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. Drugs can be used to remove all feeling from one part of your body or to lessen or remove feeling in all of your body. Or they may relieve pain without a total loss of feeling. Methods of relaxation called prepared childbirth may help you have your baby with very little or no pain medicine.

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 are a type of pain medicine. Sedatives are drugs used to relieve anxiety and help you relax. 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 usually injected into a vein (IV) or muscle. Narcotics do not cause a complete loss of feeling, but they do lessen the pain. Sedatives are usually injected into a muscle. When sedatives are given with a narcotic, they help the narcotic lessen the pain by helping you feel less tense or anxious. By themselves, sedatives do not take pain away. Both narcotics and sedatives affect the entire 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. The epidural block is a commonly used type of regional anesthesia.

For an epidural block, you are given a shot of pain-relieving medicine in the lower spinal area of your back. Usually a small tube is inserted into your back, inside the spinal canal, through the needle. Then the needle is removed, leaving the tube in place. More medicine can later be given through the tube instead of with another shot.

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 for cesarean births.

You may still feel your contractions with an epidural block. 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 a forceps or vacuum extractor, to help the baby through the birth canal. Another choice is to lessen or stop the medicine so you can push the baby out.

Other types of blocks sometimes used to relieve pain are the pudendal block, spinal block, saddle block, and paracervical block. The injection sites and areas that are numbed are different for each type of block. For example, a pudendal block is injected inside the vagina just before delivery of the baby. 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. Epidural blocks are usually used instead of spinal or saddle blocks. Paracervical blocks are given while in labor before the cervix is completely dilated to control labor pains.

What is general anesthesia?

General anesthesia is another form of pain relief. It relaxes your muscles, puts you to sleep, and prevents you from feeling pain. General anesthesia may be necessary for a cesarean delivery (C-section) or a difficult vaginal delivery (for example, if you are bleeding too much or the baby is having problems and you need a quick delivery with forceps or vacuum extraction).

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. More serious is the possible slowing of your breathing or heart rate or a slowing of the baby's reflexes, heart rate and breathing at birth. To reduce such 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 in most methods of regional anesthesia are less likely to pass to the baby and affect the baby because the medicine does not enter your bloodstream. However, regional anesthesia can make it harder for you to push. The baby's head may not turn normally during delivery. In these cases your provider may have to use forceps or another tool to help the baby move out of the birth canal.

An epidural or spinal 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 (an 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. Epidural or spinal block anesthesia 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 prepared childbirth: 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 needing 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 applied to specific areas of the body to lessen the pain of contractions.
• Transcutaneous electric 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.