Pain Management Options

Options for pain relief during labor.

doctor feeling pregrant bellyHere's the thing. Labor and delivery hurt. Any woman who tells you they don't either had effective medication or has a poor memory. There are numerous medications and other options you can use, most of which are detailed below, to make you as comfortable as possible.


Pain Management Option How It works Cautions
Narcotics (Demerol, morphine, Stadol, Fentanyl, Nubain) Given by injection into the spinal cord or arm, IV or self-administered pump (depends on the drug). These medications help you relax and take the "edge" off the pain without interfering with pushing or slowing labor. Depends on the drug, but may cause drowsiness or breathing difficulties in babies and nausea and vomiting in you. Nubain, Fentanyl, Stadol and morphine have minimal effects on the fetus unless used in a spinal block.
Epidural The most common form of anesthesia used during labor and delivery. An epidural is regional anesthesia that blocks pain to a particular part of the body; in this instance, nerves leading to the uterus. You need to have an IV started before you can receive an epidural, usually before active labor begins. The epidural is typically inserted when the cervix has dilated to four or five centimeters. An anesthesiologist or nurse anesthetist usually administers the epidural. You need to arch your back while sitting up or lying on your side. After cleaning and numbing the area, a needle is inserted into the area surrounding the spinal cord, a small tube or catheter is threaded through the needle into the space around the spinal cord (the epidural space). Then medication is given through the tube as needed. May result in sudden blood pressure drop and, rarely, severe headache if there is any spinal fluid leakage. May slow labor and make pushing more difficult. May cause some breastfeeding or respiratory difficulties in babies.
Spinal block When narcotics are injected directly into the spinal column. The pain relief lasts about two hours. They are rarely used these days given the availability of epidurals. The medication crosses into the placenta and may affect the baby. May cause low blood pressure, problems pushing during labor and severe headache.
Pudendal block An injection of a local anesthetic such as lidocaine into the pudendal canal in the pelvis to provide quick pain relief to the perineum, vulva and vagina as the baby moves through the birth canal. Typically used in the second stage of labor when you're pushing, just before the baby is delivered. May cross the placenta; slight risk of blood clot or infection.
Local anesthesia Primarily used at the end of labor to provide pain relief for an episiotomy (a cut in the perineum to make it easier for the baby to come out). May also be used after birth for pain relief from episiotomy or perineal tears. Given by injection into the specific area of pain. Rare allergic reactions.
Patterned breathing This nonmedical approach uses breathing patterns to calm and relax you while providing a sense of control during contractions. Must be practiced before labor.
Relaxation techniques Listening to soothing music, surrounding yourself with a scent that soothes and comforts you, having your partner massage, kneed or put pressure on various parts of your body and focusing on an item like a candle throughout the contraction can all help reduce the pain and the feeling of being out of control.  
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