Pain Management Options in Labor?

An epidural block isn’t your only analgesic or anesthetic option during childbirth. You can obtain relief for a vaginal delivery with both pharmacologic as well as drug-free ways for the pain of contractions.

Hi, I’m Hilary — the curly-headed nurse behind Pulling Curls.

Grab my pain mangement options here:

I’ve been an RN for over 22 years and I’ve been at the labor bedside for almost 20 of those. I’m so excited you’re thinking about your birth in advance. I think it really helps!

Pain is clearly something a LOT of women are afraid of in labor, and one that many women confide to me about. This post is part of my labor pain series.

Honestly, it will be very different than you imagind (but, I have a whole post on what contractions feel like to get you started).

Today we are going to focus on the five (although most hospitals only have three of these) options in labor.

I also have a podcast on pain management in labor:

Options for Pain Management in Labor:

Education for Pain

We all know that when facing the unknown is much scarier than when you know what to expect.

Think of a scary movie when someone is in the dark, and the music plays behind them…. MUCH scarier than with the light on.

Knowing what to expect in labor can lessen your pain, stress, and anxiety quite significantly. It basically “turns the light on” for you!

I loved teaching prenatal classes in the hospital (and I always loved patients who took them), because they were so much more laid-back in labor.

But, 5 pm on Tuesdays doesn’t work for SO many people, I created my own. I’m excited to see you inside, to make this whole scary thing a whole lot simpler

Save 10% with code PC10! I even guarantee you’ll feel more comfortable with your upcoming birth after you finish.

Drug-Free Pain Relief

Clearly, there are a lot of options in this arena — but essentially, you are managing the pain on your own. BTW, I have a whole post on having an unmedicated hospital delivery. But, options include

• Positioning (harder to do in the hospital as they have to monitor the baby)
• Massage/pressure
• Temperature (warm/cold packs)
• Sounds or Distraction (TV, etc)

Honestly, I do think you need some preparation for this one. I love the crash course on these options that are included as a bonus here.

Many women consider using a doula if they want a drug-free delivery — and they can be a good option as well!

You can also consider taking a strictly pain mangement class — I have had patients/friends have the most luck with Hypnobabies — which I talk about towards the bottom of this post.

Pro’s of Drug-Free Labor

• You don’t feel “out of it”
• No medication gets to the baby
• Euphoric relief when baby is out

Con’s of a Drug-Free Labor

• Some women feel so stressed out in labor it isn’t good for them or the baby
• Women feel traumatized with no ways to deal with the pain
• All of the pain is felt.

IV Pain Medicine

This is the sometimes forgotten option for women in labor.

Yes, some of the medication gets to your baby. But when given by a trained provider it can really help you get through the last few hours of labor.

There are two main options, and it just depends on your provider which one they offer (some offer both). They are Stadol & Fentanyl.

The nurse will administer them, they act fairly quickly, and while they won’t take away all the pain — it definitely takes the edge off the pain.

Pro tip: These medications only work well 1-2 (sometimes three) times. After that your body becomes tolerant and they just don’t provide the same relief. So, if you plan to use this option I would recommend not taking it until you are further into your labor progression.

Pro’s of IV Pain Medicine

• Less risk involved than other options
• Awesome prior to transition to “get you through”
• Wears off fairly quickly

** Not sure what transition is? I talk about it in chapter 5.

Con’s of IV pain Medicine

• Some of the medication can get to the baby
• Can’t be given close to delivery as baby will be sedated
• Must have an IV to get it

I have a whole post about labor IV’s that might help about the IV in general.

And yes, we go into the pro’s and cons of these and when to consider them in here.

Epidural

In the US, this is often the pain management chosen by most women. But it varies by location. The epidural is given by an anesthesiologist and I have several posts that address this best. You can find them linked here, and also in my Encyclopedia of Epidurals.

I also have a video all about when is the best time to get an epidural:

Keep in mind that there are three fairly similar options when people talk about an epidural Block:

Epidural (medically known as an epidural block): Most frequently given option in labor. Medication is injected in your epidural space that helps to numb the appropriate nerves for labor pain

Spinal Block: Given in the OR for cesarean section. Women are more numb, and movement is very limited.

Combined Spinal Epidural (CSE): There is an initial dose given in the spinal area and then a tube is placed in the epidural space for continuous pain management.

FYI, the decision between epidural and CSE is based on the anesthesiologist and preference (as well as what they are used to).

Pro’s of an Epidural

• Good Pain management, patients should be about 80% numb from knees to the bra line
• Done frequently, and very safe
• No medication gets to the baby as it isn’t in the bloodstream
• Should last through delivery

Con’s of an Epidural

• More risk as you are dealing with a patient’s back area, the chance of infection, etc.
• Some pain with epidural placement
• Some back pain afterward due to puncture
• Chance of a spinal headache
• Some women’s blood pressure drops requiring further interventions

Keep in mind the anesthesiologist should go over the risks and benefits of an epidural when they give you informed consent before an epidural.

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Nitrous Oxide

While I have heard a LOT of buzz about this, my hospital doesn’t actually have it yet (and as far as I know, none of the hospitals in my metro area have it either).

But, just like the dentist’s chair this, similar to IV pain medication, takes the edge off. BUT, the good news is that it is out of your system so quickly, you are allowed to administer it to yourself (I am guessing once you’re pushing we try not to use it, but I’m not even sure).

BUT, since it’s so new — be sure to check with your doctor if he/she knows of any hospitals in the area that offer it.

Just a reminder, this isn’t going to take away all of your pain, just taking the edge off. 🙂

Pro’s of Nitrous Oxide

• No IV necessary (although most providers prefer an IV during labor due to other risks)
• Easily administered with little equipment
• Mom has control over it
• It wears off very quickly

Con’s of Nitrous Oxide

• Not as available in the US
• Studies show that some women with the MTHFR gene might have issues

So, that’s the 4 options. I hope you found this post helpful — I’d love to see you in my free prenatal class — which you can sign up for right here: