Medical Pain Relief Options during birth
Pain relief during birth is a conversation mothers have been having for thousands of years. With the advancement of medical technology in our current day and age, there are many more options available than there were even a few decades ago.
You may have family and friends who tell you, “You HAVE to get an epidural,” or “You won’t be able to birth without the drugs.” Others may say, “Women have been having babies forever without pain medication,” or “I had all seven of my children without any drugs at all.”
My advice is to ignore them all.
The decision to use medical pain relief options in your labor is deeply personal. Pain medication is simply a tool, much like a hammer or a saw, and as such, it is morally neutral. There is no right or wrong answer. If you choose to utilize this tool to assist your birthing process, it’s the same as choosing to use a hammer to assist you in making a table. Could you do it without the hammer? Absolutely. Do you have to? Nope.
Now that the air is clear on that, I’ll step down from my soapbox (Which I built with a hammer. Because I chose to).
There are three main categories of pain relief in labor: systemic, regional, and local.
Systemic pain relief comes mainly in the form of IV narcotics and nitrous oxide. They are systemic because they utilize medication to affect the entire nervous system.
IV Narcotics, such as stadol or fentanyl, are administered through an IV catheter in your arm.
PROS
Can be administered by your nurse, which means very little wait time.
They are fast acting, granting (moderate) relief in moments.
No special equipment or procedures necessary.
Cons
They take the edge off the pain, they do not erase it entirely.
IV narcotics cross the placenta, and can cause baby’s heart rate to dip. They can also cause repressed breathing when the baby is born. For this reason, they are not an option if you are suspected to be close to delivery.
Narcotics can make your loopy and dizzy. Some people have termed it an “out of body” experience.
Learn more about IV Narcotics here.
Nitrous oxide (laughing gas) is another form of systemic pain relief. Nitrous is a gas that is inhaled through a special mask.
PROS
Fast-acting
Self-administered
Minimal side effects for mom or baby.
Pain relief without mental fuzziness.
CONS
Because of special ventilation requirements and training, not all birthing locations offer nitrous.
May cause dizziness.
Learn more about nitrous oxide here.
Local pain relief, such as lidocaine, is used to numb tissue in a specific area. It is typically administered as a precursor to an epidural (to numb the entrance site), or when stitches are needed in the pereneum or vagina post birth.
PROS
Focused pain relief
Minimal side effects
CONS
Stinging sensation upon administration
Short duration
Regional anesthesia is used to cause the reduction of pain in an entire section of the body. The most common forms of regional anesthesia seen in birth are epidurals and spinals.
Epidurals are administered through a catheter inserted into the epidural space of the spinal column. The catheter is attached to a pump, which gives a continuous dose of medication. The aim of an epidural is to block sensation from your ribcage to your knees.
PROS
Typically very effective pain relief
Pain sensation usually decreases quickly. Complete relief take about twenty minutes.
No grogginess or mental effects. You are able to be awake and alert.
Often gives exhausted moms a chance for rest
CONS
You will be confined to bed with limited mobility.
Epidurals are only administered by anesthesiologists or nurse anesthetists. If requesting an epidural, you will have to wait if there is no anesthesia staff immediately available.
Continuous monitoring of your vital signs and baby’s heart rate are required.
Can cause a drop in your blood pressure (usually treated with IV medication)
Can cause a drop in baby’s heart rate.
Risk of spinal headache.
Epidurals can provide only patchy relief, or fail altogether.
Learn more about epidurals here and here.
Spinal blocks are another form of regional anesthesia. They are similar to an epidural, in that they are placed in the spinal column, but a spinal block is a one-time injection that gives numbness for a set period of time. Spinals are more commonly used during a cesarean birth.
PROS
Rapid pain relief.
Complete numbness for surgical birth.
No grogginess or mental effects. You will be awake and alert.
CONS
Can only be administered by anesthesiologists or nurse anesthetists.
Shorter duration (about two hours)
Risk of spinal headache.
Confined to bed with limited mobility.
Continuous monitoring of your vital signs and baby’s heart rate are required.
There are many factors to take into consideration when choosing pain relief in labor, such as your personal history with anesthesia or narcotics, the stage of labor you are in, and what kind of relief you are seeking. The best way to prepare yourself to make these decisions is to be as educated as possible, discuss all the options with your care provider before birth, and ensure that you have a dedicated support team who can help you weigh pros and cons in the moment.
Remember: this is YOUR decision, with no right or wrong answers. You can absolutely build that table (or soapbox!) without the hammer, but only if you want to.
Christine Rogers is a birth, postpartum, and bereavement doula and childbirth educator. She is the owner/operator of Draw Near Doula Services and serves in-person in Anchorage, Eagle River and the Mat-Su Valley region of Alaska. A mom of four, she works hard to ensure every client she serves has a positive and empowering birth experience. She can be reached online at www.drawneardoula.com, or emailed directly at drawneardoula@gmail.com.
Looking for more birth planning resources? Check out my free Birth Preferences Worksheet and free Guide to Choosing A Care Provider!
