Coping with Labor Pain - Know Your Medication Options

Nothing can truly prepare you for how you’ll handle the pain of childbirth. Whereas some moms describe birth as the most excruciating pain they’ve ever experienced, other moms recall their baby just sliding out. Pain during childbirth can be caused by uterine muscle contractions, pressure on your cervix, bladder, and bowels, and stretching of the birth canal as your baby passes through it. But the amount of pain a woman experiences is entirely subjective. Besides your individual pain threshold, so many factors affect how you’ll feel during childbirth, including the positioning of your baby, the duration of your labor, and the preparation of your birthing muscles.

Whether you choose to have a low-intervention birth or opt for the aid of modern medicine, the decision is yours to make. Giving birth in a hospital does not mean you’ll be forced to medicate (as we covered in “5 Common Misconceptions about Childbirth”), but one way to prepare for childbirth is by familiarizing yourself with all of your pain management options (both natural and medical) ahead of time. Each medical intervention has its own purpose depending on how labor progresses, as well as its own set of benefits and risks depending on what drugs are used. To feel ready for any surprises labor might throw at you and reduce anxiety about childbirth, learn about your medical pain management options below.

Let’s start off by defining the terms commonly used in pain relief medications for labor. Medical interventions for childbirth fall under two categories: analgesics (which reduce pain but allow feeling) and anesthetics (which block pain and all feeling). Pain relief medications can be either systemic (affecting the entire body), regional (affecting a certain region of the body), or local (affecting only a small area).

Sedation

Administered either intravenously (through an IV) or intramuscularly (by injection), narcotic medications, also known as opioids, take the edge off labor pain but do not eliminate it entirely. They can also reduce the anxiety that sometimes accompanies the childbirth process. Narcotics have a long history of use as a pain reliever during labor. The most commonly used narcotics are meperidine (Demerol), morphine, fentanyl, butorphanol (Stadol), and nalbuphine (Nubain). They typically work within a few minutes and last for 2-6 hours.

The side effects from these medications vary and might include nausea, vomiting, sleepiness, dizziness, and respiratory depression in both you and your baby. Not only do narcotics enter your bloodstream, but they also cross the placenta and can affect your baby’s heart rate, breathing, and alertness after delivery. They are only administered in the earlier stages of labor (before you’re 6-7 centimeters dilated) to give your baby adequate time to metabolize the medication. There are no known long-term risks associated with these temporary side effects.

Epidural Block

Often referred to as just an “epidural,” this option is the most popular form of pain relief for labor in the U.S. For an epidural block, an anesthesiologist injects medicine into the lining of your spinal cord through a small tube (catheter) placed in your lower back, causing loss of sensation from the waist down without loss of alertness. The drug starts working about 10-20 minutes after it’s injected, and the dosage can be increased or decreased easily without requiring another injection. As an option for both vaginal births and C-sections, the medication includes an anesthetic that may be mixed with an opioid analgesic. Though the ideal window to get an epidural is when you are between 5-6 centimeters dilated, an epidural is an option at any point in labor as long as you are able to sit still for 5-10 minutes.

Once an epidural block is administered, your blood pressure may drop, triggering nausea and faintness, and your baby’s heart rate will need to be monitored continuously in case of stress. IV fluid can be used to relieve these side effects. Because of the loss of sensation in your lower half, you might be confined to bed and need the help of a urinary catheter to relieve your bladder. Though an epidural alleviates the pain of contractions, you should still feel pressure and be able to bear down and push your baby through the birth canal. However, occasionally, an epidural can extend the second stage of labor by reducing the sensations and muscle strength needed to push effectively.

Around 1% of women experience a headache shortly after receiving an epidural. The use of opioids in an epidural block increases the risk that you will experience itching, nausea, and low blood pressure and that your baby will experience drowsiness, a variable heart rate, breathing problems, and reduced breastfeeding. All of these side effects are temporary, however, and some can be resolved with another medication (e.g. antihistamines for itchiness). Some women feel tenderness where the epidural was injected, and in rare cases, ongoing numbness on their lower back near the injection site.

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