Medical Pain Relief Options during Childbirth

Introduction

It is no secret that labor and delivery can be an incredibly painful experience. While some people prefer to have a natural birth (i.e. one without pain medications), others want to take pain meds as soon as possible. In the case that you decide to forego the natural route, this post discusses some of the medical pain relief options available to you.

Epidural Block

Ah, yes. The most popular L&D pain medication of them all. This is an anesthetic (pain-eliminating drug) that is continuously injected via a catheter in the lower back. It requires an anesthesiologist for administration which can increase the cost. It takes 1-15 minutes before the effects are felt. Although the pain will be gone, there still might be feelings of stretching or pressure.1 In a study that compared laboring patients who received an epidural to those who went natural, it was found that both groups experienced the first stage of labor in similar time lengths, but patients with epidurals had significantly longer second stages of labor. In addition, while there were similar proportions of Cesarean sections between groups, the patients with epidurals had more operative vaginal deliveries (deliveries where forceps or a vacuum is placed in the lower vagina to assist in the delivery).2

Pros

  • Most effective pain relief option2
  • Does not slow labor progression in the first stage1
  • Rare to see permanent maternal side effects1 (the idea that epidurals is the reason why older women have lower back pain is a myth!)

Cons

  • Failure rate of 10%2
  • Maternal side effects include fever, itchiness, back soreness, and headache1
  • 10% of patients get low blood pressure (hypotension), which affects uterine blood flow, and therefore fetal oxygenation.2 This can slow the fetal heart rate.1
  • Potential nerve damage if the catheter is too rigid or put in too deep2

Spinal Block

The spinal block is often confused with the epidural block. While the spinal block is also injected into the lower back, the spinal block is a one-time dose of a narcotic (fentanyl, lidocaine, or bupivacaine) through a needle, while an epidural is a continuous supply of an anesthetic through a catheter.3 The two can be combined to form a combined spinal-epidural block1

Pros

  • Lasts an hour or two (might be a con but some patients just want a short break)1
  • Administered in one injection1
  • Patient is awake and alert1

Cons

  • Maternal hypotension, which can slow the baby’s heart rate1
  • Difficulty pushing during the second stage of labor3
  • Maternal side effects include headaches, dizziness3, fever, itchiness, and back soreness1

Fentanyl

Fentanyl is a type of opioid that can be used for pain relief. It can be injected through the muscle or through an IV catheter.1 It is often described as a way to “take the edge off” of the labor pain. People who get fentanyl have no significant difference in heart rate, blood pressure, or Cesarean section rate versus people who go natural. In addition, the first stage of labor is actually shorter for those who get fentanyl, although the total length of labor is longer. In addition, fentanyl has a rather short half-life, so pain might increase in the third hour after receiving a dose. Again, some patients might prefer this so they can have a short break from the pain.4

Pros

  • Takes effect within minutes1
  • No need for anesthesiologist1  
  • No permanent infant side effects4

Cons

  • Doesn’t completely eliminate labor pain, especially not during delivery1
  • Maternal side effects include nausea, vomiting, drowsiness1, respiratory depression, euphoria, and sedation4
  • Can affect newborn’s breathing and cause baby to be sleepy upon delivery, which can negatively affect breastfeeding1

Nitrous Oxide

Nitrous oxide, colloquially called laughing gas, is an odorless and tasteless gas that is inhaled through a face mask.1 The inhaled gas is a 50/50 mix of nitrous oxide and air. It is self-administered, and for optimal pain relief, the birthing patient should start inhaling 30 seconds before each contraction. The effects quickly wear off when the mask is removed (i.e. when the patient stops inhaling it).5

Pros

  • Self-administered, so can be used intermittently or continuously1
  • Mother can walk during labor, which is beneficial for progressing labor and coping with pain1
  • Little effect on baby1

Cons

  • Doesn’t entirely eliminate pain (helps to relax and reduce awareness of pain)1
  • Maternal side effects include nausea, vomiting, dizziness, drowsiness1, and reduced awareness of experience5

Pudendal Nerve Block

The pudendal nerve block inhibits sensation of the pudendal nerve, a nerve in the perineum (the area that includes the anus and vulva).6 It is injected into the vaginal wall near the pudendal nerve and takes effect in 10-20 minutes.1 This does not reduce pain from uterine contractions or cervical dilation, but it blocks feeling of the perineum and lower vagina. Therefore, it can be useful during operative vaginal delivery or during laceration repair post-delivery.6

Pros

  • Rare negative effects for baby1
  • Pain relief only in lower vagina and vulva (good option if you want natural delivery but don’t want to feel the repair after)1

Cons

  • Does not always work1
  • Some people experience allergic reaction or infection1
  • 31% of people lose the bearing down reflex (the natural urge to push), which can increase the second stage of labor6

Conclusion

If you decide to use pain medications during labor and delivery, there are more options than the epidural!! In this post, I discussed the epidural, spinal block, fentanyl, nitrous oxide, and pudendal nerve block. There are others, too! I mentioned the combined spinal-epidural block, and there are also other opioid options. Educate yourself on different options and their pros and cons, so you can make an informed decision that is best for you.

References

1. Mayo Clinic Staff. (2017, July 8). Labor and Delivery: Pain Medications. Retrieved from:  https://www.mayoclinic.org

2. Silva, M. & Halpern, S.H. (2010, December 8). Epidural analgesia for labor: Current techniques. Local and Regional Anesthesia, 3, 143-153. doi: 10.2147/LRA.S10237

3. Anonymous. (2019). Spinal Block. Retrieved from: americanpregancy.org

4. Shoorab, N.J., Zagami, S.E., Mirzakhani, K., and Mazlom, S.R. (2013, August 23). The Effect of Intravenous Fentanyl on Pain and Duration of the Active Phase of First Stage Labor. Oman Medical Journal, 28(5), 306-310. doi: 10. 5001/omj.2013.92

5. Likis, F.E., Andrews, J.C., Collins, M.R., … McPheeters, M.L. (2014, January). Nitrous Oxide for the Management of Labor Pain: A Systemic Review. Anesthesia and Analgesia, 118(1), 153 – 167. doi: 10.1213/ANE.0b013e3182a7f73c

6. Anderson, D. (2014). Pudendal Nerve Block for Vaginal Birth. Journal of Midwifery and Women’s Health, 59(6), 651-659. doi: 10.1111/jmwh.12222

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6 thoughts on “Medical Pain Relief Options during Childbirth

Add yours

  1. I had no idea that there were so many options for pain relief during the birthing process! It’s good for people to know about the options earlier so that they can do their research and form their opinions beforehand – I can’t even imagine how stressful it would be if expecting mothers were given all these options at the hospital and didn’t know how to pick!

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  2. This is a very informative post! I was surprised to learn that there are so many options for medical pain relief during childbirth. Is it possible that given the current opioid addiction epidemic in America, an additional con of fentanyl use could be increased risk of addiction later in life for the baby?

    Like

  3. This was so informative! Thank you for also including your sources so that I can continue my research. I really appreciate this source of credible information!

    Like

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