Types of Pain Relief in Labor and Delivery
Each woman’s labor is unique, and the amount of pain she feels during labor depends on many factors. Her discomfort can be affected by the size and position of the baby and the strength of contractions. Some women take classes to learn breathing and relaxation techniques to help cope with pain during childbirth.
Others may find it helpful to use these techniques along with pain medications outlined below:
Analgesics vs. Anesthetics
There are two types of pain-relieving drugs — analgesics and anesthetics. Analgesia is the relief of pain without total loss of feeling or muscle movement. Analgesics do not always stop pain completely, but they do lessen it.
Anesthesia is blockage of all feeling, including pain. Some forms of anesthesia, such as general anesthesia, cause you to lose consciousness. Other forms, such as regional anesthesia, remove all feeling of pain from parts of the body while you stay conscious. In most cases, analgesia is offered to women in labor or after surgery or delivery, whereas anesthesia is used during a surgical procedure such as cesarean delivery.
Not all hospitals are able to offer all types of pain relief medications. However, at most hospitals, an anesthesiologist will work with your health care team to pick the best method for you.
Systemic analgesics often are given as injections into a muscle or vein. They lessen pain but will not cause you to lose consciousness. They act on the whole nervous system rather than a specific area. Sometimes other drugs are given with analgesics to relieve the tension or nausea that may be caused by these types of pain relief.
Like other types of drugs, this pain medicine can have side effects. Most are minor, such as nausea, feeling drowsy or having trouble concentrating. Systemic analgesics are not given right before delivery because they may slow the baby’s reflexes and breathing at birth.
Local anesthesia provides numbness or loss of sensation in a small area. It does not, however, lessen the pain of contractions.
A procedure called an episiotomy may be done by your doctor before delivery. Local anesthesia is helpful when an episiotomy needs to be done or when any vaginal tears that happened during birth are repaired.
Local anesthesia rarely affects the baby. There usually are no side effects after the local anesthetic has worn off.
Regional analgesia tends to be the most effective method of pain relief during labor and causes few side effects. Epidural analgesia, spinal blocks and combined spinal–epidural blocks are all types of regional analgesia that are used to decrease labor pain.
Epidural Analgesia — Epidural analgesia, sometimes called an epidural block, causes some loss of feeling in the lower areas of your body, yet you remain awake and alert. An epidural block may be given soon after your contractions start, or later as your labor progresses. An epidural block with more or stronger medications (anesthetics, not analgesics) can be used for a cesarean delivery or if vaginal birth requires the help of forceps or vacuum extraction. Your doctors will work with you to determine the proper time to give the epidural.
An epidural block is given in the lower back into a small area (the epidural space) below the spinal cord. You will be asked to sit or lie on your side with your back curved outward and to stay this way until the procedure is completed. You can move when it’s done, but you probably will not be allowed to walk around.
Spinal Block — A spinal block—like an epidural block—is an injection in the lower back. While you sit or lie on your side in bed, a small amount of medication is injected into the spinal fluid to numb the lower half of the body. It brings good relief from pain and starts working fast, but it lasts only an hour or two.
A spinal block can be given using a much thinner needle in the same place on the back where an epidural block is placed. The spinal block uses a much smaller dose of the drug, and it is injected into the sac of spinal fluid below the level of the spinal cord. Once this drug is injected, pain relief occurs right away.
A spinal block usually is given only once during labor, so it is best suited for pain relief during delivery. A spinal block with a much stronger medication (anesthetic, not analgesic) is often used for a cesarean delivery. It also can be used in a vaginal birth if the baby needs to be helped out of the birth canal with forceps or by vacuum extraction. Spinal block can cause the same side effects as epidural block, and these side effects are treated in the same way.
Combined Spinal–Epidural Block — A combined spinal–epidural block has the benefits of both types of pain relief. The spinal part helps provide pain relief right away. Drugs given through the epidural provide pain relief throughout labor. This type of pain relief is injected into the spinal fluid and into the space below the spinal cord. Some women may be able to walk around after the block is in place. For this reason this method sometimes is called the “walking epidural.”
General anesthetics are medications that make you lose consciousness. If you have general anesthesia, you are not awake and you feel no pain. General anesthesia often is used when a regional block anesthetic is not possible or is not the best choice for medical or other reasons. It can be started quickly and causes a rapid loss of consciousness. Therefore, it is often used when an urgent cesarean delivery is needed.
Anesthesia for Cesarean Births
Whether you have general, spinal or epidural anesthesia for a cesarean birth will depend on your health and that of your baby. It also depends on why the cesarean delivery is being done. In emergencies or when bleeding occurs, general anesthesia may be needed. If you already have an epidural catheter in place and then need a cesarean delivery, most of the time your anesthesiologist will be able to inject a much stronger drug through the same catheter to increase your pain relief. This will numb the entire abdomen for the surgery. Although there is no pain, there may be a feeling of pressure.