Pain Relief Options During Labor

By Dr. Kenosha Gleaton, OBGYN

While previous childbirth and media representations can paint a certain image in your head, there is no real way to know what your labor will be like. Labor pains can even vary from one pregnancy to the next. [1] Some people find that natural pain relief methods will suffice, while others prefer pain medication. There are also certain health conditions that may prohibit you from using certain pain relief methods. [2] It’s important to be aware of your pain relief options and their associated benefits and risks prior to labor so that you can feel more prepared. 

What to Consider

Deciding what will work best for you during labor is a personal decision. It is important to discuss your preferences, questions, and concerns with your partner and a healthcare provider, but ultimately the decision is yours. [2] You know your body better than anyone else and you should not feel pressured by anyone when making a decision about pain relief. 

One of the most important things to keep in mind is that the use of pain medications does not make labor any less “natural”. [2] Medications and other pain relief methods can be very helpful for some people and can make labor and delivery more manageable. It’s also okay to change your mind about pain relief options. The goal today is to go over your options so you can take the time to consider what will work best for you. Learn 5 misconceptions about labor. 

Pain Relief Options During Labor

There are many different options for relieving labor pain, ranging from medications to natural relief methods. There are two general types of pain relief medications- analgesia and anesthesia. [1-2] Analgesia, known as opioids, relieves pain without the loss of feeling or movement. These medications can lessen pain but may not stop the pain completely. Anesthesia relieves pain by blocking most of the feeling, essentially numbing the area. [1-2] Pain medications can be local, regional, or systemic. This refers to how much of the body is impacted. [1-2] For example, local medications will only affect a small area of the body, like the vagina, vulva, and perineum, whereas systemic medications affect the entire body. 

Epidural Blocks and Spinal Blocks (Regional Pain Relief)

Regional pain relief, such as epidural and spinal blocks, are used to target pain below the waist. These medications are typically given as a single shot or through a thin tube placed in the lower back. [1-2] An epidural is the most common type of pain relief used for childbirth in the United States. [1] This can be a combination of analgesics and anesthetics that will cause some loss of feeling in the lower areas of the body while keeping you awake and alert. For cesarean delivery, the dose of anesthetic may be increased, causing a loss of sensation in the lower half of the body. [1-2] 

The provider will first clean the skin of the lower back and numb the area with local anesthesia. A needle will then be inserted into the lower back and a thin tube will be inserted through it. Medication is supplied through this tube and is often felt within 20 minutes. [2] Epidurals can make labor much more comfortable, but you will still be able to move and may feel contractions. 

A spinal block is very similar to an epidural block but works more quickly and only lasts for an hour or two. [1-2] A spinal block is commonly used for cesarean births, while epidurals are commonly used for labor and vaginal delivery. There is also something called a CSE block, or a combined spinal-epidural block, that can be given to provide immediate pain relief with the option to extend pain relief if necessary. [1-2]  Are you experiencing Braxton Hicks or true labor contractions? Find out here→ 

Risks and Side Effects

Risks and side effects are similar for both spinal and epidural blocks. Itching is a common side effect, but can be treated with other medications. [2] Other less common side effects include nausea, vomiting, fever, headache, soreness, decreased blood pressure, difficulty breathing, reactivation of cold sores, and difficulty emptying the bladder. [1-2] 

Serious complications and risks are low, but include [1-2]:

• Breathing problems 
• Numbness, tingling, or rapid heartbeat
• Injury to the spinal cord or nerves

In your baby*:

• Change in heart rate
• Breathing problems
• Drowsiness
• Reduced breastfeeding
• Reduced muscle tone 

*These effects are short-term, and most research suggests that an epidural or spinal block is safe for you and your baby. [1-2] 

Nitrous Oxide (Laughing Gas)

Nitrous oxide, commonly known as laughing gas, is an analgesic sometimes used during labor. Laughing gas is tasteless, odorless, and does not relieve pain, but can reduce anxiety. Nitrous oxide is not used as often in the U.S. as it is in other countries, but some hospitals may provide this option. [1-2] Nitrous oxide works quickly and wears off quickly, meaning it is not a great long-lasting solution. The gas is mixed with oxygen and inhaled through a mask, often right before a contraction starts. It is considered safe for you and your baby, although it can lead to side effects such as dizziness, nausea, and vomiting. [1-2] 

General Anesthesia

General anesthesia is what many people think of when they hear “anesthesia”. With this method, you are not awake and you do not feel pain. [1-2] General anesthesia is typically only used for emergency situations and is given through an IVF line or mask. This usually requires a breathing tube to help you breathe while unconscious. Someone may be given general anesthesia if they experience excessive bleeding, need an emergency c-section, or have another urgent medical problem. [1-2] 

Risks and Side Effects

While rare, a major risk of general anesthesia is the aspiration of food or liquids. Risks and side effects to your baby include [2]:

• Decrease in breathing rate
• Decreased alertness 
• Difficulty breathing after birth 

Pudendal Block (Local Anesthesia)

A pudendal block requires local anesthesia, meaning medications are given to prevent pain in a small, focused area of the body. A pudendal block focuses on numbing the nerves around the vagina, vulva, and perineum. [1-2] During childbirth, a pudendal block is often given just before delivery. This pain relief method can also be used to prepare for an episiotomy or other tissue repair following childbirth. [1-2] 

Risks and Side Effects

There are few risks and side effects associated with local anesthesia. These include allergic reactions, and heart or nerve problems if given too high a dose. Local anesthetics very rarely impact the baby. [1-2] 

Systemic Analgesia (Opioids)

The last medical pain relief option is systemic analgesia, a type of opioid. These medications impact the entire nervous system rather than a specific area. Systemic analgesia reduces your awareness of pain and promotes a calming feeling while still keeping you awake.[1-2]  These medications are generally given through a shot or IV line early in labor. 

Risks and Side Effects

Side effects include itching, nausea, vomiting, drowsiness, and difficulty concentrating. [1-2] High doses can also lead to breathing problems. There are additional risks to your baby’s health, including changes to [1-2]:

• Breathing
• Heart rate
• Drowsiness

Natural Pain Relief During Labor

There are also nonmedical pain options that can be used by themselves or in combination with medical pain relief. Options for nonmedical pain relief include [1-4]:

• Breathing techniques
• Massage
• Changing positions
• Using ice or warm compresses
• Temperature regulation (cooling yourself down with moist cloths or warming yourself with a blanket or warm compress)
• Meditation
• Encouragement and support from loved ones
• Music therapy
• Maintaining a soothing atmosphere
• Using a birthing ball
• Yoga
• Taking a bath or shower (if permitted)
• Soothing scents

Speak with your provider about your options for nonmedical pain relief. 

What Can Influence Pain Relief Options?

In some cases, certain medical conditions may influence your options for pain relief. If you have any heart conditions, blood disorders, previous spinal surgeries, or liver disease, you should ask your provider about your options. [2] You may not be suitable for certain forms of pain relief medications. Fortunately, you can still come up with a plan beforehand by talking with your provider and other professionals, such as an anesthesiologist. 

It’s also important to keep in mind that birth can be very unpredictable. Maybe your labor progresses faster than you were expecting, you have to have an emergency surgery, or you run into some complications while in labor. These factors are hard to plan for and may require fast decision-making. 

Preparing for Childbirth With Natalist

Preparing for childbirth takes physical, mental, and emotional preparation. Childbirth can be unpredictable, but planning ahead for your labor experience is a great way to relieve some of the day-of stress and decision-making. Speak with your provider and your partner about your desires, concerns, and questions surrounding childbirth. It can be helpful to pack a hospital bag a few weeks before your due date so you have some of the necessities ready to go. While you’re packing away your birth plan, comfy socks, and toiletries, give yourself a bit of encouragement as well. Your body is capable of amazing things, including growing and bringing new life into the world! 

You may also want to prepare for postpartum life when nearing the end of your pregnancy. Consider ordering some postnatal supplements and other products to nourish yourself and your baby while recovering from childbirth. Wishing you all the best! 

Dr. Kenosha Gleaton is board-certified in gynecology and obstetrics and is the Medical Advisor of Natalist. She received her MD from MUSC and completed her residency at Carolinas Medical Center in Charlotte, NC.

Dr. Gleaton is passionate about women, health equity, and mentoring. She is the CEO of The EpiCentre, an OBGYN spa-like practice, and is a Clinical faculty member of Charleston Southern University.  She is also a member of the American College of Obstetrics & Gynecology, the American Association of Gynecologic Laparoscopists, and the American Association of Professional Women. 

References:

1. Labor Pain Relief. Cleveland Clinic. March 2023. https://my.clevelandclinic.org/health/articles/4450-labor-pain-relief
2. Medications for Pain Relief During Labor and Delivery. ACOG. FAQ086. August 2022. https://www.acog.org/womens-health/faqs/medications-for-pain-relief-during-labor-and-delivery
3. What are the options for pain relief during labor and delivery? NIH Office of Communications. Last Reviewed Date 4/17/2023. https://www.nichd.nih.gov/health/topics/labor-delivery/topicinfo/pain-relief
4. Options for Managing Pain During Labor. Am Fam Physician. 2012;85(5):456-457 https://www.aafp.org/pubs/afp/issues/2012/0301/p456.html