If you’re not a candidate for an epidural, you still have options when it comes to pain management during labor and delivery.

By Kristi Pahr
January 13, 2020
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If you want a pain-free (or at least pain-minimized) labor and delivery but can't have an epidural, don't despair. There are still medical or drug-free options available to make your delivery more manageable.

"The most powerful influence on a woman's satisfaction with pain relief appears to be the attitude and behavior of her physician," says Eduardo Hariton, M.D., an OB-GYN at the University of California San Francisco. "Pain is very personal and so are pain management decisions. As doctors, we should always respect and support a woman’s choice for pain control while counseling her about what is safe and can help her have a positive birth experience."

Here are some ways to prep for labor and delivery without an epidural as well as alternative drug options to discuss with your medical team.

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Preparations During Pregnancy

"Patients can get educated and prepare themselves for the pain of contractions," says Ozhan Turan, M.D., professor of obstetrics, gynecology, and reproductive sciences at the University of

Maryland School of Medicine and a maternal-fetal medicine specialist at the University of

Maryland Medical Center. "If you have a good idea of what’s going to happen, you might not get as anxious. How much pain a person can tolerate often depends on the person, culture, education, and knowledge."

Take birthing classes

Birthing classes that teach the Bradley Method or Lamaze are a great way to both mentally and emotionally prepare you for your marathon of labor. Instructors teach different methods for managing the pain of contractions and techniques for breathing and moving during labor, as well as educate birth partners in how best to support you while you labor.

Enroll in Prenatal Yoga Classes

This exercise can put you in touch with your body, relax your muscles, and can help you to tap into inner reserves needed for labor and birth. You can learn more about the benefits of prenatal yoga for labor and delivery here.

Hire a Labor Doula

Doulas can be invaluable as an advocate and support system in the delivery room. "A doula can provide psychological help for the patient," explains Dr. Turan."This person can help you take deep breaths, walk around, and get yourself into a comfortable position. Having someone with you at all times can be very comforting and help with the pain."

Alternative Drugs During Delivery

Nitrous Oxide

An inhaled anesthetic, nitrous oxide, also called laughing gas, is gaining popularity in the delivery room. According to the American Pregnancy Association, nitrous oxide has several benefits: It can reduce the mother's awareness of pain and increase relaxation, it does not interfere with breastfeeding, and does not inhibit the release of oxytocin, a hormone that helps encourage mother-baby bonding. Also, the effects wear off within five minutes of the gas being discontinued, unlike epidurals which can take hours to subside. However, only a few hundred American hospitals offer laughing gas during delivery, so ask your OB if it's an option for you.

Local Anesthesia

According to Dr. Hariton, an injection of medicine "that blocks the nerves to the perineum, vulva, and vagina can help during the second stage of labor [pushing]." While this type of anesthesia, known as a pudendal block, doesn't help with the pain associated with contractions, "it relieves pain around the vagina and rectum as the baby comes down the birth canal." The medicine used for this type of block is injected into the pudendal nerve, a large nerve found in the pelvis and effectively numbs the entire area, relieving the pain of crowning and pushing the baby out through the birth canal.

Opioid and Non-Opioid Analgesics

Though they aren't recommended for use later in labor, opioids are very effective in helping with early labor pain. Certain complications arise if they are used too late though—they cross the placenta and can result in the baby experiencing respiratory depression or the need for neonatal resuscitation after birth. "If needed, we recommend only short-acting [opiates] to minimize the baby's exposure time,' explains Jeremy Dennis, M.D., assistant professor of clinical anesthesiology at Yale-New Haven Hospital, Yale University.

Non-opioid analgesics, like acetaminophen or ibuprofen, are also options, but according to Dr. Hariton, they might not have much effect as they are generally not strong enough to combat labor pain.

The Bottom Line

If you are unable to have an epidural, be sure to discuss all your options with your health care provider to find the one (or combination) that works best for you and your birth plan.

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