Pain Relief During Labor and Delivery

Overview

There are many ways to lessen the pain a woman feels during labor and delivery.

Several kinds of medication, various methods of relaxation, and changes in position or physical surroundings can all help to deal with childbirth pain.

The type of pain relief that is right for each woman depends on her physical condition, her training for childbirth, the length and stage of her labor, the amount of labor pain, and the condition of the baby. During prenatal visits we will discuss the various methods of pain relief and the kind of childbirth experience you would like to have. Knowledge, itself, can also help reduce the fear of labor, and therefore the pain.

What types of medications are used for pain relief?

Synthetic narcotics (such as Nubain and Stadol) and sedatives (such as Phenergan) may be used during the first stage of labor to help you relax. Narcotics are usually given as an injection. They enter the bloodstream and affect the entire body. They do not cause a complete loss of sensation, but they do lessen the pain. Sedatives do not lessen the pain, but they can help you feel less tense or anxious.

Regional anesthesia lessens or completely blocks the pain in a specific area of the body. It works like the shot a dentist gives to numb a tooth. The epidural block, or spinal block, are commonly used types of regional anesthesia.

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

General anesthesia is another form of pain relief. It numbs the whole body and causes you to be asleep. This type of anesthesia is commonly used for many surgical procedures, but it is not used for pain relief during labor. However, general anesthesia may be necessary for a cesarean delivery if there is not time for regional anesthesia.

What is an epidural block?

In an epidural block, pain-relieving medicine is injected into the mother's lower back by an anesthesiologist . A small tube (catheter) is inserted into the area outside the spinal canal (epidural space) to make it possible to give medication continuously through the catheter instead of another injection.

In small doses, an epidural block numbs the birth canal and the area surrounding the uterus during labor and delivery. It eases the pain of contractions and vaginal stretch during delivery. In higher doses, an epidural may be used for cesarean sections.

If you have an epidural, you may still be aware of your contractions. With low doses of medication, most women are able to help deliver the baby by pushing. If you are very numb, delivery by forceps or vacuum extraction may be necessary, or the medicine may be turned off or the dosage reduced to allow you to push the baby out.

What is a spinal block?

In a spinal block, the local anesthesia is given into the spinal canal, numbing you completely from the chest down. A spinal block is frequently used for a cesarean section, especially when an epidural is not in place for labor.

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

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

The medications used in most methods of regional anesthesia are less likely to pass to the baby and affect the baby because the medication does not enter the mother's bloodstream. However, regional anesthesia can make it more difficult for the mother to push. In this case we may have to allow the anesthetic to wear off somewhat, or use forceps or vacuum extraction to guide the baby out of the birth canal.

An epidural or spinal block can cause a mother's blood pressure to drop, which may slow the baby's heartbeat. To help prevent this from happening, the mother is given fluids through her vein (an IV) before she is given the medication. Other side effects that the mother may have include difficulty breathing and headache.

How can pain during labor be relieved without medications?

Some techniques that help a woman cope with labor pain without medication are:

Prepared childbirth classes: Pregnant women and their partners take classes to learn about childbirth, bodybuilding exercises, and methods of relaxation. Breathing exercises, meditation, massage and other relaxation techniques are emphasized. Many mothers who use these methods are able to go through labor and delivery with less or no medication for pain.

Hypnosis: The usefulness of this procedure varies from person to person.

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