Pain Relief in Labor and Delivery

There are many ways to lessen pain during labor and the birth of a baby. Several kinds of drugs can relieve the pain. Drugs can be used to remove all feeling from just one part of your body or from all of your body. Or they may relieve pain without a total loss of feeling. Methods of relaxation called prepared childbirth may help you have your baby with very little or no pain medicine.

The type of pain relief that is right for you depends on:

• your physical condition
• your training for childbirth
• the length and stage of your labor
• the amount of labor pain
• the condition of the baby.

During prenatal visits talk with your health care provider about the kind of childbirth experience you would like to have. Ask about ways to relieve pain. Also discuss any fears you have about labor and delivery.

What types of drugs are used for pain relief?

Your health care provider will try to provide maximum pain relief for you without hurting the baby.

Narcotics (such as Demerol and morphine) and sedatives (such as Phenergan) may be used during the first stage of labor to help you relax. Narcotics are usually injected into a vein (IV) or into a muscle. They affect the entire body. Narcotics do not cause a complete loss of feeling, but they do lessen the pain. Sedatives are usually injected into a muscle. They do not lessen the pain, but they can help you feel less tense or anxious.

Regional anesthesia lessens or blocks completely the pain in a specific part of the body. It works like the shot a dentist gives to numb a tooth. The epidural block is a commonly used type of regional anesthesia.

With either narcotic pain relief or regional anesthesia, you can stay awake and play an active role in the birth.

General anesthesia is another form of pain relief. It relaxes your muscles, puts you to sleep, and prevents you from feeling pain. This type of anesthesia is often used for surgery, but it is not used for pain relief during labor. General anesthesia may be necessary for a cesarean delivery or a difficult vaginal delivery (for example, if you are bleeding too much or the baby is having problems and you need a quick delivery with forceps or vacuum extraction).

What is an epidural block?

For an epidural block, you are given a shot of pain-relieving medicine in your lower back. Usually a small tube is inserted into this area of your back through the needle. Then the needle is removed. This makes it possible for you to be given more medicine again, or continuously through a catheter, instead having another shot.

In low doses, an epidural block numbs the birth canal and the area around the baby during labor and delivery. It eases the pain of contractions. In higher doses, an epidural may be used for cesarean births.

You may still feel your contractions with an epidural block. You may still be able to help deliver the baby by pushing. If you are very numb, your provider may need to use forceps or vacuum extraction to deliver the baby. Another choice is to lessen or stop the medicine so you can push the baby out.

Other types of blocks to relieve pain are sometimes used: pudendal block, spinal block, saddle block, and paracervical block. The injection sites and areas that are numbed are different for each type of block. For example, a pudendal block is given just before delivery of the baby. It relieves pain around the vagina and rectum as the baby comes down the birth canal. It is also helpful just before an episiotomy. (An episiotomy is a procedure in which a small cut is made by your provider to make the birth canal opening bigger). The medicine for a pudendal block is injected inside the vagina. Pudendal blocks are one of the safest forms of pain medication.

Epidural blocks are usually used instead of spinal, saddle, or paracervical blocks.

What are the risks of using drugs for pain relief during labor?

Because narcotics and sedatives affect all of your body, both you and your baby may have side effects from these drugs. You may feel drowsy or dizzy. You may have trouble concentrating and it may be harder for you to push during delivery. More serious possible side effects are a slowing of your breathing or heart rate or a slowing of the baby's reflexes and breathing at birth. To reduce such problems, narcotics and sedatives are given in small doses. They are usually not used when the baby is about to be delivered.

The medicines used in most methods of regional anesthesia are less likely to pass to the baby and affect the baby because the medicine does not enter your bloodstream. However, regional anesthesia can make it harder for you to push. Or it may cause the baby's head to not turn normally during delivery. In these cases your provider may have to use forceps or vacuum extraction to guide the baby out of the birth canal.

An epidural or spinal block can cause your blood pressure to drop. This may slow the baby's heartbeat. To help stop this from happening, you will be given fluids through your vein (an IV) before you are given the block. Other possible side effects are trouble breathing and headache.

How can pain during labor be relieved without drugs?

Some ways to cope with labor pain without drugs are:

• Lamaze or Bradley methods of prepared childbirth: You and your partner can take classes to learn about childbirth, body conditioning exercises, and methods of relaxation. Breathing exercises are an important part of the Lamaze method. Forms of meditation are emphasized in the Bradley method. Many mothers who use these methods are able to go through childbirth with less or no medicine for pain.
• Hypnosis: The usefulness of this procedure varies from person to person. Hypnosis requires a lot of time and classes with your health care provider before you are ready for delivery.
• Acupuncture: Small needles are applied to special areas of the body to lessen the pain of contractions.
• Transcutaneous electric nerve stimulation (TENS): Mild electric impulses are used to stimulate the nerves and block pain.

All of these techniques can be used with other treatments for labor pain.