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McKesson Clinical Reference Systems: Women's Health Advisor 2002.2
Pain Relief in Labor and Delivery
There are many ways to lessen pain during labor and the
birth of a baby. Several kinds of drugs can relieve the
pain. Drugs can be used to remove all feeling from just one
part of your body or from all of your body. Or they may
relieve pain without a total loss of feeling. Methods of
relaxation called prepared childbirth may help you have your
baby with very little or no pain medicine.
The type of pain relief that is right for you depends on:
- your physical condition
- your training for childbirth
- the length and stage of your labor
- the amount of labor pain
- the condition of the baby.
During prenatal visits talk with your health care provider
about the kind of childbirth experience you would like to
have. Ask about ways to relieve pain. Also discuss any
fears you have about labor and delivery.
What types of drugs are used for pain relief?
Your health care provider will try to provide maximum pain
relief for you without hurting the baby.
Narcotics (such as Demerol and morphine) and sedatives (such
as Phenergan) may be used during the first stage of labor to
help you relax. Narcotics are usually injected into a vein
(IV) or into a muscle. They affect the entire body.
Narcotics do not cause a complete loss of feeling, but they
do lessen the pain. Sedatives are usually injected into a
muscle. They do not lessen the pain, but they can help you
feel less tense or anxious.
Regional anesthesia lessens or blocks completely the pain in
a specific part of the body. It works like the shot a
dentist gives to numb a tooth. The epidural block is a
commonly used type of regional anesthesia.
With either narcotic pain relief or regional anesthesia, you
can stay awake and play an active role in the birth.
General anesthesia is another form of pain relief. It
relaxes your muscles, puts you to sleep, and prevents you
from feeling pain. This type of anesthesia is often used
for surgery, but it is not used for pain relief during
labor. General anesthesia may be necessary for a cesarean
delivery or a difficult vaginal delivery (for example, if
you are bleeding too much or the baby is having problems and
you need a quick delivery with forceps or vacuum
extraction).
What is an epidural block?
For an epidural block, you are given a shot of
pain-relieving medicine in your lower back. Usually a small
tube is inserted into this area of your back through the
needle. Then the needle is removed. This makes it possible
for you to be given more medicine again, or continuously
through a catheter, instead having another shot.
In low doses, an epidural block numbs the birth canal and
the area around the baby during labor and delivery. It
eases the pain of contractions. In higher doses, an
epidural may be used for cesarean births.
You may still feel your contractions with an epidural block.
You may still be able to help deliver the baby by pushing.
If you are very numb, your provider may need to use forceps
or vacuum extraction to deliver the baby. Another choice is
to lessen or stop the medicine so you can push the baby out.
Other types of blocks to relieve pain are sometimes used:
pudendal block, spinal block, saddle block, and paracervical
block. The injection sites and areas that are numbed are
different for each type of block. For example, a pudendal
block is given just before delivery of the baby. It
relieves pain around the vagina and rectum as the baby comes
down the birth canal. It is also helpful just before an
episiotomy. (An episiotomy is a procedure in which a small
cut is made by your provider to make the birth canal opening
bigger). The medicine for a pudendal block 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.
What are the risks of using drugs for pain relief during
labor?
Because narcotics and sedatives affect all of your body,
both you and your baby may have side effects from these
drugs. You may feel drowsy or dizzy. You may have trouble
concentrating and it may be harder for you to push during
delivery. More serious possible side effects are a slowing
of your breathing or heart rate or a slowing of the baby's
reflexes and breathing at birth. To reduce such problems,
narcotics and sedatives are given in small doses. They are
usually not used when the baby is about to be delivered.
The medicines used in most methods of regional anesthesia
are less likely to pass to the baby and affect the baby
because the medicine does not enter your bloodstream.
However, regional anesthesia can make it harder for you to
push. Or it may cause the baby's head to not turn normally
during delivery. In these cases your provider may have to
use forceps or vacuum extraction to guide the baby out of
the birth canal.
An epidural or spinal block can cause your blood pressure to
drop. This may slow the baby's heartbeat. To help stop
this from happening, you will be given fluids through your
vein (an IV) before you are given the block. Other possible
side effects are trouble breathing and headache.
How can pain during labor be relieved without drugs?
Some ways to cope with labor pain without drugs are:
- Lamaze or Bradley methods of prepared childbirth: You and
your partner can take classes to learn about childbirth,
body conditioning exercises, and methods of relaxation.
Breathing exercises are an important part of the Lamaze
method. Forms of meditation are emphasized in the
Bradley method. Many mothers who use these methods are
able to go through childbirth with less or no medicine
for pain.
- Hypnosis: The usefulness of this procedure varies from
person to person. Hypnosis requires a lot of time and
classes with your health care provider before you are
ready for delivery.
- Acupuncture: Small needles are applied to special areas
of the body to lessen the pain of contractions.
- Transcutaneous electric nerve stimulation (TENS): Mild
electric impulses are used to stimulate the nerves and
block pain.
All of these techniques can be used with other treatments
for labor pain.
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