The Basics of Pain Control During Labor and Delivery

Labor can be unpredictable, but you can get informed. 

Labor can be unpredictable, but knowing which pain control options are available before you begin can help you make more informed decisions and give you some control over the process.

Study up about labor and what to expect.

I encourage all moms-to-be to do their own research in preparation for labor. Moms can speak to their obstetricians about their desired birth plan and the specifics of laboring in the hospital. Classes are also available to teach breathing techniques and provide more information about what to expect during labor.

Everyone experiences labor differently, that's why hospitals offer a range of safe pain control options for moms-to-be.

Natural techniques are for every mom. 

There are many soothing, natural options to ease labor pains that can also be used in conjunction with other pain control methods. These include:

• Massage
• Breathing techniques
• Acupressure
• Music
• Aromatherapy
• Hot showers
• Ice packs
• Birth positioners
• Walking and movement

With a bit of preparation and the assistance of a support person, most of these options can be available in the hospital. If your birth plan includes the desire to have a low-medication birth, these are available throughout labor. Once medications are administered, movement may be restricted.

As labor progresses, moms may decide medication is the right choice for them. These options include:

1. Epidural block

Often called an epidural, this pain control method is the most utilized option in the United States. 

• How does it work? First, a numbing agent is used on an area of the back and a catheter is threaded through a needle into the epidural space near the spine. This small tube allows for anesthetic and/or narcotics to be added throughout labor. These medications numb the nerve fibers in the spinal cord, so the pain of contractions is greatly reduced. Once an epidural is placed, most patients become numb from the waist to the top of the knees in about 10-20 minutes. However, you will still feel pressure from contractions, so you can experience labor and push when the time comes. Epidurals can be placed at any time during labor and are also used for C-sections. 
• What are the side effects and risks? Epidurals are considered safe and complications are rare. However, the medications can cause your or your baby's heart rate to slow down. In this case, an anesthesiologist will deliver additional medications and IV fluids via a small tube in the arm or hand. They may also direct you to lie on your left side to help raise your blood pressure back to a normal level. According to the American College of Obstetricians and Gynecologists (ACOG), use of opioids in an epidural block increases short-term the risk that your baby will experience drowsiness or breathing problems, reduced muscle tone and breastfeeding. The needle used to insert the medications and the catheter placement can also cause a temporary sore back or nerve damage. Rarely, the needle used to insert the medication pierces the covering of the spinal cord and results in a headache, which lasts a few days. Inform your physician if this happens. 

2. Spinal Block

A spinal block is an injection of anesthetic and/or narcotics placed in the middle of the back–much like an epidural. Spinal blocks are not as common as epidurals, but they are sometimes administered during C-sections or in emergency situations. 

• How does it work? After numbing the back area, medications are injected into the back. This immediately numbs the body from the injection site down. Unlike an epidural, a catheter is not placed during a spinal block, so the needle used is typically smaller. This also means the pain control from a spinal block is limited, usually lasting around two hours. 
• What are the risks and side effects? According to ACOG, the risks of a spinal block mirror most of those of epidurals. 

3. Nitrous Oxide

Nitrous oxide is a combination of drugs used for anxiety relief (anxiolytic) and pain relief (analgesic). It’s commonly called “laughing gas,” but contrary to its name, most moms describe it as giving them a sense of calm. While nitrous oxide has traditionally been more widely used during birth in other countries, it has recently become more popular in the United States.  

• How does it work? Nitrous oxide is mixed with oxygen and is self-administered during labor using a breathing mask. According to the ACOG, it works best when you begin inhaling 30 seconds from the start of a contraction. Because it is not delivered intravenously, you retain the ability to walk and move while in labor. Nitrous oxide is a very versatile pain control option, because you can switch to a different option if more pain control is needed. 
• What are the risks and side effects? According to the ACOG, nitrous oxide can cause nausea, drowsiness or dizziness, which dissipates once usage is stopped. Nitrous oxide can pass through the placenta, but the baby quickly eliminates the medications once he or she begins to breathe.

4. Systemic analgesics

Rather than targeting a specific area of the body, systemic analgesics impact the entire nervous system, giving moms a sense of calm and pain reduction. 

• How do they work? Systemic analgesics are intravenous narcotics and sedatives given to a patient via injection or self-controlled IV line. These drugs cause drowsiness and are often given during early labor, so you can rest. Unlike other options, analgesics are usually discontinued as pushing nears. 
• What are the risks and side effects? According to the ACOG, side effects are minor and include nausea, drowsiness, itching or lack of concentration. Like the epidural and spinal block opioids, intravenous opioids can affect your baby’s breathing and heart rate for a short time. They can also cause babies to be drowsy, which can impact breastfeeding directly after birth. 

There are many options for pain relief during childbirth. Talk to your doctor about which options are right for you.