Get Set: Pain Relief Options

In early labor when contractions are getting intense but are still not close enough to leave for the hospital, there are a few ways you can ease the pain.

Nonmedical Solutions

First have plenty of pillows on hand. Experiment with different positions, such as on all-fours, against a wall, and leaning against someone or something while bent forward at the waist.

If you don't want to be bound to your bed during labor, find out whether your birth facility has fetal monitors that use telemetry. These wireless monitors strap on like a regular external device so that you don't have to remain plugged into anything. There are even telemetry units that are waterproof, if you plan on easing labor pains with hydrotherapy.

Back labor, which occurs when baby's face is toward your abdomen rather than toward your spine, can cause severe lower back pain. Ask your partner to try massage or a warm water bottle to ease contractions. The soothing jets of a whirlpool tub can do wonders, if you have one. If your water has broken, however, never take a soak without approval from your provider.

Keep positive, supportive people around you. Let your coach be your buffer and clear out any distractions. Try to remain focused on riding through and past the contraction. Fix your eyes on something that relaxes you and practice the breathing exercises you learned in childbirth class to keep the oxygen and blood flowing. Don't hyperventilate. Talk or groan through the peak of the contraction if it helps.

It's difficult to relax while you're in the midst of a really big, really uncomfortable contraction. However, letting go in between contractions can help ease your mind and body and loosen you up for impending delivery. You probably learned a few relaxation exercises in childbirth class. If so, now is the time to try them, since they can make the pain more manageable.

Progressive relaxation, which is a series of muscle tightening and release, is a good way to release your stress. Make sure you're in comfortable clothes in a soothing atmosphere (that is, quiet and perhaps dim). Recline with your head and back elevated, then start tensing and releasing each muscle group, from your head to your toes. Breathe in with the tension and blow out with the release. Try to clear your head of everything but the sensation at hand. If you practice this prior to labor, it can be a good tool for managing some of the early pain when contractions are still relatively far apart.

Pharmaceutical Options

Once you arrive at the hospital, you will have analgesics and anesthetics available for pain relief, if you choose to use them.

Analgesics

Analgesics deaden the pain by depressing your nervous system. They make you sleepy and help you rest between contractions. The analgesics Demerol (meperidine), Stadol (butorphanol), Nubain (nalbuphine), and Sublimaze (fentanyl) are commonly used in labor. Although some of these drugs, such as Demerol, can even allow you to nap between contractions, you remain conscious under their influence (albeit a bit giddy). Although these medications can cross the placenta, when they are properly administered in the appropriate dosages they should not cause baby any serious side effects.

Pain relief in labor was roundly condemned for many centuries, partly on biblical grounds (think Eve and the apple), until Queen Victoria of England requested and was administered chloroform for the birth of her eighth and ninth children. The resultant births of Prince Leopold and Princess Beatrice were attended by a pioneer in anesthetic use, Dr. John Snow.

General Anesthesia

You may also receive either a general or local (regional) anesthetic. General anesthesia brings about a complete loss of consciousness (or “puts you to sleep”). General anesthesia is rarely used in labor and delivery, usually only in cases of an emergency cesarean section when there isn't adequate time to prep the patient with a local anesthetic. Newborns arriving under the influence of a general anesthesia can be drowsy and slow to respond due to the effects of the anesthesia.

Local Anesthesia

Local anesthesia, also called regional anesthesia, numbs only a specific portion of the body and leaves you awake and alert. The most commonly used local anesthesia is probably the lumbar epidural. Injected into the space between two vertebrae of your lower back (the epidural space), this type of anesthesia is administered when you are well into labor and will temporarily numb the nerves all the way from your bellybutton to your knees. An epidural takes twenty minutes to start working and can also lower your blood pressure. For this reason you'll be put on the fetal monitor and hooked up to an IV fluid drip if you're given an epidural.

Some providers may require you to wait until you reach a certain dilation benchmark or stage of labor to have an epidural. But if you are being induced, an epidural might be in order earlier since you can experience a lot of pain before there is any major progress in the dilation of your cervix. With an epidural most providers will give you more time to push because your sensation is impaired. If you have concerns about epidural timing, discuss them with your health care provider.

The epidural is administered through a small plastic catheter in your back. An anesthesiologist will place the epidural catheter and administer the local anesthetic agent. Before he starts, your lower back will be draped and the insertion spot swabbed with antiseptic or iodine. You might be asked to pull your knees and chin toward your chest so your spine is more visible. The catheter is inserted in the space between the fourth and fifth vertebrae and the anesthesia injected into it. You may feel a slight stinging sensation down your legs, but your breathing and the involuntary muscles working those contractions won't be affected. The insertion of an epidural catheter allows anesthetics to be administered on an as-needed basis and is useful should a C-section be required.

After insertion the doctor will secure the catheter, and you can get comfortable again. Watch the fetal monitor for the start of the next contraction. You'll be amazed at how what was turning you inside out a moment ago is barely perceptible now. The numbness will take several hours to wear off and may restrict your movements during the birth, but an epidural can be a great pain management tool.

A spinal block is similar to an epidural in that it's administered in the lower back. However, a spinal is delivered directly into your lower spine, not into the spaces between your vertebrae as in an epidural. Used right at delivery only or during a C-section, the spinal will numb you all the way from your rib cage down.

Women who want the pain relief benefits of an epidural but also to retain the ability to move around during labor are candidates for a low-dose combination spinal epidural, sometimes referred to as a walking epidural. An epidural catheter is inserted, and an injection of a narcotic is administered into the spinal fluid by using a smaller needle that fits through the epidural catheter. A walking epidural is usually faster acting than a conventional epidural and allows you to retain enough sensation to move and walk, which can speed the labor process.

Other anesthetic blocks that are used less frequently include:

A caudal block is administered into the bony area right at the end of your spine, which affects the abdominal and pelvic muscles.

A saddle block is a type of low spinal that numbs a more limited area of your body — your perineum, inner thighs, and bottom.

With a paracervical block, the anesthetic is injected into either side of your cervix during labor to numb the area.

With a pudendal block, the anesthetic is administered to the nerves around the vagina and pelvic floor to help control pain when the baby's head bulges into your cervix.

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