Giving birth is a powerful, joyful, and yes, painful experience. Happily, birthing people have lots of choices to help cope with pain relief during labor, particularly pain medications.
Pain during labor is normal, and the goal of pain medication during labor is to help you cope, not completely remove the pain of labor. Sometimes you just need to “labor down” and get some rest— others, you just need to “take the edge off” so that the pain isn’t quite so intense.
In an ideal world, childbirth would be quick and efficient. But most women experience labor first as contractions coming in starts and stops without a rhythm or pattern that can go on for 2-3 days before active labor kicks in. This process is known as “prodromal” labor, or the earliest labor, and during this phase you should rest as much as possible.
As your pregnancy care providers, we hear you when you say it’s quite difficult to sleep with all of those contractions! That’s where therapeutic rest comes in as medication to help you sleep through some of those early contractions so that you have the energy to cope in the busiest and most challenging part of labor for some women—active labor.
You may find that a sleep aid is enough to help you ignore the contractions and rest. Two common options are hydroxyzine (an antihistamine) and zolpidem (a sedative). Both of these are given in pill form.
Still, sometimes the pain of contractions in prodromal labor is too strong to sleep through. In these cases a long-acting opioid, like morphine (given as an injection by your nurse) can relieve the pain and provide a bit of sedation. An opioid for therapeutic rest can also be used well in advance of baby’s impending birth so that baby isn’t sedated when they’re born.
Your body, your birth It’s important to remember that there is no single right way to give birth. You will know what is right for you in the moment. your instincts and trust Follow yourself as you give birth. Happy pushing!
Pain relief during labor: “Something to take the edge off”
If you want to be upright and active in birth, you may still want something to “take the edge off” so that labor pain isn’t quite as intense while avoiding an epidural. Other times, you may be planning to use epidural for labor pain but aren’t quite ready for that yet. In either case, you have options.
An up-and-coming favorite is nitrous oxide, or laughing gas, which doesn’t require an IV to use. You inhale the medication through a face mask, which you hold in place yourself, and as soon as you take the mask off and stop breathing it in, it stops working.
Nitrous oxide is relatively new in the U.S., so it may not be available in your birthing facility. It has been in use for many decades in the United Kingdom and other parts of Europe, so you can rest assured there have been plenty of studies on its safety. Research shows that very little (if any) of the medication crosses the placenta, so this is one of the least risky options for the baby in providing pain relief during labor. In addition, nitrous oxide does not seem to affect labor progress, breastfeeding, or increase the risk of postpartum depression.
Another option for pain relief during labor is a short-acting opioid, like fentanyl or butorphanol, which can be given to you by your nurse through an IV or as an injection. All opioids easily cross the placenta, so your care providers will advise avoiding this option if you’re likely to birth your baby within the next hour or two. Opioids can make your baby sleepy, and if given too close to the time of birth, they increase the risk for slow and ineffective breathing, or respiratory depression in baby. Your baby may need more time and help latching to nurse, so plan for lots of skin-to-skin contact, and ask for breastfeeding support if you use a short-acting opioid.
SEE ALSO: Managing Labor Pain
Pain Relief during labor: “I just want the pain to stop!”
If your goal is to feel as little pain as possible during childbirth, and you want the maximum pain relief during labor, an epidural is the way to go.
Some women will experience total pain relief during labor with epidural anesthesia, still many will feel some tightening or pressure with contractions, and most of us will feel a lot of pelvic pressure as baby is born. This is a good thing; it means you’ll have enough sensation to work with your body when it’s time to push.
An anesthesiologist or nurse anesthetist will place the epidural, so you may have to wait until they’re available to receive some pain relief. They will use a needle to insert a thin, soft tube in your lower back through which you’ll receive pain medication during labor.
Because this is anesthesia, you won’t be able to walk or get out of bed until it’s worn off. Most women will also need a Foley catheter (a tube that drains urine from the bladder) until they can regain the sensation to empty their bladder on their own.
Science is conflicted about whether baby’s starting breastfeeding is affected by the anesthesia, so as always, snuggle your baby with lots of skin-to-skin contact and encouragement toward breastfeeding early on. And while the research does not show an increased risk for cesarean birth, epidurals can affect labor progress in some women, so it’s not uncommon to need Pitocin (a synthetic form of the natural oxytocin that your brain makes to start and sustain labor) to keep labor progressing with an epidural.
Similarly, women who receive epidural anesthesia are slightly more likely to need assistance with birthing baby, either with forceps or a vacuum, and are at higher risk for developing a fever during labor.
The good news is that very little of the medication used for pain relief during labor goes to the baby, so there’s no concern that the baby will be sedated when born. This means that it’s considered safe to get an epidural, even if birth is imminent.