Pain Management During Childbirth

There are many techniques and medications available to you, but the perfect method for eliminating the pain of childbirth from beginning to end has not been developed.

Each person’s perception of pain is unique. Labor sometimes hurts more than you might have expected. There are many techniques and medications available to you, but the perfect method for eliminating the pain of childbirth from beginning to end has not been developed.

That’s why it is important that the decision you make about pain relief be the right one for you. 

The pain of childbirth can be lessened by use of comfort measures taught in childbirth classes, including:

  • Relaxation techniques
  • Visual imagery and focusing
  • Position changes
  • Breathing techniques
  • Birth Balls
  • Heat and Cold Therapy
  • Music Therapy
  • Showers
  • Rice socks  
  • Some women find comfort techniques are all they need to cope with the pain of childbirth. Other women find they desire pain medications in addition to the comfort techniques. Throughout your labor and birth your nurse will be able to provide reassurance and suggestions for relief of pain.

    If you choose to use pain medication in labor, you will be offered a systemic medication in early labor and possible anesthesia in later labor. Systemic medications are usually given intravenously (IV) or in the muscle. They provide pain relief. Anesthesia provides comfort by reducing or eliminating pain sensation.

    Some common pain relief options are described below.

    Local Anesthesia
    Your physician can inject a local anesthetic into your vagina or the area surrounding it to ease pain during delivery. These medications usually affect a small area and are especially useful prior to an episiotomy or the repair of a laceration. One advantage to a local anesthetic is that it rarely affects the baby. After it wears off, there are usually no lingering effects. The main limitation is that they do not relieve the pain of contractions during labor.

    Epidural
    Epidural anesthesia is performed by an anesthesiologist and involves the placement of a small catheter into the lower back. This kind of anesthesia is helpful for easing the pain of uterine contractions, the pain of delivery and the pain of an episiotomy. You may lose muscle control in your legs but you can usually still push during contractions. Epidural blocks are also effective during cesarean birth.

    After the epidural medication is initially injected, a continuous infusion of medication will be given. This will help keep a constant level of anesthesia during your labor and delivery.

    If the covering of the spinal cord, called a Dura, is punctured when the drug is given, the drug may enter the spinal fluid. The patient may then get a severe headache, which can last for a day or more. In rare cases, the muscles in the patient's chest may be temporarily affected, causing breathing problems. If the drug enters a vein, it could cause dizziness, or rarely, seizures. Special precautions are taken to avoid these problems.

    There are some special situations that preclude the administration of an epidural. These include abnormal bleeding in the mother or a problem with the baby.

    Epidural blocks can have some side effects. It may cause the mother's blood pressure to drop, which in turn may slow the baby's heartbeat. Usually preventative steps are taken to avoid this problem: before the mother receives the epidural, fluids are given through an intravenous line (IV) and she is positioned on her side to improve circulation. With epidural anesthesia, the mother's blood pressure and heart rate, as well as the baby's heart rate, will be continuously monitored.

    It may be harder for the mother to push her baby through the birth canal and it may be necessary to use either a vacuum extractor or forceps to assist with delivery.

    Spinal Block
    A spinal block is given as an injection into the lower back. However, a spinal block has to be injected into the spinal fluid so the needle is inserted a little deeper than an epidural (though it does not touch the spinal cord itself). Spinal blocks are best suited for delivery and are most often used for cesarean births. This is because the medication is short acting and is usually given only once. A spinal block numbs the lower half of the body. It provides good relief from pain, starts working quickly, and is effective in small doses.

    It also has the same possible side effects as an epidural block: headaches, a drop in the mother's blood pressure and a drop in the baby's heartbeat.

    General Anesthesia
    General anesthetics are medications that cause a loss of consciousness. When used for childbirth, the mother will not be awake during delivery. It is rarely used for routine deliveries, but may be used for an emergency cesarean delivery.

    These drugs are given in one of two ways: through a face mask or injected through an IV line. Once the drug is given, it works very quickly and is usually given just before delivery.

    If the mother's stomach is not empty when she is given general anesthesia, she may vomit and breathe food and stomach acid into her lungs. There are some precautions that can help avoid this complication. Your care provider may tell you not to eat anything once labor begins and you may be given an antacid before delivery if a general anesthetic is possible.

    After general anesthesia wears off, you will feel woozy and tired for several hours after waking up. You may also feel sick to your stomach. This feeling usually fades within a day. Your throat may be sore from the tube that was inserted to provide oxygen.