Pain Management During Labor and Delivery

June 10, 2008 - 7:30am

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Pain Management During Labor and Delivery

There are several options—both natural and medical—for managing labor pain. Most women use a combination of methods. Since it is difficult to predict how you will feel during labor, explore all your options ahead of time, and talk with your partner and doctor about your preferences. It is difficult for women to have an accurate expectation for the experience of pain in labor (even women who have had babies before often forget). Luckily, there are pain medications available to most women who want them.

Natural Means of Pain Control

The term “natural childbirth” encompasses 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 by stretching and strengthening muscles.

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 communicate with 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 medications are very helpful for many women in labor. Some pain medications reduce pain while others eliminate it all together. Most women are still able to feel sensations like pressure while anesthetized.

Pain Relievers (Analgesics or Narcotics)

Pain relievers, such as meperidine (Demerol), fentalyl, or nubain can reduce your pain. You may receive a pain reliever as an intramuscular shot or through an intravenous (IV) line. You may receive more than one dose. These drugs may cause nausea and sleepiness, and may 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 medication.

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 once active labor has begun. 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. The anesthesiologist injects medicine into this catheter, causing numbness and pain relief from your belly button to your toes. A woman can continue to use the epidural for pain relief throughout the entire labor and birth process.

Epidural Injection

In some cases, labor takes longer with an epidural. Higher doses can decrease your ability to push and may increase the need for a forceps delivery or c-section. However, the amount of medicine you are given, and the amount that you feel, can be adjusted. For example, just before delivery, the medicine may be lowered so that you can feel the contractions more in order to 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 down to the toes. The medicine is injected in one dose directly into the spinal fluid. Spinal anesthesia acts very quickly and women get almost instant relief. Since there is no catheter placed, repeat doses of medication cannot easily be given. Spinal anesthesia is most often used for c-sections or in combination with epidurals.

Nerve blocks are another form of regional 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 epiosotomy 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, so they may be used along with pain relievers.

References:

Dealing with pain during childbirth. Nemours Foundation website. Available at: http://kidshealth.org/parent/pregnancy_newborn/pregnancy/childbirth_pain.html . Accessed August 12, 2005.

Epidural anesthesia for childbirth. Sutter Health website. Available at: http://babies.sutterhealth.org/health/healthinfo/index.cfm?section=healthinfo&page=article&sgml_id=tn7466-sec . Accessed August 14, 2005.

Labor and delivery: Cesarean birth (c-section). Sutter Health website. Available at: http://babies.sutterhealth.org/laboranddelivery/ld_c-section.html . Accessed August 12, 2005.

Labor and delivery: your birthing options. Sutter Health website. Available at: http://babies.sutterhealth.org/health/healthinfo/index.cfm?section=healthinfo&page=article&sgml_id=tp22258 . Accessed August 14, 2005.

Management of normal delivery. The Merck Manual of Diagnosis and Therapy online. Available at: http://www.merck.com/mrkshared/mmanual/section18/chapter249/249f.jsp . Accessed August 14, 2005.

Management of normal labor. The Merck Manual of Diagnosis and Therapy online. Available at: http://www.merck.com/mrkshared/mmanual/section18/chapter249/249e.jsp . Accessed August 12, 2005.

Problems in the first and second stages of labor. The Merck Manual of Diagnosis and Therapy online. Available at: http://www.merck.com/mrkshared/mmanual/section18/chapter253/253g.jsp . Accessed August 12, 2005.

Should I use epidural anesthesia during childbirth? Sutter Health website. Available at: http://babies.sutterhealth.org/ . Accessed August 14, 2005.

RESOURCES:

Mayo Foundation for Medical Education and Research
http://www.mayoclinic.com

Womenshealth.gov
http://www.4woman.gov

Last reviewed May 2007 by ]]>Jeff Andrews, MD, FRCSC, FACOG]]>

Please be aware that this information is provided to supplement the care provided by your physician. It is neither intended nor implied to be a substitute for professional medical advice. CALL YOUR HEALTHCARE PROVIDER IMMEDIATELY IF YOU THINK YOU MAY HAVE A MEDICAL EMERGENCY. Always seek the advice of your physician or other qualified health provider prior to starting any new treatment or with any questions you may have regarding a medical condition.