What are the options for pain relief during labor and delivery?

The amount of pain felt during labor and delivery is different for every woman. The level of pain depends on many factors, including the size and position of the baby, the woman's level of comfort with the process, and the strength of her contractions.

There are two general ways to relieve pain during labor and delivery: using medications and using "natural" methods (no medications). Some women choose one way or another, while other women rely on a combination of the two.

A woman should discuss the many aspects of labor with her health care provider well before labor begins to ensure that she understands all of the options, risks, and benefits of pain relief during labor and delivery before making a decision. It might also be helpful to put all the decisions in writing to clarify things for all those who might be involved with delivering the baby.

Pain-relief drugs fall into two categories: analgesics (pronounced an-uhl-JEE-ziks) and anesthetics (pronounced an-uhs-THET-iks).1

Each category has different forms of medications. Some of these medications carry risks. It is important for women to discuss medications with their health care provider before going into labor to ensure that they are making informed decisions about pain relief.

Analgesics

Analgesics relieve pain without causing total loss of feeling or muscle movement. These drugs do not always stop pain completely, but they reduce it.

  • Systemic analgesics affect the whole nervous system rather than a single area. They ease pain but do not cause the patient to go to sleep. Systemic analgesics are often used in early labor. They are not given right before delivery, because they may slow the baby's breathing and reflexes. They are given in three ways:
    • Injected into a muscle or vein
    • Administered through a small tube placed in a vein. The woman can often control the amount of analgesic flowing through the tube.
    • Inhaled or breathed in with a mixture of oxygen.2 The woman holds a mask to her face, so she decides how much or how little analgesic she receives for pain relief.
  • Regional analgesics relieve pain in one region of the body. In the United States, regional analgesia is the most common way to relieve pain during labor.3 Several types of regional analgesia can be given during labor, so you should discuss your options with a health care provider before your due date. Examples include (but are not limited to) the following:
    • Epidural analgesia, also called an epidural block or an epidural, causes loss of feeling in the lower body while the patient stays awake. The drug starts working about 10 minutes to 20 minutes after it is given. A health care provider injects the drug near the spinal cord. A small tube (catheter) is placed through the needle. The needle is then withdrawn, but the tube stays in place. Small amounts of the drug can then be given through the catheter throughout labor without the need for another injection.
    • A spinal block is an injection of a much smaller amount of the drug into the sac of spinal fluid around the spine. The drug starts working right away, but it lasts for only 1 to 2 hours. Usually, a spinal block is given only once during labor, to help with pain during delivery.

Anesthetics

Anesthetics block all feeling, including pain.

  • General anesthesia causes the patient to go to sleep. The patient does not feel pain while asleep.
  • Local anesthesia removes all feeling, including pain, from a small part of the body while the patient stays awake. It does not lessen the pain of contractions. Health care providers often use it when performing an episiotomy (pronounced uh-pee-zee-OT-uh-mee), a surgical cut made in the region between the vagina and anus to widen the vaginal opening for delivery or when repairing vaginal tears that happen during birth.

Women who choose natural childbirth rely on a number of ways to ease pain without taking medication. These include:4,5,6

  • The company of others who offer reassurance, advice, or other help throughout labor, also known as continuous labor support7,8
  • Relaxation techniques, such as deep breathing, music therapy, or biofeedback
  • A soothing atmosphere
  • Moving and changing positions frequently
  • Using a birthing ball
  • Massage
  • Yoga
  • Taking a bath or shower
  • Hypnosis
  • Using soothing scents (aromatherapy)
  • Acupuncture or acupressure
  • Applying small doses of electrical stimulation to nerve fibers to activate the body's own pain-relieving substances (called transcutaneous electrical nerve stimulation, or TENS)
  • Injecting sterile water into the lower back, which can relieve the intense discomfort and pain in the lower back known as back labor

Lamaze International offers information on many aspects of natural childbirth in its Healthy Birth Practices website.

Citations

  1. American College of Obstetricians and Gynecologists. (2014). FAQ: Medications for pain relief during labor and delivery. Retrieved February 13, 2017, from http://www.acog.org/Patients/FAQs/Medications-for-Pain-Relief-During-Labor-and-Delivery external link
  2. American College of Nurse-Midwives. (2013). Nitrous oxide for pain relief in labor. Retrieved February 13, 2017, from http://www.midwife.org/acnm/files/ccLibraryFiles/Filename/000000003905/
    Nitrous_oxide_for_pain_relief_pregnancy.pdf     external link(PDF 125 KB)
  3. Schrock, S. D., & Harraway-Smith, C. (2012). Labor analgesia. American Family Physician, 85(5), 447–454. Retrieved February 23, 2017, from http://www.aafp.org/afp/2012/0301/p447.html external link
  4. Leeman, L., Fontaine, P., King, V., Klein, M. C., & Ratcliffe, S. (2003). The nature and management of labor pain: Part I. Nonpharmacologic pain relief. American Family Physician, 68(6), 1109–1113.
  5. Tournaire, M., & Theau-Yonneau, A. (2007). Complementary and alternative approaches to pain relief during labor. Evidence-Based Complementary and Alternative Medicine, 4(4), 409–417.
  6. Makvandi, S., Roudsari, R. L., Sadeghi, R., & Karimi, L. (2015). Effect of birth ball on labor pain relief: A systematic review and meta-analysis. Journal of Obstetrics and Gynecology Research, 41(11), 1679–1686
  7. American College of Obstetricians and Gynecologists. (2017). Approaches to limit intervention during labor and birth. Committee Opinion No. 687. Obstetrics and Gynecology, 129, e20–e28. Retrieved March 20, 2017, from http://www.acog.org/Resources-And-Publications/Committee-Opinions/Committee-on-Obstetric-Practice/Approaches-to-Limit-Intervention-During-Labor-and-Birth external link
  8. Hodnett, E. D., Gates, S., Hofmeyr, G., & Sakala, C. (2013). Continuous support for women during childbirth. Retrieved March 20, 2017, from https://www.cochrane.org/CD003766/PREG_continuous-support-women-during-childbirth external link
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