Pain relief during labor and childbirth

Some women choose to use only natural measures to cope with the pain of labor and childbirth, while others use medication. Many women use a combination of both. During your prenatal visits, talk with your doctor about the options available, as well as the possible side effects for you and your baby.


Natural comfort measures
Many natural comfort measures are used to help decrease the tension, fear and anxiety often associated with childbirth. Some are based on the theory that distraction can prevent the brain from processing pain sensations.
Advance preparation for childbirth is an important part of pain control. Lack of knowledge can lead to fear and anxiety, which can increase your physical discomfort during labor. Learn as much as you can by talking with your physician, reading books and articles on pregnancy and childbirth, and attending childbirth classes. Here are some of the comfort measures often taught in childbirth classes:

Relaxation: If the abdominal wall is relaxed during contractions, there is less pain as the uterus pushes against it. Conscious relaxation techniques often help reduce tension and anxiety. Resting in a comfortable position, having comfortable surroundings, and listening to soothing music can also aid relaxation.

Imagery: Focusing your attention on a pleasant thought or memory can help you shift your focus from the pain, which aids relaxation. Imagery is typically most effective if practiced before labor.

Massage: Light rubbing or deeper massage can help encourage relaxation and decrease pain.

Breathing techniques: Concentrating on breathing in certain ways can also help relax your abdomen and distract you from pain.
Labor support
Having someone to support you throughout labor is important. This can be the baby's father, a close relative or friend, or someone else. Some women choose to hire a birth companion or labor assistant who is trained to provide labor support for women and their families. Through physical and emotional contact during labor, your support person strives to enhance the childbirth experience and help you achieve your goals for a safe delivery. Having a support person has been associated with the use of less pain medication during labor, a lower risk of cesarean birth and better infant Apgar scores (a system for evaluating an infant's physical condition at birth).

Acupuncture and acupressure
Acupuncture and acupressure are ancient practices based on the theory that energy flows along channels, called meridians, throughout the human body. Specific places on the skin, called acupuncture points, are thought to conduct energy between internal organs and the body surface. If something happens to disturb the movement of energy, pain or illness may result. Acupuncture points are stimulated to correct this disruption in energy flow. Very fine needles are inserted into the skin at specific accupuncture points to relieve pain in specific areas of the body. You remain fully awake during the procedure. Although some studies support the theory that acupuncture may help provide pain relief during labor, the practice is not widely used in the United States today. Acupuncture has been used to relieve labor pain in China for centuries, however. These techniques are believed to increase endorphins, natural substances that aid in pain relief.

With acupressure, also known as pressure point massage, pressure is applied to specific acupoints. During labor, points on different parts of the body are used to promote relaxation and relieve pain, such as the point Ho-ku on the back of the hand between the thumb and index finger. Sometimes acupressure is discussed in childbirth classes. As with other natural methods of pain relief, it's best to practice accupressure before actual labor begins.

Transcutaneous electrical nerve stimulation (TENS)
Transcutaneous electrical nerve stimulation (TENS) may be used to relieve pain during active labor. TENS uses a battery-powered device that delivers low-intensity electrical stimulation through two electrodes taped to your lower back. TENS is thought to stimulate the nerve pathways to the uterus and cervix and block other sensations, such as pain. The stimulation can be applied continuously or increased during each contraction and then decreased when it ends. As labor progresses, the electrodes must be moved to other nerves and the intensity of the stimulation is usually increased. The effectiveness of TENS to relieve labor pain has not been well established. It may be most beneficial for women who have severe back pain during labor.

Hypnosis
Hypnosis uses an altered state of consciousness to eliminate or suppress the perception of pain. Advance preparation with a hypnotherapist over a period of weeks or months before your due date is necessary. Not everyone can be successfully hypnotized. This form of pain control is not widely used in the United States.

Biofeedback
Biofeedback is a technique that trains you to voluntarily control bodily functions, such as blood pressure, muscle tension or heart rate, in an effort to improve health and performance. Some women use biofeedback to learn to control pain during active labor. During a number of sessions prior to labor, a biofeedback specialist can teach you how to control your muscle tension and relax. During labor, a biofeedback machine is used to measure the muscle tension in the abdominal wall. In addition to reducing pain, biofeedback may actually help shorten labor.


Pain relief through medication
Medication can be used to relieve labor pain in two ways. With analgesia, you become less aware of your pain while remaining conscious. With anesthesia, you experience a partial or complete loss of feeling. Depending on the type of anesthesia, a certain part of your body may be numbed while you remain conscious. Other types of anesthesia cause you to lose consciousness.
The medications used for pain relief during labor may cross the placenta and affect your baby. Some can affect your contractions or ability to push. Generally, it's best to use the least amount of medication to control your pain for minimal effects on your baby and the progress of your labor. Analgesia and anesthesia may be used alone or in combination as necessary.

Systemic analgesia
Systemic medications are injected into a muscle or vein and affect the whole nervous system to relieve pain and anxiety. Narcotic medications, such as meperidine, nalbuphine, butorphanol, fentanyl and morphine, can be given during labor to reduce pain. Tranquilizer medications, such as promethazine, may be given as well to reduce anxiety. The use of these medications must be timed to reduce possible side effects to the baby. If given soon before delivery, for example, your baby's breathing and reflexes may be slow at birth. If given too soon (before you're dilated to 5 centimeters for a first delivery or 3 centimeters if you've labored before), your labor may be slowed down.

Serious side effects of systemic analgesia are rare. You may experience sleepiness, nausea, dizziness, difficulty concentrating, itching, slowed breathing or low blood pressure. Your baby may experience slowed breathing, difficulty breastfeeding or difficulty controlling body temperature. If necessary, medication can be given to your baby to reverse the effect of narcotic medications.

Local anesthesia
Local anesthesia may be used when pain relief is needed in a small area, such as the perineum (the area between the vagina and anus) when an episiotomy incision is made or repaired. An episiotomy creates more room for delivery of a baby and helps prevent tearing of the vaginal tissues. An anesthetic medication, such as lidocaine, is injected into the skin and underlying tissue. From there, it comes directly in contact with the nerves close to the skin to cause temporary numbness in the area. Local anesthesia is generally considered safe for both mother and baby.

Pudendal block
A pudendal block is a safe technique that has no effect on the progress of labor. It may be given during the pushing stage to numb the perineum, vagina and rectum in preparation for delivery. An anesthetic medication, such as lidocaine, is injected through the vaginal wall into the pudendal nerve, which supplies this area. Numbness occurs within three to four minutes and eases the pain of delivery or an episiotomy.

Paracervical block
A paracervical block may be given during active labor to relieve the pain of contractions. An anesthetic medication is injected into the vaginal wall, near the cervix. Due to potential side effects, this form of anesthesia has become uncommon in the United States. A paracervical block can decrease the blood supply to your baby, leading to a drop in his or her heart rate and a decrease in oxygen. It does not effect the progress of labor.

Epidural block
An epidural block is given to numb the lower half of the body. It typically provides effective pain control during active labor or the pushing stage, as well as for a cesarean birth. An anesthetic medication, such as chloroprocaine, lidocaine or bupivacaine, is injected through the lower back into the epidural space, which surrounds the spinal cord. There, the medication blocks the pain messages reaching the spinal cord from the lower body.

An epidural block should be done by an experienced anesthesiologist or obstetrician. During the procedure, you will sit or lie with your back curved. A local anesthetic may be used to numb the injection area, and then a needle is inserted into the epidural space. A small catheter (tube) is threaded through the needle. When the needle is removed, the catheter is left in the epidural space. Anesthetic medication is given through the catheter as needed to relieve your pain. Initially, it may take 10 to 20 minutes for the medication to take effect. Instead of pain, your contractions may feel like mild pressure in your abdominal or pelvic area. The degree of numbness you feel will depend on how much medication is given and how often it's injected. You'll be awake, but may need to stay in bed. You'll probably receive intravenous fluids and may have a urinary catheter and continuous electronic fetal monitoring.

Many women experience no side effects from epidural anesthesia. When side effects occur, they may include:

itching
nausea or vomiting
headache
back soreness
low blood pressure, which can lead to a slowing of your baby's heartbeat
difficulty pushing from not feeling the contractions, which may prolong the pushing stage of labor
dizziness or seizure if the medication goes into a vein
difficulty breathing if the medication goes into the spinal fluid
Spinal analgesia
Injecting narcotic medication, such as fentanyl and morphine, into the fluid that surrounds the spinal cord can provide effective pain relief during the active stage of labor. This type of analgesia, known as an intrathecal narcotic, is usually given once. It takes effect within about five minutes and lasts up to three hours. The medication will not interfere with your ability to move around or the urge to push the baby out. Once the intrathecal narcotics wear off, a pudendal or epidural block may be used to control pain during the later stages of labor. Another type of intrathecal injection combines a small amount of anesthetic medication with the narcotic, which prolongs the pain relief and provides some numbness of the perineum.

Side effects of intrathecal narcotics for the mother may include itching, nausea, vomiting, difficulty urinating and headache. Rarely, the medication can affect your breathing or blood pressure or the baby's heart rate.

Spinal block
A spinal block is given to numb the lower half of the body and is used most often for cesarean births. An anesthetic medication, such as tetracaine or lidocaine, is injected through the lower back into the fluid that surrounds the spinal cord. When the spinal block is started, you may be sitting with your legs dangling and your head bent forward or lying on your side with your knees pulled up to curve your back so that your back is curved. Numbness from the area below your sternum (the middle part of your chest) to your toes begins within minutes of the injection and lasts up to two hours. You will not be able to move until the numbness wears off. You will also need a urinary catheter and an intravenous infusion of fluids. Although epidural blocks are now used more often than spinal blocks in the United States, spinal blocks can be done more quickly and easily and may be used in an emergency situation.

Side effects of spinal blocks may include:

headache
difficulty urinating
low blood pressure, which can lead to the slowing of your baby's heart beat
difficulty breathing
Saddle block
A saddle block is a type of spinal block that may be used during the pushing stage of labor. A heavy anesthetic medication, such as lidocaine, is given. Because of its weight, the medication drops to a lower level of the spinal column, resulting in numbness only in the buttocks, perineum and vagina.

General anesthesia
General anesthesia relieves pain by causing you to lose consciousness. It's used most often for cesarean births when rapid delivery is needed due to a pregnancy complication. Anesthetic medications that cause unconsciousness are given through a vein or inhaled through a mask. The baby is delivered very soon after the medication is given, minimizing the amount of medication he or she receives through the placenta. You remain unconscious until shortly after the surgery.

During surgery there is a risk of vomiting and breathing the material into your lungs. To help prevent this complication, an endotracheal tube may be placed through your mouth and into your trachea (windpipe). Most women who receive general anesthesia do not experience serious side effects. When side effects occur, they may include nausea, vomiting, difficulty urinating or sore throat (if an endotracheal tube was used). You will have a higher risk of postpartum bleeding due to the relaxing effect the anesthesia has on your uterus. Your baby may also be very sleepy immediately after birth.