Labor and Delivery: Options for Controlling the Pain

The thought of going through the childbirth process can make you cringe. The stories you hear about the pain, can be overwhelming and scary. Knowing what kind of medications are available helps you voice your desires to your OB-GYN or midwife and feel more in control when it comes to a very vulnerable time-the delivery of your baby. Most of these discussions occur in the third trimester.

Every woman experiences labor and childbirth pains differently depending on factors such as the baby's position and weight, and the length of the delivery. In the first stage, the contractions help open the cervix until it has almost dilated completely. During this stage there may be pain in the abdomen, back, upper legs, or sides. In the next stage, when the cervix is fully dilated, the baby begins to descend from the uterus into the vagina. There is often a burning sensation as pelvic and vaginal tissues are stretched and pushed aside to make way for the baby.

Some of the types of pain medicication include anesthesia (epridural) or analgesics (narcotics). In the US, epidurals are the most common form of medication used to alleviate pain during labor and childbirth. The medication, inserted into a woman's lower spine, works on nerves and prevents pain messages from reaching the brain. Commonly used medications administered in epidurals are Lidocaine and Nesacaine. Low doses allow women to remain mobile while higher doses take away mobility.

To receive an epidural, a woman lies on her side, her body curled. The anesthesiologist then numbs the skin before placing a thin tube or catheter into the epidural space between the spinal bone and the spinal cord. This tube remains in place so that pain medication can be administered as needed.

Instead of offering localized pain relief, analgesics work on the entire body. Demerol, Nubain, and Stadol are the commercial names of narcotics sometimes given to relieve labor pain. These medications travel through the body in the bloodstream.

There is a variety of epidurals available. These include:

Traditional or Basic Epidural

Medication injected into the lower spine takes effect in 10 to 20 minutes, numbing the body below the waist. The legs can sometimes become numb to the point of being immobile.

Spinal Block

Instead of requiring a tube in the back to administer pain relief, a spinal block involves one injection into the lower spine for instant pain relief that will last for several hours. A spinal block may cause immobility.

Combined Spinal Epidural (CSE)

A CSE brings together the instant relief of a spinal block with varying medication amounts of an epidural. The anesthesiologist inserts a tube in the back as with a traditional epidural, but the laboring woman is given a spinal injection first for instant pain relief. Lower dosages of pain relief can then be administered as needed.

Patient-Controlled Epidural Analgesia (PCEA)

A woman is given an epidural along with a button to administer pain medication. When she wants relief, she need only press the button. The PCEA gives laboring women a sense of control.

Analgesics may cause dizziness, drowsiness, and nausea, a woman may not be able to move around during labor. For that reason a woman may also experience lower blood pressure, so constant monitoring of both mother and baby are required. The soothing effect of the narcotic helps some women relax so that labor comes more quickly.

Depending on the amount of medication a woman receives, she may still be mobile with an epidural, however some hospital policies prohibit walking once medication has been given. Epidurals may help a mother relax, hastening labor, but they may also prolong labor by lessening the urge to push.

No medication can guarantee a pain-free childbirth, but by knowing what's available, you have a better chance of finding the right pain management to fit your needs.