As you get closer to your due date, you may be thinking about your birth plan. An important part of that plan is determining how you want to manage your pain during labor.
Labor pain can be unpredictable, and your plans may change as it’s happening. You may experience the pain differently than you imagined, or your healthcare provider may suggest an option that wasn’t part of your original plan.
However, “just like there’s no one right way to give birth, there’s no one right way to manage pain. What you choose is a personal decision,” says Dr. Nicole Calloway Rankins, a board-certified ob/gyn. That’s why it’s important to familiarize yourself now with the available pain management options.
Read on to learn about the many ways to manage pain during labor, including their benefits, risks, and side effects.
Epidural
When it comes to pain management during labor, the first thing many people think of is an epidural. According to the American Pregnancy Association, this is the most common method of pain relief in the U.S., used by more than 50% of women who give birth in hospitals. An epidural helps to decrease most sensation, including pain, in the lower half of your body.
If you choose to get an epidural, an anesthesiologist will place a thin tube (catheter) in the epidural space, which is the outermost part of your spinal canal. This allows for a continuous or repeated stream of pain-relieving medication. The dose can be adjusted as needed, either by your healthcare team or by a pump that you control with a button. (The device is programmed to ensure you can’t give yourself too much medication.)
Once the epidural is in place, you typically won’t have enough sensation in your legs to stand or walk around. But you should still have enough feeling to push when the time comes. “If you find that you don’t have enough feeling at that stage, you can ask your nurse to decrease the dose,” Dr. Rankins advises.
One benefit of an epidural is that it allows you to rest if you have a long labor, so you have more energy for pushing. “I had an epidural to manage my pain during labor,” explains mom Shelby. “I found that I could focus more on the birth and I could pay better attention to my body if I could have support from the epidural to relieve the pain.”
But, as with any medication, there are possible risks and side effects with an epidural. These include:
- Headache
- Itching
- Shivering
- Nausea or vomiting
- The chance that the epidural may need to be replaced
- A drop in your blood pressure that can affect the baby’s heart rate
- A slight increase in the likelihood of having an assisted vaginal delivery with forceps or a vacuum
- Extending your labor by a short amount of time
- A short-term impact on early breastfeeding
These are all things you’ll want to keep in mind as you weigh your options for pain management, Dr. Rankins explains.
Other medications
Epidurals are common, but they are not the only medication used to manage pain during childbirth. Other options include opioids and nitrous oxide.
Opioids
Opioids are narcotic medications that can be given as a shot into your muscle or through an intravenous, or IV, line. The pain relief lasts anywhere from 2 to 6 hours. There are a variety of opioids available; the specific one used will depend upon your hospital and healthcare provider.
Opioids do not numb the pain like an epidural; instead, they “take the edge off” the pain.
Common side effects and risks of IV opioid medications may include:
- Allergic reaction
- Itching
- Nausea or vomiting
- Feeling drowsy or having trouble concentrating
It’s also important to note that opioids do cross the placenta and affect your baby. They may impact your baby’s heart rate during labor and their breathing once they are born. Your baby may also be drowsy, which could make it harder to breastfeed in the first few hours. Babies will clear the medication from their system like you do—it just takes little ones longer to do so.
Nitrous Oxide
Another option is nitrous oxide, more commonly known as “laughing gas.” You may be familiar with this medication from the dentist’s office. This tasteless and odorless gas is inhaled through a mouthpiece or facemask, and it clears your system quickly with no known risks for the baby.
During labor, nitrous oxide can help reduce your anxiety and make the pain easier to deal with, according to the American College of Obstetricians and Gynecologists. As with epidurals and opioids, with nitrous oxide you will remain alert throughout the birth experience.
Common effects and risks of nitrous oxide include:
- Dizziness
- Nausea or vomiting
- Feeling drowsy or silly
If you are interested in these non-epidural options for pain relief, talk with your healthcare provider as you build out your birth plan. They will be able to tell you what is most readily available at your hospital or birth center.
Non-medication options
Some mamas choose to experience labor and birth without any medical interventions. If you want to aim for a medication-free birth, this will take more preparation. “It’s important to plan for what techniques you’ll use to manage pain,” says Dr. Rankins. “If you don’t have a plan, the pain can potentially feel overwhelming.”
Dr. Rankins also recommends having a support person present for your labor and birth, whether that’s a partner, family member, or birth doula. “Communicate your plans for a medication-free birth ahead of time, so your support person can help you and advocate for your wishes while you’re focused on your labor,” she says.
There are quite a few techniques for easing labor pains without medication. These include:
- Focused breathing or relaxation exercises, which can help you relax and distract you from the labor pains.
- Hydrotherapy, which uses warm water to help alleviate pain. Many moms find this very soothing, Dr. Rankins points out. “You can do this both at home while you’re in the early stages of labor, and in your labor room at the hospital if it’s available,” she says. “It’s a good idea to check with your hospital ahead of time to see if they have showers or tubs.”
- A birthing ball, which is an exercise ball you can bounce, roll, or lean on during labor. You can ask if your hospital has birthing balls available, or plan to bring your own from home.
- Walking, moving, or changing positions. Motions like leaning, lunging, or getting on all fours can all help reduce pain. Being on all fours is also a great position for a support person to give you a lower back massage, which can help you get through painful contractions.
These are just some of the techniques available to you. If you desire a medication-free birth, explore your options ahead of time, so you have them in your toolbox for the big day.
A personal choice
There is no one right way to manage labor pain. Every woman, pregnancy, and birth are unique. You might even combine these techniques over the course of your labor and birth. And if your birth plan changes midstream, that’s OK.
The best plan is going into your labor with an understanding of the available pain management options—so you’ll be empowered to make the choice that works best for you and your baby.
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