Pain Relief for Childbirth

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As the big day approaches, you are probably getting more concerned about the pain of childbirth. Outlined below are the most common pain relief choices available at most hospitals, with risks and benefits defined.


Epidural
Epidurals are the most popular form of pain relief in the United States as they block pain but do not enter the bloodstream.


“Epidurals are fantastic for pain relief. Overall, serious risks of an epidural are extremely low,” says Kristen Innes, M.D., an obstetrician running her own practice in Dallas, Texas. Over the years, physicians have honed the epidural by reducing dosages and combining drugs that minimize side effects. Some are known as “walking” epidurals that allow you to get up and walk the halls during labor. Not all hospitals offer these, so you need to ask your physician. Some hospitals also offer the patient-controlled epidural, allowing the laboring woman to control the amount of medication delivered by pushing a button.


What happens: An anesthesiologist injects a needle with a catheter into your spinal column. The catheter stays in, delivering medication continuously into the covering around the spinal cord, called the dura.


Pros:


  • Blocks most pain in the lower body and usually allows some lower extremity movement
  • Can be used continuously for several hours
  • Doesn’t make you drowsy, but relaxes you since the pain is gone, so you are able to rest or even sleep until the pushing stage
  • May help some anxious women dilate, as a result of the relaxation
  • Doesn’t cause significant slowing of labor


Cons:


  • May provide uneven pain relief, affecting one side of the body more than the other. “They can be uneven because the medicine is essentially distributed by gravity. For example, if a patient is tilted with a particular side down, that side will be more numb,” explains Innes.
  • May decrease blood pressure, which can slow the baby’s heart rate
  • May increase the length of time you push as it can decrease your ability to use your pelvic floor muscles
  • May cause a “spinal headache” if spinal fluid leaks during or after the procedure. Also may require the placement of a “blood patch” over the leak to prevent more fluid from leaking and causing persistence of the headache
  • Other rare side effects include nausea, vomiting, itching and shaking, which usually go away after the drugs wear off
  • According to Innes, an epidural may (rarely) affect your chest muscles and cause difficulty breathing, or that sensation, caused by having too high a dose


Spinal Block
What happens: As with an epidural, a spinal is administered by an injection in the lower back. The needle goes through the dura, directly into the spinal canal. Most women feel numb from the waist down, which can affect their ability to push. Spinals are usually given as close to delivery as possible, because they usually wear off after a couple of hours.


Pros:


  • Provides almost immediate and complete pain relief from the chest down, with a lower drug dosage than an epidural
  • Allows you to remain awake and alert


Cons:


  • May decrease blood pressure, which can slow the baby’s heart rate
  • Rarely, causes lightheadedness, nausea, or shaking
  • Higher risk of spinal headache compared to epidural blocks
  • Loss of bladder control (Sometimes there is the temporary need for a bladder catheter.)
  • May wear off before baby is born since it’s hard to predict delivery times and doctors don’t like to give more than one spinal block for risk of severe headache


Combined Epidural-Spinal
What happens: An anesthesiologist administers a spinal needle and inserts a micro-catheter in the needle to be able to provide an epidural later, if necessary.


Pros:


  • Provides the immediate pain relief of a spinal, plus the continuous medication of an epidural if you need it. You also don’t lose the ability to move


Cons:


  • Same side effects as are associated with a spinal and an epidural


Intravenous Narcotics
What happens: medications such as Stadol, Sublimaze, Demerol, and Nubain may be injected, or most likely administered intravenously. In some instances, you may be able to control your dosage by pressing a button that injects a fixed dose of the medication into your IV. The effect usually lasts two to six hours. The best time for them is in early labor to minimize the side effects, including low blood pressure. Typically, doctors do not give narcotics often.


“Narcotics during labor and delivery are usually not used because they can be passed to the fetus and cause the fetus to have respiratory depression at delivery. Sometimes we have to give the infant Narcan, which is a narcotic antagonist, after delivery to cancel the effects and stimulate the infant to breathe,” explains Innes.


 “There are very few narcotics that are given in labor, and usually in small amounts, Stadol is probably the most popular drug. It takes the edge off the pain but does not provide complete relief like spinal or epidural anesthesia can,” Innes adds.


Pros:


  • These drugs won’t cause numbness or difficulty when you’re pushing


Cons:


  • People need differing levels of narcotics—so at set levels, some patients may still feel pain, while others may pass out, which is why experts say it is better to opt for the patient-controlled pumps when narcotics are absolutely necessary
  • The narcotic enters your bloodstream directly, so more of it reaches the baby, whose short-term side effects may include drowsiness and difficulty breathing
  • May temporarily make it harder for you to breathe as well
  • May decrease the memory of your labor

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