Your Options for Pain Relief in Childbirth

Today, women have more options for reducing pain during labor and delivery than ever before. But there’s a lot of debate over which methods are best. It’s important to know your options in order to make the right decision for you. Research shows that women who make personal choices about pain relief during childbirth report higher levels of satisfaction. Here’s a look at the options and their benefits and risks.

Many non-pharmacologic methods exist to help you cope with pain: doulas, massage, movement and relaxation techniques, warm water, acupressure, hypnosis, and more.

Pros: Forgoing pharmacologic pain relief has no side effects for you or your baby. Some women report a greater sense of control, and appreciate being alert and active throughout the birthing process. Many feel considerable happiness and accomplishment after giving birth without medication.

Cons: The intensity of contractions may be stronger than you anticipate. If you’re in a hospital, you may be able to change your mind and choose pain medication, but in a birth center or homebirth setting, your options may be limited. If you experience complications during your pregnancy or labor, birthing without pain medication may not be an option.

Narcotics include Demerol, Stadol, Fentanyl, and Nubain. They are often the first pain medication offered after attempting natural methods. Narcotics can be administered via injection or IV and take effect within minutes. Some hospitals provide a patient-controlled device so that you can choose the amount of medication released into your IV.

Pros: Narcotics are helpful if you’re coping well with the pain but want extra support. Narcotic administration is easier and less invasive than an epidural or spinal block and does not require the presence of an anesthesiologist.  You can continue moving around while using narcotics.

Cons: Narcotics often dull the pain, but do not eliminate it, and often make you drowsy. Narcotics may make natural pain relief options less effective.

Possible risks to you: May make you dizzy, less alert, and cause nausea or vomiting. In large doses, narcotics can impair your breathing.

Possible risks to your baby: Narcotics can impact the baby’s breathing and contribute to fetal distress. Providers avoid administering narcotics close to delivery because of the risk of suppressing newborn respiration.

Nitrous oxide is an option used frequently in the UK, Canada, Australia, New Zealand, and Scandinavia, but is found in only a few hospitals in the US. It’s offered at UCSF where patients in One Medical Group’s San Francisco-based prenatal program give birth. Laboring women self-administer the medication when contractions peak via a hand-held face mask.

Pros: The medication is self-administered, providing women with greater control over their pain relief. Nitrous oxide is not associated with changes to your contractions.

Cons: Research suggests that while nitrous oxide can provide considerable pain relief to many women, it doesn’t significantly reduce pain in all women.

Possible risks: Nitrous oxide is eliminated quickly through the lungs so it does not build up in your body or in the fetus’s. It is generally considered safe for both you and your baby.

The most common form of pain relief in the US, a catheter is inserted between the vertebrae of your spine and medication is administered into the epidural space just outside the sac of fluid that surrounds your vertebrae. An epidural provides excellent pain relief without impairing your awareness. It typically takes 5 to 20 minutes for an epidural to take effect.

Epidurals cause numbness in the lower half of your body; therefore, it will confine you to bed. Some hospitals offer a “walking epidural,” in which you are injected with a narcotic, a very low-dose anesthetic, or a combination. With a walking epidural, you may be able to stand or possibly walk with support, although some hospitals do not allow this.

Pros: Epidurals provide more complete pain relief than narcotics. An epidural may be particularly helpful if a woman is exhausted and could benefit from rest and sleep. Some providers consider walking epidurals to be an ideal pain relief method because they use less medication than narcotics but provide greater pain relief.

Cons: Some women report that the relief isn’t enough. Breakthrough pain also can happen, although it is uncommon. Once an epidural is placed, women cannot move freely, require a catheter to urinate, and are not allowed to eat—although they can continue to drink clear liquids. Epidurals must be administered by anesthesiologists or nurse anesthetists and are not available at home births or at most birth centers.

Possible risks to you: Epidurals can make pushing and bearing down less effective and are associated with more time spent pushing. Some research also links epidurals to slowing down labor progress and delaying the baby’s movements down the birth canal.

Side effects include itching , nausea and vomiting, and a drop in blood pressure. There’s also a risk of fever. Very rarely, the epidural can be administered incorrectly and a severe spinal headache can develop.

Possible risk to your baby: Fever in the fetus or newborn if the mother develops a fever and fetal distress due to a drop in the mother’s blood pressure.

There is an association between the two, meaning that women who have epidurals are more likely to have a C-section. However, considerable research has not found a direct cause-and-effect link. One explanation for the association is that women whose labors are not progressing well are more likely to seek epidurals. Therefore, the cause-and-effect could be reversed: A labor more likely to result in a C-section requires greater pharmacologic pain relief.

Talk to your provider, partner, and doula about your options and note your preferences in your birth plan. Keep in mind that birth is unpredictable and you can’t know for sure how you’ll respond to the physical sensations of labor. Experts recommend thoroughly educating yourself about your options before labor and staying open to options during labor.