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When the subject of pain control in labor comes up, most women automatically think of an epidural. While an epidural might provide the most relief, it is not your only choice. There are multiple ways your obstetrics provider can make labor less painful.

Intravenous pain medications are often given if a woman wants something for her pain but is either not ready for an epidural yet or does not want one. There are a few types of medications that can be given, and they each vary in how frequently a dose can be repeated. Examples include fentanyl, butorphanol, and nalbuphine. These primarily work via sedation. These medications do cross the placenta, so most providers will not administer them close to delivery to avoid the arrival of a sleepy baby who needs extra stimulation to breathe and cry.

Nitrous oxide, or “laughing gas,” is becoming a more common option in labor and delivery rooms across the United States. This involves holding a mask over your mouth and nose and inhaling a mixture of nitrous oxide and oxygen. When used it can bring relief of pain and anxiety in under a minute and is short-lived enough to have minimal effect on the baby. While it doesn’t give as much relief as an epidural, it is a nice option to have when in labor.

Local anesthetics can be used for labor relief and also during repair of any lacerations or episiotomies after delivery. A pudendal nerve block is when a numbing medication like lidocaine is injected into the inside of the vagina to numb the pudendal nerves. This can be done right before delivery or if you need something like a forceps delivery, which can be painful without anesthesia.

Non-narcotic options for pain relief also exist. For example, laboring in a chair or on a birthing ball may help your contractions feel less intense, as does laboring in a shower or tub. Some women employ massage, guided imagery, controlled breathing, or a combination of all of these to help them get through labor. If you are planning on using any of these techniques, it may be helpful to attend a childbirth class ahead of time that reviews how these methods work.

If you initially planned on avoiding pain medications in labor but then experience a change of heart, try not to feel disappointed. It can be hard to know what to expect until you are in the midst of the real thing, and every woman perceives labor differently! Be sure to speak up and let those caring for you know how they can help you best.

Reviewed by Dr. Jen Lincoln, December 2018

Takeaways

  • An epidural may provide the best pain relief, but it is not the only option.
  • IV pain medication mainly works by sedation.
  • Non-narcotic options like changing positions, massage, and breathing techniques may be helpful.
  • Don’t feel like a failure if you decide on pain medication if you didn’t plan on it!

References

  1. American College of Obstetrics/Gynecology Practice Bulletin # 36. Obstetric Analgesia and Anesthesia.
  2. March of Dimes. Natural relief for labor pain.

Comments

  1. I did not have an epidural, but I did receive some pain meds because I had to be put on meds to keep my blood pressure in check and to increase my platelet count. Since I was confined to the hospital bed and unable to manage pain in the natural ways I had planned on (exercise ball, walking, bath/shower), I was given pain meds in my IV. However nice it was to have that pain relief, I don’t think I will do it again. There are 2 whole hours of my labor that I don’t remember at all. My husband and I had discussions that I don’t recall, and things happened that I just have no memory of whatsoever. So for me, losing that time was not worth the little bit of pain relief I received. I say that now, but when the time comes for baby #2, I might be singing a different tune! 😉 I have a right to change my mind!

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