Coping with Labor Pain - Know Your Medication Options

Updated: Sep 30

This is one of many topics covered in our “Birth Prep Basics” webinar.


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.



Spinal Block

Like an epidural block, a spinal block is a form of regional anesthesia. A much smaller amount of the pain-relieving drug is injected as a single shot into the sac of spinal fluid around the spine. Though it starts to relieve pain immediately, it only lasts an hour or so. A spinal block is commonly used for C-sections because it is effective so quickly, exposes the baby to less medicine, and provides better pain relief than an epidural. The side effects and risks of a spinal block are the same as for an epidural.



Combined Spinal-Epidural Block (CSE)

This form of regional anesthesia combines the benefits of a spinal block and an epidural block. While the spinal part works quickly for instant pain relief, the epidural part allows a continuous flow of medicine as needed. With a CSE, a lower dosage of medication can be used to achieve the same level of pain relief. Sometimes called a “walking epidural,” a CSE generally does not take away your ability to walk a short distance. The risks are the same as for an epidural.



Nitrous Oxide

A tasteless, odorless gas, nitrous oxide (also known as “laughing gas”) is mixed with oxygen and inhaled through a face mask. Used as a labor analgesic in many hospitals, nitrous oxide creates a feeling of well-being and suppresses anxiety to dull the perception of pain. Rather than blocking pain entirely, it takes the edge off the intensity of contractions and makes the pain easier to cope with.


Unlike most other medications, nitrous oxide can be administered and controlled by the patient. You can be in direct control of taking it when you need it by holding the mask and taking a deep breath 30 seconds before the start of a contraction. Though it can cause temporary dizziness, nausea, disorientation, or feelings of claustrophobia, nitrous oxide does not linger in the body and is safe for both you and your baby.



Local Anesthesia

To prevent pain in a localized area of the body, an anesthetic drug is injected near the nerves that provide sensation to the vagina, vulva, and perineum. It can be administered just before delivery to block feeling in those areas, though it does not lessen the pain of internal contractions. It is also frequently used just before delivery in an episiotomy procedure (when a surgical cut is made to widen the vaginal opening) or for stitching up tissues that have been damaged during birth. In rare cases, local anesthesia causes an allergic reaction or heart or nerve problems when the dose is too high. It does not affect the baby in any way.



General Anesthesia

Unlike local anesthesia, which allows you to stay awake and alert, general anesthesia puts you completely to sleep. It is generally reserved for specific (often emergent) situations when spinal anesthesia is not an option, such as an emergency C-section. The anesthetic drug is delivered through either an IV line or a mask, and once you are fully asleep, an anesthesiologist inserts a breathing tube into your mouth and windpipe to help you breathe while you are unconscious.


The placement of the breathing tube into the lungs is a tricky procedure and risky since undigested material in your stomach could be aspirated, causing a lung infection (aspiration pneumonia). General anesthesia can also cause your baby to become drowsy and sometimes have difficulty breathing. In all cases, general anesthesia prevents you from consciously participating in the childbirth process and holding your baby immediately afterward.


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Just as no two women experience pain the same way, each individual’s response to pain medication differs. Find out which medical interventions are available at your place of delivery, and then discuss your preferences with both your partner and healthcare provider. Remember to remain flexible since complications during childbirth might require your care team to pivot on your management plan. Even if you’re not interested in a medicated birth, it’s a good idea to educate yourself on all of your pain-relieving options. Stay tuned for another post on natural childbirth pain relief methods.


With Warmth and Wellness,

Your EmmaWell Team

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