Labor Pain Medication at a Glance

Pain Medication Education

You don't have to take pain medication when you're giving birth, but some women choose this option. Whether or not you decide that pain medication is right for you, it's important to be educated about the different options available and their side effects. Review these quick facts about the different types of medications used to ease labor pain and be aware of possible side effects.

Analgesics

What they do: Opiod analgesics like Demerol act on the whole nervous system, rather than on any particular area. Analgesics don't completely erase pain, but they can lessen its intensity.

When they're used: Analgesics are used mainly during early labor and after birth. They help to reduce anxiety, and are especially good for long, tense labors.

How they're given: They're usually given as a shot into a muscle or through an IV. Some can be self-administered, wherein you control the amount of medication you receive by pushing a button attached to the IV tube. You'll generally respond to the drug within 15-30 minutes.

Pros:

• They provide pain relief over the entire body without causing loss of consciousness.
• You'll be able to rest during the early part of labor, saving energy for the second stage.

Cons:

• You may experience drowsiness, dizziness, nausea, and vomiting.
• Your baby may experience respiratory difficulties, exhibit poor sucking, and have slower reflexes at birth.

Local Anesthetics

What they do: Local anesthetics relieve pain by numbing or reducing sensation in a small area. They ease the pain of delivery, but they don't lessen the pain of contractions.

When they're used: This type of drug is used in the second stage of labor to numb your birth canal and perineum for forceps delivery, episiotomy, and repair.

How they're given: Local anesthetics are generally injected around the pudendal nerves inside the vagina. You'll usually respond in about two to three minutes and the effects of the drug may last one hour.

Pros:

• You probably won't experience any lingering aftereffects. There are no known negative side effects for your baby.

Cons:

• Pain relief is limited to specific area and it's relatively short-lived. Also, it doesn't relieve the pain of uterine contractions.

Regional Blocks: Epidural

What it does: An epidural numbs sensation from the waist down -- how much depends on the drug and dosage used. It eases the pain of uterine contractions and pain in the vagina as the baby is being delivered. You'll be awake and alert. During a long labor it can prevent you from becoming exhausted or distressed.

When it's used: An epidural can be given in active labor, in the second stage of labor, and before a cesarean birth. An epidural is administered after 4-6 cm cervix dilation.

How it's given: An epidural is administered either as a single injection or a continuous flow. You'll be asked to sit or lie on your side for about 10 minutes while it's injected into a small space around your spinal cord in your lower back. You'll respond to the drug in about 10-20 minutes.

Pros:

• You'll feel pressure, but not pain.
• A low concentration of the drugs is used, which reduces side effects.

Cons:

• Your legs will feel heavy, and you may have trouble moving or urinating.
• You may lose the urge to push, which can slow down labor or increase the use of interventions such as IVs, fetal monitors, and forceps delivery.
• Your blood pressure may drop, which may slow the baby's heart rate.
• If the needle punctures the membranes around the spinal cord, you may develop a headache. More rarely, it can cause nerve injury or infection.
• You may get only spotty pain relief.

Spinal Block

What it does: A spinal block numbs the lower half of your body, and works more quickly than an epidural. It provides relief from pain, and is effective in small doses.

When it's used: It's best suited for pain relief during delivery -- not labor -- because it's usually only given once and the effects don't last long. It's most often used when the mother is too tired to push. A spinal block is frequently used for a cesarean birth, or if forceps or vacuum extraction are necessary.

How it's given: A spinal block is administered as a single injection into your spinal fluid while you're lying on your side. A thin needle is inserted in the same location of your back as the epidural. Once the spinal anesthetic is injected, the onset of numbness is quite rapid.

Pros:

• It works more quickly than an epidural.
• A much smaller dose is needed than for an epidural.

Cons:

• You may experience a drop in blood pressure, headache, and some difficulty with urination.
• As your blood pressure drops, oxygen flow to your baby decreases.
• You'll need to lie flat on your back for four to eight hours after delivery.

Combined or Walking Epidural

What it does: A relatively new technique, the "walking epidural" blocks pain nerves but not motor nerves. It provides the rapid pain relief of a spinal block and the continuous relief of an epidural. It works fast -- pain subsides within two minutes -- and in some hospitals, you can regulate your own dosage.

When it's used: A walking epidural is administered similarly to an epidural, and lasts as long as baby's delivery, supplying a continuous infusion of medication as needed.

How it's given: It's usually administered as a two-injection procedure, the first injection being about half the usual epidural dose. Further injections are given only as needed, reducing the total amount of drug used.

Pros:

• Maternal blood pressure usually doesn't drop.
• Since less medication is delivered, less is absorbed by the baby.
• The use of a thin needle reduces risk of headache.
• This method reduces risk of long-term backache and need for forceps delivery.

Cons:

• It can cause dizziness so you may not feel like walking around.

General Anesthesia

What it does: General anesthetics are medications that make you lose consciousness. When used during childbirth, the mother will not be awake or feel any pain during delivery.

When it's used: General anesthesia is used only for emergencies. It is not used to relieve the pain of labor. It may be used for cesarean delivery or other urgent situations.

How it's given: These drugs are given through a face mask or injected through an IV line. Once the drug is given, it works very quickly.

Pros:

• You'll feel no pain and be unaware of labor or delivery distress.

Cons:

• It may cause nausea and vomiting.
• It depresses your central nervous system.
• You blood pressure may drop.
• The drug may cross the placenta to the baby.
• Forceps may become necessary for delivery.
• Grogginess may make it difficult to hold and bond with your baby right after delivery.

Sources: American College of Obstetricians and Gynecologists (ACOG); American Society of Anesthesiologists (ASA); American Association of Nurse Anesthetists (AANA)

All content here, including advice from doctors and other health professionals, should be considered as opinion only. Always seek the direct advice of your own doctor in connection with any questions or issues you may have regarding your own health or the health of others.