Pain Relief during Labor and Delivery

Every woman experiences childbirth differently, and every woman feels pain differently. Breathing and relaxation techniques learned in childbirth classes are all some women need to cope with the pain of delivery. Other women want the option of pain relief medication, and pain medication may help these women have a more comfortable childbirth.

Systemic analgesics are injected into your vein or muscle. These medicines act on your entire nervous system to dull pain. They may not eliminate all pain and they may cause both you and your baby to become sleepy. They usually do not slow labor or weaken contractions. Some women find that analgesics help them relax and make labor easier. Others feel as though analgesics make them lose control.

An epidural block numbs the lower half your body. A specialist physician or anesthesiologist inserts a small soft tube called a catheter into the epidural space near your spinal column. Pain medication is given continuously or in small doses through this tube as long as it is needed. An epidural block reduces the pain of contractions and delivery. For the safety of you and your baby, medication is usually given in low doses, and it may take 10-20 minutes to take effect.

Epidural blocks are relatively safe but some risk is associated with them:

• your blood pressure may drop temporarily and slow the baby's heart rate. Intravenous fluids can help keep your blood pressure stable. You also may be asked to lie on your side to make blood circulation easier, and you may be given medication to bring up your blood pressure.
• you may find it harder to bear down and push the baby through the birth canal
• contractions may decrease for a short time, and your caregiver may give you medication to speed up your contractions
• you may, on rare occasions, have a headache
• you may experience temporary dizziness, difficulty breathing, or a seizure on rare occasions if medicine gets into the spinal fluid
• you may have shivering, but shivering often occurs during labor

A spinal block is like an epidural, except that the medication is given in a single dose, and pain relief only lasts 1 to 2 hours. Women who are giving birth vaginally are often given a spinal block when forceps or vacuum extraction must be used. The risks of a spinal block are the same as those for an epidural. Both epidural and spinal blocks may be given for c-sections.

A saddle block is a form of spinal block used to numb the buttocks, perineum, and vagina. A saddle block is more often used for delivery than for labor.

A combined spinal/epidural block may provide faster pain relief for women who are in very active labor and want relief right away.

A walking epidural block reduces pain but doesn’t completely impair ability to move your legs. Most women can’t actually walk with this type of epidural.

Local anesthesia (pudendal block) uses pain medication to numb the vaginal and rectal areas at the time of delivery to reduce pain as the baby is delivered and to prepare for an episiotomy.

Even if you choose to receive pain medication, it is useful to prepare yourself for natural childbirth. The breathing and relaxation techniques may be very helpful. The key to making the best choice is to learn all you can about what is available. Be flexible and open. Things often change when labor begins. Sometimes the pain is worse than anticipated. Your health and the health of your baby should come first.