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What are the options for pain relief during labor and delivery?

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The amount of pain felt during labor and delivery is different for every woman. The level of pain can depend on many factors, including the size and position of the baby and the strength of contractions. Some women learn breathing and relaxation techniques to help them cope with the pain. These techniques can be used along with one or more pain-relieving drugs.

A woman should discuss the many aspects of labor with her health care provider well before labor begins to ensure that she understands all of the options, risks, and benefits of pain relief during labor and delivery. It might also be helpful to put all the decisions in writing to clarify the options chosen.

Types of Pain-Relieving Medications

Pain-relief drugs fall into two categories: analgesics (pronounced an-l-JEE-ziks) and anesthetics (pronounced an-uhs-THET-iks).1

There are different forms of each.1

Analgesics

Analgesics relieve pain without causing total loss of feeling or muscle movement. These drugs do not always stop pain completely, but they reduce it.

  • Systemic analgesics affect the whole nervous system rather than a single area. They ease pain but do not cause the patient to go to sleep. Systemic analgesics are often used in early labor. They are not given right before delivery because they may slow the baby’s breathing and reflexes. They are given in two ways:
    • Injected into a muscle or vein
    • Inhaled or breathed in with a mixture of oxygen.2 The woman holds a mask to her face, meaning she decides how much or how little analgesic is needed for pain relief.
  • Regional analgesics relieve pain in one region of the body. In the United States, regional analgesia is the most common way to relieve pain during labor.3 Several types of regional analgesia can be given during labor:
    • Epidural analgesia, also called an epidural block or an epidural, causes loss of feeling in the lower body while the patient stays awake. The drug starts working about 10 to 20 minutes after it is given. A health care provider injects the drug near the spinal cord. A small tube (catheter) is placed through the needle. The needle is then withdrawn, but the tube stays in place. Small amounts of the drug can then be given through the catheter throughout labor without the need for another injection.
    • A spinal block is an injection of a much smaller amount of the drug into the sac of spinal fluid around the spine. The drug starts working right away, but it only lasts for 1 to 2 hours. Usually a spinal block is given only once during labor, to help with pain during delivery.
    • A combined spinal-epidural block, also called a “walking epidural,” gives the benefits of an epidural block and a spinal block. The spinal part relieves pain immediately. The epidural part allows drugs to be given throughout labor. Some women may be able to walk around after a combined spinal-epidural block.

Anesthetics

Anesthetics block all feeling, including pain.

  • General anesthesia causes the patient to go to sleep. The patient does not feel pain while asleep.
  • Local anesthesia removes all feeling, including pain, from a small part of the body while the patient stays awake. It does not lessen the pain of contractions. Health care providers often use it when performing an episiotomy (pronounced uh-pee-zee-OT-uh-mee), a surgical cut made in the region between the vagina and anus to widen the vaginal opening for delivery, or when repairing vaginal tears that happen during birth.

  1. American College of Obstetricians and Gynecologists. (2011). FAQs: Medications for pain relief during labor and delivery. Retrieved July 22, 2013, from http://www.acog.org/~/media/For%20Patients/faq086.pdf?dmc=1&ts=20130515T1004441971External Web Site Policy (PDF – 235 KB) [top]
  2. American College of Nurse-Midwives. (2011). Nitrous oxide for labor analgesia. Retrieved December 27, 2013, from http://www.midwife.org/acnm/files/acnmlibrarydata/uploadfilename/000000000080/nitrous_oxide_12_09.pdfExternal Web Site Policy (PDF – 82 KB) [top]
  3. Schrock, S. D., & Harraway-Smith, C. (2012). Labor analgesia. American Family Physician, 85(5), 447–454. [top]

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