Maternal and Infant Health Program Maternal and Infant Health Program

Phone:
  SLC area: (801) 538-9970

FAX:
  SLC area: (801) 538-9409

Mail:
Maternal and Infant Health Program
  P.O. Box 142001
  Salt Lake City UT
  84112-2001




Pain Relief During Labor:
The Choice is Yours!

What can I do to help with the pain of labor and childbirth?
There are several ways to help relieve the pain of labor contractions and childbirth.  In the United States, the most common ways to help decrease the pain of labor and birth are narcotic pain medications and epidural anesthesia.          
           
There are also a variety of complementary therapies used to help with the pain and discomforts of labor and birth.  These include hypnosis, acupuncture, massage, reflexology, herbal medicines, homeopathy, use of water (shower or tub) during labor, distraction techniques, and position changes during labor.  There is evidence that acupuncture and hypnosis may help relieve labor pain (Cochrane reference).  Some
techniques may be learned and practiced in childbirth classes, and other techniques involve more lengthy practice and preparation.

How are narcotic pain medicines used in labor?
Narcotic pain medications (for example, Demerol, Morphine, Stadol) are often given during early labor, with the hope that some sleep may result from their use.  Then the woman may awaken after contractions have stopped, or else awaken with further dilation and be in a more active labor pattern.  For early labor, these  medications are given as an injection into the buttocks muscle, allowing for a larger amount of the medication to be given which is released more slowly and therefore lasts longer.  The same medications may also be given via  the intravenous (IV) route during active labor, where less is given and takes effect much more quickly than  when given as an intramuscular (IM) injection.   When given IV during labor, these medications are safe to use since they also wear off quickly.  If labor speeds up after a woman receives narcotic pain medication and the baby is born quickly, the baby’s breathing may be depressed from the drug effect.  However  there is a medication which can be given to immediately remove the narcotic effect from the newborn.  Some women who have given birth with epidurals and then have another birth using just IV pain medication feel that they recover from the labor and delivery process more quickly in the delivery where they did not have an epidural. 

What are complications or side effects from narcotic pain medicines?
As with any medication, there may be side effects.  For narcotic pain medicines, the most common side effects include nausea or vomiting (thus anti-nausea medications are almost always given together with the pain medication), feeling of dizziness or lightheadedness, skin rash or itching.  The pain medication as well as the anti-nausea drug often cause notable relaxation or sleepiness; this level of relaxation also often results in progress in labor and dilation of the cervix. 

What is Epidural Anesthesia?
An epidural is sometimes called “regional anesthesia,” which means feelings of pain from a part of the body (in this case, from below the waist) are blocked while a person remains conscious or awake.  A “spinal” is a similar type of regional anesthesia, where the medication is placed in a slightly different spot around the spine. 

How does epidural anesthesia work?
A local anesthetic drug is given in the epidural space of the spine, which numbs the nerves from the uterus and birth canal. When the nerve impulses are blocked, there is decreased feeling in the lower half of the body. With the numbing effect, the labor contractions of birth are barely felt.

How is it given?
Before an epidural is given an IV is started and the woman receives extra fluids. She is then positioned on her left side or in a sitting position. The waistline area of the lower back is cleansed. The skin is numbed with a local anesthetic. A larger needle is placed through the numbed area and into the epidural space of the spine, and then a catheter (smaller flexible tube) is threaded through the needle into the epidural space so that the needle can be removed. The catheter remains in place so that more doses of medication can be given if needed. The catheter is removed after the baby is born and the anesthesia wears off in one or two hours.

Is the epidural a painful procedure?
There is some discomfort when the skin is numbed, and after that slight pain or pressure may be felt as the catheter is placed.

When will the epidural be placed?
The epidural is usually placed when a woman is in the active stage of labor, usually at 4 centimeters dilation. An epidural can also be given before a cesarean section delivery.

Can anyone get an epidural?
No, an epidural may not be an option in certain situations. If labor is progressing rapidly there may not be time to receive an epidural. If a woman uses blood thinners, has had back surgery, has heart or blood disorders, or has allergies to medications, she should discuss these with her provider and anesthesiologist, because an epidural may not be advised.

What are the benefits of epidural anesthesia?
A woman can be awake, alert and comfortable in labor and childbirth. The reduced discomfort can help women to rest during labor. If other medications or techniques are no longer helping, rest and pain relief from an epidural can help her to relax, and get re-focused.  In some cases an epidural can actually help to resolve a labor which is stalled.  Complications and side effects are rare.

What are the possible complications, side effects and risks?
It is required that the woman who receives an epidural will stay in bed, and she will have several automatic monitors attached for the rest of her labor.  Women often have catheters in the bladder when having an epidural. The medications used may decrease the mother’s blood pressure, which can be recognized and treated.  A woman’s back may be sore from the injection for a few days or more.  Sometimes an epidural does not work effectively and a woman may still feel pain, or pain on one side. Labor contractions may slow down after an epidural, so the medication Pitocin is used to stimulate contractions.  Although minimal amounts of medication are used, an epidural (or a decrease in mother’s blood pressure) may cause the baby’s heart rate to decrease.  A woman may not be able to push effectively after an epidural  is given or re-dosed (difficult for her to change positions, and may require longer pushing), so forceps or vacuum extraction may be required to help deliver the baby’s head.  A cesarean birth may become necessary.  Epidurals may be associated with some fevers during labor.

After delivery, having an epidural may result in being unable to move for a time after birth, and the inability to pass urine for a time.  Less than one woman in 100 will suffer from a bad headache, which can be treated  with another procedure.  Studies have suggested that there are more breastfeeding difficulties after birth in mothers who have used epidural anesthesia.  Serious complications are very rare, but if the drug enters a vein a woman could get dizzy or have a seizure, and if the drug enters the spinal fluid it can make it hard to breathe. To avoid these complications, a test dose is given and a woman is monitored very closely when an epidural is in place.  Permanent nerve injury, paralysis, meningitis (infection of the fluid surrounding the spinal cord) are all extremely rare complications of an epidural.    

What is general anesthesia?
General anesthesia is faster to start than an epidural or spinal, so is used in an emergency when time is critical.  It may also be used with a woman who is unable to have spinal or epidural anesthesia.  An anesthesiologist will give medication either via an IV line, or by way of a mask where the woman inhales a gas.  General anesthesia causes the woman to be put more or less into a deep sleep state where no pain is felt.  If you have ever had any problems with general anesthesia, it is important to tell the anesthesiologist, even if you are just planning to have an epidural.  The anesthesiologist will stay by your side during general anesthesia, monitoring all your vital signs continuously, and help to reawaken you when the procedure is complete.  It takes a few weeks for all the medication from general anesthesia to break down and get completely out of your system.  This usually means that people who receive general anesthesia for surgery feel tired for longer than after other types of anesthesia. 

This information is for educational purposes only, and is not intended to replace the advice of a trained health care professional.  Please discuss further your questions about pain relief during labor with your midwife or doctor.