fever, Headache, and Soreness.” More serious complications with epidurals, like injury or breathing problems, rarely occur.
Babies are particularly susceptible to risks with the use of IV narcotics, which enters your bloodstream and crosses the placenta, which is why you would not be a candidate if you are in more advanced labor and your baby could potentially be born with those narcotics in your system.
General anesthesia presents the highest risk. Most hospitals and providers only put patients under for a cesarean section if the life-saving benefits are sure to outweigh the risks of delaying the procedure to place an epidural. Risks include breathing and responsiveness issues for the baby, as well as potential respiratory issues for mom. Though risks do present themselves, modern advances in medicine have worked to make this most extreme form of anesthesia as safe as possible for patients.
<Click here to go to part 2, where we discuss natural pain relief and comfort measures!>
Sources:
- “Medications for Pain Relief During Labor and Delivery,” The American College of Obstetrics and Gynecology
- Why Epidurals Do Not Always Work
- Epidural and Spinal Anesthesia Use During Labor: 27-state Reporting Area, 2008
- Cochrane – Eating and drinking in labour
- Most healthy women would benefit from light meal during labor
- Cochrane – Continuous support for women during childbirth
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