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Pain Management During Labor and Delivery

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There are several options—both natural and medical—to manage labor pain. Most women use a combination of methods. It is difficult to predict how you will feel during labor. You should explore all your options ahead of time. Talk with your partner and doctor about your choices. It is difficult for women to know exactly what to expect from labor pain. Even women who have had babies before often forget what to expect. Luckily, there are many safe options for pain management.

Natural Means of Pain Control

The term “natural childbirth” includes a variety of non-drug methods of coping with labor and birth. In childbirth classes, including the Lamaze method, hypnobirthing, or the Bradley method, you can learn focused breathing, distraction, massage, mental imagery, and other relaxation techniques. Prenatal exercise, yoga classes, or similar physical preparation can also aid your delivery. These exercises help stretch and strengthen muscles. In addition, acupressure may offer natural pain relief during labor.

Many women benefit from a support person other than their partner during labor. This may be a doula, nurse, nurse midwife, or childbirth educator. This person’s job is to provide constant support, massage, calming words, or whatever else you need from early labor through delivery. The support person can also talk to your medical team for you. If possible, meet with your support person during pregnancy to discuss your wishes for labor and delivery.

Medical Means of Pain Control

Pain medicines are helpful for many women in labor. Some pain medicines reduce pain while others end it. Most women are still able to feel sensations like pressure while anesthetized.

Pain Relievers (Analgesics or Narcotics)

Pain relievers, such as meperidine, fentanyl, or nubain can reduce your pain. You may receive a pain reliever as an intramuscular shot or through an IV. You may receive more than one dose. These drugs may cause nausea and sleepiness. They may also slow the progress of labor. If the drug is given too near to delivery, it may cause the baby to be extra sleepy when born. To avoid a sleepy newborn, your doctor will give a pain reliever several hours before the expected time of birth. An overly sleepy baby can be treated with oxygen or medicine.

Regional Anesthesia (Epidural and Nerve Block)

An epidural is the most common form of anesthesia used during delivery. It can be used for a vaginal delivery or a C-section. An anesthesiologist will administer the epidural when active labor begins. A catheter is inserted into the lower back and rests in the epidural space, which is the space just before the outer membrane of the spinal canal. Medicine is injected into the catheter. The medicine causes numbness and pain relief from your belly button to your toes. A woman can use the epidural for pain relief throughout the labor and birth process.

Epidural Injection
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In some cases, labor takes longer with an epidural. Higher doses can decrease your ability to push. It may also increase the need for a forceps delivery or c-section. The amount of medicine you are given, and the amount that you feel, can be adjusted. For example, the medicine may be lowered just before delivery so you can feel the contractions better and push more effectively.

An epidural can lower the mother’s blood pressure. Other, less common, side effects include severe headache after delivery, difficulty urinating or walking after delivery, and fever. The baby should not be affected by the medicine in an epidural.

Spinal anesthesia is similar to an epidural. Like an epidural, it is given in the back and produces numbness from the belly button to the toes. The medicine is injected in one dose directly into the spinal fluid. Spinal anesthesia acts quickly and women get almost instant relief. Because it does not require a catheter, repeat doses of medicine cannot be given easily. Spinal anesthesia is most often used for c-sections or in combination with epidurals.

Nerve blocks are a form of local anesthesia. A pudendal block is an injection given into the vaginal wall to numb the perineum. Given just before delivery, this injection works quickly to reduce pain. The effects last about one hour.

Local anesthesia may be used in women who did not use another form of regional anesthesia during labor and birth but have a tear or episiotomy that must be repaired after delivery. In these cases, an anesthetic is injected in the area that will be sewn. The effect lasts for about one hour.

Tranquilizers

Tranquilizers are given to help a woman calm down if she is feeling very anxious before or during labor. These drugs do not reduce pain. They may be used along with pain relievers.

Revision Information

  • American Congress of Obstetricians and Gynecologists

    http://www.acog.org/For%5FPatients

  • American Pregnancy Association

    http://www.americanpregnancy.org

  • The Society of Obstetricians and Gynaecologists of Canada

    http://www.sogc.org

  • Women's Health Matters

    http://www.womenshealthmatters.ca

  • Alternative relaxation techniques. American Pregnancy Association website. Available at: http://www.americanpregnancy.org/labornbirth/relaxationtechniques.html. Updated November 2007. Accessed December 27, 2012.

  • Dealing with pain during childbirth. Nemours Foundation website. Available at: http://kidshealth.org/parent/pregnancy%5Fnewborn/pregnancy/childbirth%5Fpain.html. Updated November 2011. Accessed December 27, 2012.

  • Pain relief during labor and delivery. American College of Obstetricians and Gynecologists website. Available at: http://www.acog.org/~/media/For%20Patients/faq086.pdf?dmc=1&ts=20121227T0650154572. Accessed December 27, 2012.

  • Using narcotics for pain relief during childbirth. American Pregnancy Association website. Available at: http://www.americanpregnancy.org/labornbirth/narcotics.html. Updated July 2011. Accessed December 27, 2012.

  • 4/29/2011 DynaMed's Systematic Literature Surveillance http://www.ebscohost.com/dynamed: Hjelmstedt A, Shenoy ST, Stener-Victorin E, Lekander M, Bhat M, Balakumaran L, Waldenström U. Acupressure to reduce labor pain: a randomized controlled trial. Acta Obstet Gynecol Scand. 2010;89(11):1453-1459.