Pain Relief in Labor and Delivery

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There are many ways to lessen the pain during labor and delivery of a baby. Several kinds of medication can relieve the pain. Also, various methods of relaxation called prepared childbirth help some women have a baby with minimal or no medication.

The type of pain relief that is right for each woman depends on her physical condition, her training for childbirth, the length and stage of her labor, the amount of labor pain, and the condition of the baby. During prenatal visits, we encourage you to discuss the various methods of pain relief and the kind of childbirth experience you would like to have. This is also a good time to discuss any fears you have regarding labor and delivery.

WHAT TYPE OF MEDICATIONS ARE USED FOR PAIN RELIEF?

When labor is especially painful or when the baby is in an abnormal position, medications can ease the pain. Pain-relieving medications are also used if a cesarean section is necessary. These medications may remove all sensation in a specific region or in all of the body, or they may relieve the pain without a total loss of sensation. The type of medication used depends on the stage of labor, the progress of labor, and the condition of the mother and the baby. In each case, the purpose is to provide the most appropriate pain relief and to minimize the risks to the mother and the baby.

Narcotics (such as Demerol, Stadol and morphine) and sedatives (such as Phenergan) may be used during the first stage of labor to relieve pain and promote relaxation. Narcotics are usually given as an injection. They enter the bloodstream and affect the entire body. They do not cause a complete loss of sensation, but they can relieve the nausea and help the mother feel less tense or anxious.

Regional anesthesia lessens or blocks completely the pain in a specific area of the body. It works like the shot a dentist gives to numb a tooth or the shot a doctor gives to numb a cut that requires stitches. The epidural block is a commonly used type of regional anesthesia.

With either narcotic pain relief or regional anaesthesia, the mother can stay awake and play an active role in the birth.

General anesthesia is another form of pain relief. It numbs the whole body and causes a loss of consciousness, (which means that the mother is asleep). This type of anesthesia is commonly used for many surgical procedures, but it is not used for pain relief during labor. However, general anesthesia may be necessary for cesarean delivery or a difficult vaginal delivery (for example, if the mother is bleeding too much or the baby is having problems).

WHAT IS AN EPIDURAL BLOCK?

In an epidural block, a small needle is inserted into the mother's lower back. A tiny tube is then inserted into the epidural space through this needle. Then the needle is removed and the tube or catheter is left in place. Pain-relieving medication is continuously administered throughout labor. The epidural catheter functions like a miniature IV, and the rate at which the medication is given can be adjusted as needed.

In small doses, an epidural block numbs the birth canal and the area surrounding the baby during labor and delivery. It eases the pain of contractions and the pain associated with the actual delivery of the baby. In higher doses, an epidural may be used for cesarean sections.

Other types of blocks to relieve pain are sometimes used: pudendal block, spinal block, saddle block, and paracervical block. The injection sites and area that are numbed differ for each type of block. For example, a pudendal block is given just before delivery of the baby. It relives pain around the vagina and rectum as the baby comes down the birth canal. It is also helpful just before an episiotomy. The medication is injected inside the vagina. Pudendal blocks are one of the safest forms of pain medication.

Epidural blocks are usually used instead of spinal, saddle or paracervical blocks.

Controversy continues as to whether an epidural block can slow the labor process, and studies designed to evaluate this issue have had conflicting results. Patient with painful and/or difficult labors are likely to have a prolonged labor course whether or not they choose an epidural anesthesia. In well designed studies, epidural anesthesia has not been shown to significantly affect the duration of labor.

WHAT ARE THE RISKS OF USING MEDICATIONS FOR PAIN RELIEF DURING LABOR?

Because narcotics and sedatives affect all of a mother's body, both the mother and the baby may have side effects from these medications. The mother may feel drowsy or dizzy. She may have trouble concentrating and it may harder for her to concentrate on pushing during delivery. More serious possible side effects are a slowing of the mother's breathing or heart rate or a slowing of the baby's reflexes and breathing at birth. To reduce such complications, narcotics and sedatives are given in small doses and are usually not used when the baby is about to be delivered. In reality, complications related to these medications are rare.

Regional anesthesia does not directly pass to the baby and affect the baby because the medication does not enter the mother's bloodstream. However, regional anesthesia can make it more difficult for the mother to learn to push. In these cases, the use of forceps may be necessary to help the guide the baby out of the birth canal. On the other hand, an epidural anesthetic allows many women to push more effectively than they would be able to do on their own.

An epidural or spinal block can also cause a mother's blood pressure to drop. This can cause her to be lightheaded, and it can slow the baby's heartbeat. To help prevent this from happening, the mother is given fluids through her veins (an IV) before she is given the medication. Additionally, the blood pressure is followed very closely while an epidural level is being achieved. Significant decreases are controlled with medication given intravenously. Other side effects that the mother may have include difficulty breathing and headache. The incidence of headaches is approximately 1%.

HOW CAN PAIN DURING LABOR BE RELIEVED WITHOUT MEDICATIONS?

Some techniques that help a woman cope with labor pain without medications are:

  • Lamaze or Bradley methods of prepared childbirth: Pregnant women and their partners take classes to learn about childbirth, body-building exercises, and methods of relaxation. Breathing exercises are an important part of the Lamaze method. Various forms of meditation are emphasized in the Bradley method. Many mothers who use these methods are able to go through labor and delivery with no medication for pain. A major advantage of these techniques is that they can easily be combined with other methods for controlling labor pain.
  • Hypnosis, acupuncture, and TENS (transcutaneous electric nerve stimulation) have also been used to help treat the pain of labor and delivery. None of these methods are used to any significant degree in this country.