Understanding Your Pain Relief Options During Childbirth
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Understanding Your Pain Relief Options During Childbirth

Learn all about five childbirth pain relief options: an epidural, a spinal block, a combined spinal-epidural, opioids, and nitrous oxide.

Published May 4, 2021

by Marianella Orlando

Medically reviewed by Stephanie Sublett

Board-Certified OB/GYN, FACOG, IBCLC
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Women may describe labor pains as many things. Some say extreme menstrual cramps, Charlie horses over the belly, intense bowel movement, a roller coaster ride of ultimate discomfort, and so forth. While no two women experience the same labor or aches from childbirth, most expecting mothers can agree upon the want and need for pain relief during the process.

Fortunately, there are various options available for managing pain. These can allow moms to select what is suitable for them (and their baby) during one of the biggest moments of their lives. Nine out of 10 women have even said pain management was effective, no matter their chosen method.1 Whether you’re debating between an epidural block or narcotics, we’ve broken down some of the pain relief options women can choose from for labor and delivery and what to know about each one.

Childbirth Pain Relief Options

Here are five pain relief options available to you during childbirth and what you can expect from them:

1. Epidural Nerve Block

Typically referred to as an “epidural,” the anesthetic is the most common type of pain relief medication women in the United States use during vaginal births.2 At some point in your life, you’ve likely heard a mama who’s endured the intensity of labor sing its praises. You’ve also maybe heard other stories about epidurals.

With the many stages of pains and aches that come with delivering a baby, it’s no surprise epidurals remain popular. More than 60% of laboring patients opted for an epidural in 2008, and those rates have since increased.3 According to a recent Stanford University study, 71% of pregnant women now receive pain-blocking medication. This is an uptick of 10% within the past decade.4

So, how does an epidural work? The nerve block is administered with a needle and a small, flexible tube (called a catheter) through the lower back. It’s inserted into a small area that surrounds the spinal cord. The needle is removed, and the catheter remains in the back to allow continuous relief throughout childbirth. It typically takes 10-15 minutes to kick in. It will numb moms-to-be from the belly button down while allowing them to stay awake. Keep in mind the effects will wear off a few hours after the epidural has stopped to offer a longer period of comfort.5

After consulting with a physician, you can ask for an epidural at any point in labor. It can be in the beginning, the middle, or even toward the end. If you want to try to hold off as long as you can while in labor (you go, mama!), remember that you can still go back to this option.

2. Spinal Block

People often confuse spinal blocks and epidural blocks and use them synonymously with one another. Like an epidural, a spinal block injects an anesthetic with a needle in the lower region of the back. It causes loss of feeling and muscle control below the waist.6,7 But what sets them apart? Spinal anesthesia is administered directly into the spinal fluid for immediate pain relief. In comparison, the epidural is not injected near the membrane that surrounds your spine. Secondly, a spinal block is a one-time injection that helps ease the pain. The epidural uses continuous infusion through a catheter.6,7

Due to the anesthetic — such as bupivacaine or lidocaine — patients experience relief for up to two hours. The pain reliever is typically given right before a vaginal delivery or cesarean section. It’s also used for more challenging deliveries and tubal ligations (“tying your tubes”).6,7

3. Combined Spinal-Epidural Anesthesia

A combined spinal-epidural (CSE) fuses the two medications into one strategy: the rapid relief of spinal anesthesia and the epidural’s continuous, long-lasting relief. Referred to as a “walking epidural,” CSE involves a lower dose of medication. It allows a little more sensation in the lower half of the body, so women can have some freedom to move around in the hospital bed.7,8

Despite its moniker, the walking concept is more of a myth. Laboring moms may have more feeling and can adjust themselves more easily, but they should not expect to walk laps around the hospital floor. The potential risks of an epidural are the same for CSE, including fever, itchiness, headache, and nausea, to name a few.7,8

For a CSE, the anesthesiologist first numbs the area where they will insert the injections. They will then insert the epidural needle into the lower back. From there, they will place a smaller spinal needle inside the epidural needle to inject a light dose of the medication into the space between the spinal column and the outer membrane of the spinal cord in the middle or lower back. Lastly, they pass the epidural catheter through the epidural needle and tape it in place.8

4. Opioids

As a type of analgesic, opioids help reduce your awareness of pain and create a relaxing effect to make labor more tolerable. Since they differ from an anesthetic, they do not completely eliminate pain or create a loss of feeling or muscle movement. Usually, they’re given as a shot into a muscle or through an intravenous (IV) line, with the medication flowing right into your bloodstream.9

If you prefer not to get an epidural, spinal block, or CSE, opioids are a good alternative. They help calm you and make you feel less of the aches that come with labor. These include meperidine (Demerol), nalbuphine (Nubain), butorphanol (Stadol), morphine, and fentanyl.9

After receiving the medication, women typically feel the effects working within a few minutes. It can last from two to six hours. Drowsiness may occur, and other side effects include nausea, slow heart rate, trouble breathing, vomiting, and itching. Newborns may experience short-term side effects because the narcotic enters a baby’s circulation after crossing the placenta. These side effects may include a slowed heart rate in utero or decreased respirations upon delivery.9

5. Nitrous Oxide

Inhalation analgesia, nitrous oxide, is a tasteless and odorless gas inhaled through a mask held over the mouth and nose. The gas, which is mixed with oxygen, helps slow the nervous system to reduce anxiety. Although nitrous oxide doesn’t completely stop the pain, it can help women get through the stages of labor. As a tip: it’s best if moms-to-be take deep breaths of the “laughing gas” for about 30 seconds before a contraction kicks in.9

Nitrous oxide only takes about 20 seconds to enter the brain. It takes a couple of minutes to relax the body and momentarily block pain receptors. Because they can self-administer it with the hand-held mask, women can have direct control over when they need relief. The gas does not limit mobility, allowing you the freedom to walk or move around when needed during labor.9 Fortunately, it also leaves the system quickly once it’s no longer in use. It doesn’t enter the baby’s body, causing no significant risk in utero. Some side effects include dizziness or nausea, but they go away quickly.9

Remember, there are options no matter which pain relief method you’re leaning toward for childbirth. If you have additional questions about the process behind a medication or concerns about side effects, consult with your physician or midwife, who can best guide you.

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Marianella Orlando was born and raised in Philadelphia. She has a Master of Science in Journalism from Columbia University. Her work has since been featured in Philadelphia Magazine, The Philadelphia… Read more

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