Fast facts:
Like so many aspects of pregnancy and childbirth, pain management during labor is a personal choice. As you near your due date, review your options for pain medication for labor with your birthing team.
We suggest making a general plan in advance while leaving room for flexibility. Be sure to confirm the options available at your chosen birthing location.
Remember, there are many possibilities and no “right” decision. It’s okay to use a different pain management plan than other birthing people.
And if you’ve given birth before, it’s okay to try a different approach this time around. You won’t know exactly what your body needs until your labor progresses.
Here’s an overview of common options. Each one has risks and benefits that should be discussed with a trusted healthcare professional.
There are many options for pain management during labor. The two main categories of pain relief are:
Each medication has unique risks and benefits, described in more detail below. Generally speaking, all medications offer the benefit of reliable pain relief. Each medication will also have potential side effects.
An epidural or epidural block is one of the most common forms of pain relief used during childbirth.
This is a type of anesthesia injected into your lower back. It offers continuous pain relief throughout labor and can be used in a vaginal or cesarean delivery to alleviate pain from the waist down.
What to expect:
You will remain alert under epidural anesthesia despite the loss of feeling. The numbness in your legs and limited mobility can interfere with certain labor and birthing positions. (But don’t worry, you’ll still have options!)
This may affect your ability to find an optimal pushing position, which can slow down the second stage of labor.
An epidural does not pass through the placenta to your baby.
In rare cases, temporary nerve damage at the site of injection may occur.
A spinal block is another type of local anesthesia. It offers similar risks and benefits as epidural anesthesia. The main distinction is the site of injection.
A spinal block injects the anesthesia into fluid around the spinal cord. This brings faster but shorter-lasting pain relief. It is commonly used in c section deliveries.
There is the additional option of a combined spinal epidural cse block. This provides the quick relief of a spinal block and the continuous effects of an epidural. The benefits, risks, and side effects are the same as an epidural or spinal used individually.
Opioids function by reducing your awareness of pain and providing a calming effect. They affect your entire body and are sometimes referred to as systemic analgesics.
The opioids most commonly used during labor include stadol, fentanyl, nubain, and demerol. They are typically administered as an injection or through an intravenous IV.
What to expect:
Opioids won’t interfere with your ability to push during labor or prevent you from using certain labor positions. They may help reduce anxiety in addition to alleviating pain.
While safe to use, opioids pass through the placenta and are more likely to affect your baby than anesthesia.
To reduce side effects for both you and your baby, they are administered in small doses, typically during early labor.
Opioids may briefly affect your baby’s breathing and heart rate or cause drowsiness.
If you’ve chosen to breastfeed, drowsiness in a newborn can make it harder to breastfeed during the first hours after delivery.
Nitrous oxide is an odorless gas that some hospitals use as an analgesic during labor. Its calming effect reduces anxiety and makes pain more manageable.
As a pain medication for labor, a low dose of nitrous oxide is mixed with oxygen and inhaled through a mask. Many women inhale it right before the start of a contraction.
What to expect:
Nitrous oxide isn’t a strong analgesic, so you may have more awareness of pain in comparison to other medications. It also will not interfere with your ability to push during labor or prevent certain labor positions.
While a minimal amount may pass through the placenta, nitrous oxide typically does not produce side effects in babies or affect breastfeeding. You may experience sedation, dizziness, nausea, and vomiting. These side effects typically do not last long.
General anesthesia — which acts on the entire body and puts you completely to sleep — may be used in emergency situations.
Sedatives and tranquilizers such as alprazolam (Xanax®), lorazepam (Ativan®), and diazepam (Valium®) have a high risk for significant side effects in newborns. They should be avoided as a treatment for anxiety during labor.
Some women choose not to use medication. This approach removes the possibility of side effects and allows the natural release of hormones to support the progression of labor.
There are many medication-free methods of pain management that provide a sense of calm and reduce discomfort.
Nobody knows what you need better than you. Ruth Health provides expert, evidence-based maternal advice so that you can make the best decisions for yourself.
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