Pain management options during labor are probably top of mind for you. It may have been one of the first things you figured out for your birth plan.
There’s no getting around how painful childbirth is. But there are measures you can take to maximize your comfort as much as possible. Whether they involve breathing and movement, pharmaceutical help, or even hypnosis, these comfort measures are all meant to support you in getting to meet your baby.
In “Overdue,” our maternal health series made in partnership with Un-ruly and Gerber, doula and registered nurse Ebony Harvey gives an overview of different options for dealing with and minimizing the pain that comes during childbirth in a healthy and safe way.
And in this article, we’re going to take a deeper look into the medical and non-medical comfort measures that are available to you for pain management during labor. Keep reading to learn more, or click on a link in the table of contents to jump to a specific section.
Table of Contents
- Pain Management Options During Labor: What to Know Before Giving Birth
- Non-medicinal Comfort Measures
- Medicinal Pain Management During Labor
- Ask Questions and Make Your Choices Known
Pain Management Options During Labor: What to Know Before Giving Birth
How painful is childbirth? The answer is different for everyone. But at the core of everyone’s experience is this: giving birth takes a lot of you physically and mentally.
So it’s so wonder you’re interested in figuring out ways to find comfort during such an intense experience. But beyond just reducing or managing your pain during labor, there are also some real health benefits to using comfort measures.
First off, a smooth labor—one where anxiety is kept to a minimum—is better for both you and your baby. Oxytocin (the chemical that regulates contractions) flows most effectively when you’re calm. Staying calm also increases the flow of endorphins later on in the labor process, helping you stay focused on your laboring.
… When you’re comfortable during labor, you’ll have an easier time sticking to your birth plan and advocating for yourself.
If you’re stressed or panicked during labor, your muscles will tense up, which makes breathing more difficult. That tension can also potentially stall your labor and/or use up your energy so you don’t feel like you can labor.
Additionally, when you’re comfortable during labor, you’ll have an easier time sticking to your birth plan and advocating for yourself.
When birthing in a hospital, sometimes you may find that their timeline is different than yours and your baby’s. While active laboring can take hours of effort, some doctors and/or labor and delivery nurses may insist on intervening if labor doesn’t seem to be progressing to their liking.
There’s nothing wrong with making use of these labor-starting tools, but the decision to do so should be made by you in partnership with your care providers. (The American College of Obstetricians and Gynecologists encourages shared decision-making to reduce unnecessary interventions and to improve patient satisfaction.)
Remember, your birth plan is something you created in partnership with your health care provider and your support team. You can refuse any treatment you don’t feel is necessary once consulting on the benefits and risks with your provider.
Non-medicinal Comfort Measures
In our video with Ebony demonstrating comfort measures, we talked about non-medicinal pain management options like using a birthing ball.
Here we’re going to quickly touch on some other comfort measures available to you.
Not all pain management options during labor need to come in the form of a pill, injection, or procedure, Ebony says.
“Ask your doctor about low-intervention birth and non-medicated/pharmacological methods such as meditation, breathing exercises, and low stimulation,” she advises.
You can also talk to them about the following options.
1. Laboring in water.
Laboring in water during the first stage of labor has been shown to shorten labor and reduce the use of epidurals and spinal blocks, according to ACOG. It’s also been found to be more comfortable for birthing people and reduce the need for an episiotomy. (And a certified nurse-midwife interviewed by Cleveland Clinic said it can help reduce the cost of laboring by a third, due to the lack of medicine being used.)
Some hospitals and many birth centers will have tubs available for you. (And if you’re laboring at home, there’s of course your own tub there.)
This comfort measure isn’t always an option for people who have:
- to be monitored regularly,
- uncontrolled health issues,
- multiples or a breeched baby, and/or
- premature or large baby.
Something to note however is that contractions can slow down or stop for a moment while you’re laboring in water, according to the Journal of Midwifery and Women’s Health. But overall, there aren’t any known risks to laboring in water, they state.
As ACOG does not recommend giving birth in water, you should talk to your provider if you’d like to have a water birth so you can be supported in that decision.
2. Changing positions.
Staying in one place and laboring and birthing on our backs isn’t really conducive to physiologic birth. (That is, birth happening naturally without medical intervention.)
Despite this, many hospitals have policies in place that restrict or limit your movement, from consistent fetal monitoring to IV fluids. However, ACOG states that moving and changing positions in the first stage of labor can “enhance maternal comfort and promote optimal fetal positioning.”
Laying on your side, walking, standing, and squatting are just some of the labor positions you can get into with the support of your birthing team.
3. Attending to your senses.
Certain things that may not seem very pressing most of the time can suddenly become very important when you’re in labor. For instance, the way a room is lit makes a difference, as your eyes may be more sensitive to light during pregnancy.
Ebony recommends keeping the light in your room off or dimmed if possible. If you’re giving birth in a hospital or birthing center, staff members may have to turn the lights on when they come in for testing. But you can always ask them to turn the lights off when they leave.
Room temperature and your body temperature may also come into play during your labor. You may feel hot, then cold, then hot again. See if you can control the temperature of your room where you’re laboring. Or, Ebony suggests, bring extra layers of clothing that can be put on or taken off as needed.
You can also use aromatherapy if you find it relaxing. But make sure the essential oils you use are pregnancy safe.
4. Eating and drinking while you labor.
Many hospitals have a policy known as “NPO,” the initials of “nothing by mouth” in Latin. This policy restricts eating and only allows for IV fluids. (It’s based on fears of patients aspirating and dying while under anesthesia should doctors need to perform a C-section.)
However, recent research has found that those concerns and policies are based on outdated techniques from the 1940s. Given the switch from general to local anesthesia, and protected airways, the risk of aspiration has significantly reduced in low-risk pregnancies, according to Evidence-Based Birth’s comprehensive guide to eating and drinking during labor.
The World Health Organization (in 1996) and the American College of Nurse-Midwives (in 2008) have recommended dropping restrictions against eating and drinking during labor. “Yet despite the evidence, the American Society of Anesthesia and the American College of Obstetricians and Gynecologists continue to recommend that oral intake for low-risk women be restricted to clear fluids,” according to a 2014 report on unnecessary medical interventions in the Journal of Perinatal Medicine.
With that in mind, talk to your provider about the possibility of eating and drinking during labor. Ebony says that proper nutrition and hydration will not only give you more energy during childbirth, but will also help you make clearer decisions because you won’t be as fatigued.
Additionally, if you have low energy during your labor, your labor can get stalled, which can lead to medical interventions that may be unnecessary.
5. Practicing hypnobirthing.
You may have heard of Lamaze breathing, but have you heard of hypnobirthing?
This relaxation tactic involves a mix of controlled breathing and positive visualizations and affirmations to get your body into a total state of relaxation as you labor. Healthline reports that hypnobirthing has been linked to shorter labor, reduced interventions, and healthier babies.
If this is something you want to consider as one of your pain management options during labor, you may want to consider adding a hypnobirthing expert to your birth team.
6. Asking for nitrous oxide (a.k.a. laughing gas).
Nitrous oxide is not commonly available to folks birthing in the United States. (And the cost isn’t standardized and can be prohibitive as one mom found out.) But if it’s an option at your hospital or birthing center, we wanted to share some information on it with you.
Usually a 50/50 mix of nitrous oxide and oxygen, this is a self-administered pain management option during labor. The gas (currently the only approved on in the States is called Nitrinox) is inhaled through a mask and used to help with managing contraction pains.
“For maximum pain management, you should actually start inhaling about 30 to 45 seconds before your contraction begins so that the drug peaks at the same time your contraction is peaking,” Evidence-Based Birth explains.
While nitrous oxide doesn’t stop the pain, “it really relaxes people so they don’t care about [it] as much,” the article continues.
That said, a 2019 report in BioMed Research International on the pros and cons of nitrous oxide use during labor pointed out that “labor pain scores were no different in a randomized double blind study comparing air to nitrous oxide, and a recent study revealed a median pain score change of zero following nitrous oxide.”
Also the overall long-term impact of exposure on humans and their babies isn’t known. (Animal studies of nitrous oxide show genetic and metabolic changes to the babies and moms.) The con side of the report ultimately concludes that nitrous oxide use be limited to “less than 3-4 hours… and probably to less than 1 hour.”
7. Letting loose.
Childbirth is among one of the most powerful things you’ll ever experience.
If you’re feeling the power—and the pain—of the moment, express it. Holding in screams, grunts, or groans because you feel self-conscious or worried about bothering your birth staff can make you tense up and potentially increase your pain levels.
Lots of different feelings may come up during your childbirth experience. It’s your prerogative to express any and all of them without second-guessing yourself. It’s fine. Let it all out; it’s part of your process.
It’s a good idea to talk about this before you give birth to get a sense of how your provider and birth team will support you if you need to make some noise.
Medicinal Pain Management During Labor
When it comes to pain management options during labor, there isn’t a “right” or “best” choice. It’s all about what makes sense for you and your needs. So if you want to use medications as part of your comfort measures, let’s go! You’ll find that you have plenty of options.
It’s important to check with your doctor to ensure that the option you choose is safe for you. Some of these medicinal treatments for labor pain are…
Epidurals are among the most well-known forms of medicinal labor pain management. But what is an epidural?
An epidural means injecting an anesthetic directly into the space around the spinal nerves, called the epidural space. Some epidurals involve inserting a catheter into the epidural space and leaving it there to deliver medication as needed, while others involve a spinal block and an epidural injection. (We’ll talk about that later.)
Establishing a trusted birth team can help you figure out which pain management options during labor makes sense for you.
Epidurals can provide much-needed pain relief within 10-20 minutes of being administered. Having that relief can help you rest and focus if you imagine laboring will be especially anxiety-inducing for you. It also allows you to stay alert during your labor or C-section so you can see your baby being born.
(Note: There are incredibly rare cases when general anesthesia needs to be used. These are considered medical emergencies as you’ll be entirely unconscious while providers work to deliver your baby.)
Although epidurals are popular and effective, that doesn’t mean they’re for everybody. People with blood-clotting issues, poorly managed diabetes, or allergies to anesthetic drugs may not be able to receive epidurals. They also restrict your movement, so if you’re someone who wants to be up and move around, that’s something to consider.
Also, plus-sized folks may experience higher instances of failed attempts to get the needle in, according to Evidence-Based Birth.
“Researchers have found that health care workers have more failed attempts when inserting epidurals in birthing people with a BMI of 40 or higher, due to a difficulty in feeling bony landmarks,” they report. “However, ultrasound-guided placement of the epidural needle can reduce the length of the procedure and lead to fewer failed attempts.”
Before deciding to have an epidural, talk to your doctor about its side effects. These can include low blood pressure, headaches, nerve damage, or—in rare cases—permanent spinal cord damage. Epidurals have also been known to slow down labor and require the use of intervention (via forceps, vacuum, or C-section) to deliver babies.
Finally, there’s a chance an epidural might not work for you. An estimated 12% of epidurals fail due to improper needle placement or medication administration, prior back surgery, and the baby’s position. This can result in patchy or insufficient numbness.
“If you do have to get an epidural, request that it’s done by the attending instead of residents or interns,” to increase your odds of a successful epidural, Ebony advises.
You may have heard your mom friends mention Pitocin in their birth stories. Oxytocin, as mentioned earlier, is the hormone that induces and regulates contractions. Pitocin is a synthetic form of oxytocin and a helpful tool when it comes to inducing labor.
If you aren’t experiencing contractions—or if they’re too far apart—pitocin delivered via an IV can help jumpstart the process. And by jumpstart, we mean jumpstart: Pitocin-induced contractions are intense. (They’re often stronger and faster than naturally-occuring contractions.)
Pitocin is considered safe and can be very useful when it comes to starting the labor process. In many cases, it helps some people deliver vaginally instead of having an unplanned C-section. It also reduces other risks associated with delayed labor, such as complications due to preeclampsia or relating to the amniotic sac rupturing.
Pitocin may be recommended to induce labor in people who have:
- low amniotic fluid,
- babies who aren’t growing fast enough,
- high-blood pressure,
- gestational diabetes, and
- issues with their major organs.
It’s also delivered after giving birth to people who are at high risk of postpartum hemorrhaging, What to Expect reports.
Of course, like all medicines, Pitocin comes with its own risks. These include changes in your baby’s heart rate, infection or overstimulation of the uterus, and potentially even uterine rupture. This can place both the parent’s and baby’s health—and lives—at risk.
As always, talk to your provider to figure out what makes the most sense for you and your delivery.
3. Pain medications
Some of the same pain medications that are used to treat millions of patients after surgeries or injuries are also used in childbirth. Medicines like Demerol and Stadol are typically administered intravenously, speeding up the rate at which they take effect.
While these medications provide useful childbirth alternatives when an epidural is not an option, they also have many potentially dangerous side effects.
Babies may experience depression of the central nervous and/or respiratory systems, as well as neurological and body temperature regulation issues. These medications—most of which are opioids—can also affect you, causing nausea, dizziness, vomiting, and sedation. They can also be habit-forming, so definitely check in with your doctor about if and/or how these medications will be used.
4. Hormonal Gels
Progesterone is a hormone in your body that plays an important role during pregnancy. It regulates uterine health. In fact, if you have low progesterone levels, you may be at an increased risk for Trigger warning: Click to reveal miscarriage.
Progesterone levels in the body can be regulated with progesterone gel, which is designed to be administered in the vagina. Often sold under the brand names Crinone, Prochieve, and Endometrin, progesterone gels aren’t just for use during labor—they’re meant to be administered throughout pregnancy in order to get progesterone levels closer to a place that’s ideal for parent and child.
Side effects can include bloating, headaches, stomach pain, or, in more serious cases, shortness of breath and/or chest pain.
5. Spinal Blocks or “Walking Epidurals”
Spinal blocks are similar to epidurals in the sense that they’re both pain-management injections delivered via needles in a patients’ backs.
The main difference between the two is placement. While the needle is inserted into the epidural space during an epidural, in a spinal block it’s injected into the dural sac. Since the dural sac contains brain and spinal fluid, this means that anesthesia takes effect faster.
While epidurals are more commonly used than spinal blocks, the quickness of spinal blocks makes them a handy tool if you need immediate pain relief. Known as a “walking epidural,” some may even prefer them as it leaves you with more feeling in your lower half than the former. (But don’t expect to be walking right away!)
The risks associated with spinal blocks are the same as those associated with epidurals.
Ask Questions and Make Your Choices Known
So as you can see, there are many different tactics and pain management options during labor available to you.
Establishing a trusted birth team can help you figure out which pain management options during labor makes sense for you.. Having that infrastructure in place means that you’ll be able to ask for more information about any of the comfort measures listed—or not listed—here and receive a personalized answer that speaks directly to your health and your pregnancy.
After that, you’ll be able to make informed decisions about which resources are right for you and add them to your birth plan.