Pain Relief During Labor and Birth

Many things can cause pain during labor and Birth, including:

• Pressure on bones and ligaments due to the baby moving through the pelvis.
• Stretching of tissues due to the baby moving through the birth canal.
• Muscle tension due to anxiety or nervousness.
• The uterus tightening (contracting) and relaxing to help move the baby.

There are many ways to deal with the pain of labor and delivery. They include:

• Taking prenatal classes. Taking these classes helps you know what to expect during your baby’s birth. What you learn will increase your confidence and decrease your anxiety.
• Practicing relaxation techniques or doing relaxing activities, such as:
  • Focused breathing.
  • Meditation.
  • Visualization.
  • Aroma therapy.
  • Listening to your favorite music.
  • Hypnosis.
• Taking a warm shower or bath (hydrotherapy). This may:
  • Provide comfort and relaxation.
  • Lessen your perception of pain.
  • Decrease the amount of pain medicine needed.
  • Decrease the length of labor.
• Getting a massage or counterpressure on your back.
• Applying warm packs or ice packs.
• Changing positions often, moving around, or using a birthing ball.
• Getting:
  • Pain medicine through an IV or injection into a muscle.
  • Pain medicine inserted into your spinal column.
  • Injections of sterile water just under the skin on your lower back (intradermal injections).
  • Laughing gas (nitrous oxide).

Discuss your pain control options with your health care provider during your prenatal visits. Explore the options offered by your hospital or birth center.

What kinds of medicine are available?

There are two kinds of medicines that can be used to relieve pain during labor and delivery:

• Analgesics. These medicines decrease pain without causing you to lose feeling or the ability to move your muscles.
• Anesthetics. These medicines block feeling in the body and can decrease your ability to move freely.

Both of these kinds of medicine can cause minor side effects, such as nausea, trouble concentrating, and sleepiness. They can also decrease the baby’s heart rate before birth and affect the baby’s breathing rate after birth. For this reason, health care providers are careful about when and how much medicine is given.

What are specific medicines and procedures that provide pain relief?

Local Anesthetics

Local anesthetics are used to numb a small area of the body. They may be used along with another kind of anesthetic or used to numb the nerves of the vagina, cervix, and perineum during the second stage of labor.

General Anesthetics

General anesthetics cause you to lose consciousness so you do not feel pain. They are usually only used for an emergency cesarean delivery. General anesthetics are given through an IV tube and a mask.

Pudendal Block

A pudendal block is a form of local anesthetic. It may be used to relieve the pain associated with pushing or stretching of the perineum at the time of delivery or to further numb the perineum. A pudendal block is done by injecting numbing medicine through the vaginal wall into a nerve in the pelvis.

Epidural Analgesia

Epidural analgesia is given through a flexible IV catheter that is inserted into the lower back. Numbing medicine is delivered continuously to the area near your spinal column nerves (epidural space). After having this type of analgesia, you may be able to move your legs but you most likely will not be able to walk. Depending on the amount of medicine given, you may lose all feeling in the lower half of your body, or you may retain some level of sensation, including the urge to push. Epidural analgesia can be used to provide pain relief for a vaginal birth.

Spinal Block

A spinal block is similar to epidural analgesia, but the medicine is injected into the spinal fluid instead of the epidural space. A spinal block is only given once. It starts to relieve pain quickly, but the pain relief lasts only 1–6 hours. Spinal blocks can be used for cesarean deliveries.

Combined Spinal-Epidural (CSE) Block

A CSE block combines the effects of a spinal block and epidural analgesia. The spinal block works quickly to block all pain. The epidural analgesia provides continuous pain relief, even after the effects of the spinal block have worn off.