Pain Relief in Labor and Delivery

What types of medicines are used for pain relief?

There are many ways to lessen pain during labor and the birth of a baby.

• Several kinds of medicines can relieve the pain. Medicines can be used to remove some or all feeling from one part of your body or to lessen or remove feeling in all of your body.
• Relaxation methods called childbirth preparation (such as Lamaze) may also help you deal with the pain.

The types of drugs that may be given for pain relief during labor are:

• narcotics and sedatives
• regional anesthesia
• general anesthesia

What are narcotics and sedatives?

Narcotics, such as fentanyl, Demerol, or morphine, and sedatives, such as Phenergan, may be used during the first stage of labor to help you relax. Narcotics are a type of pain medicine. Sedatives are drugs used to relieve anxiety and help you relax.

Narcotics are usually injected into a vein (IV) or muscle. The medicine does not cause a complete loss of feeling, but it does lessen pain. When sedatives are given with a narcotic, they help the narcotic lessen the pain by helping you feel less tense or anxious. Both narcotics and sedatives affect all of the body.

What is regional anesthesia?

Regional anesthesia lessens or completely blocks the pain in a specific part of the body. It works like the shot a dentist gives to numb a tooth.

A commonly used type of regional anesthesia is called an epidural block. A shot of pain-relieving medicine is given in the lower back. Then a needle is inserted into your back to just above the spinal canal. A thin catheter tube is placed through the needle and the needle is removed, leaving the tube in place. More medicine can later be given through the tube. After the baby is born, the tube is removed.

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 to deliver the baby surgically with a C-section.

If you have an epidural block, you may still feel your contractions. You may be able to help deliver the baby by pushing. If you are very numb, your provider may need to use a tool, such as forceps or a vacuum extractor, to help the baby through the birth canal. Another choice is to lessen or stop the medicine so you can push out the baby.

Other types of blocks are sometimes used to relieve pain. The injection sites and areas that are numbed are different for each type of block. For example, an anesthetic may be injected inside the vagina just before delivery of the baby. This is called a pudendal block. 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 small cut made by your provider to make the birth canal opening bigger.) Pudendal blocks are one of the safest forms of pain relief.

What is general anesthesia?

General anesthesia relaxes your muscles, puts you to sleep, and keeps you from feeling pain. It may be needed for a difficult vaginal delivery. For example, it may be needed if you are bleeding too much or the baby is having problems and you need a quick delivery with forceps or vacuum extraction. It may also be used for a C-section.

A breathing tube is usually put in your throat when you have general anesthesia.

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 sleepy or dizzy.
• You may have trouble thinking and it may be harder for you to push during delivery.
• Your breathing or heart rate may slow down.
• The baby’s reflexes and heart rate may slow down. The baby may breathe too slowly at birth.

To lessen the chance of serious 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 for most methods of regional anesthesia are less likely to pass to the baby and affect the baby because the medicine does not get into your bloodstream. However, regional anesthesia can make it harder for you to push. The baby's head may not turn normally during delivery. When these things happen your healthcare provider may have to use forceps or another tool to help the baby move out of the birth canal.

An epidural block may lower your blood pressure or cause a fever. This may slow the baby's heartbeat. To help prevent this, you will be given a lot of fluids through your vein (IV) before you are given the block. You will also need to lie on your left side to take the pressure off the large blood vessels in your pelvis and back. Other possible side effects are trouble breathing, headache, and longer labor. Having an epidural block may increase your risk for C-section.

How can pain during labor be relieved without drugs?

Some ways to cope with labor pain without drugs are:

• Lamaze or Bradley methods of childbirth preparation: You and your partner can take classes to learn about childbirth, body-conditioning exercises, and ways to relax. Breathing exercises are an important part of the Lamaze method. Using meditation is the focus in the Bradley method. Many mothers who use these methods are able to go through childbirth with less pain medicine or none at all.
• Hypnosis: Hypnosis requires a lot of time and classes with your healthcare provider before you are ready for delivery. How much it helps is different from person to person.
• Acupuncture: Small needles are put in specific parts of the body to lessen the pain of contractions.
• Transcutaneous electrical 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.

What type of pain relief is right for me?

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

• your physical condition during labor
• your training for childbirth
• the length of your labor
• the amount of labor pain
• the condition of the baby during labor

During prenatal visits talk with your healthcare 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.