April 10, 2024

Unsure of your options for staying comfortable during labor and delivery? Our experts discuss pain medicine options — and provide advice on how to decide what’s best for you.

When you’re pregnant, you’re eagerly anticipating the birth of your little one. But being a bit apprehensive about delivery is also normal. You may be wondering about your options when it comes to pain management — or maybe you’re hoping to deliver without pain medication. Here’s what you need to know about your available choices.

“Every situation is different, and it’s not a failure to need or want a pain medicine.”

“I like patients to know that every delivery is different,” said Dr. Camille Robinson, an obstetrician with Vanderbilt Women’s Health. “Every situation is different, and it’s not a failure to need or want a pain medicine. I think some patients think that if they don’t go ‘natural,’ that something’s wrong.”

All available pain medications are both safe for mom and baby, she added.

Delivering without pain management

“It takes a very special person to be able to withstand the pains of labor,” Robinson said. “I like to counsel patients that you really want to be mentally prepared for it.” To get prepared, patients often take childbirth hypnobirthing classes or meditation courses designed for delivery purposes. Ask your care team about your options.

Even if your goal is not to use pain medication, it’s available if you change your mind. “Know that it’s there if you need it,” she added. However, some pain-control options are best used early on.

An epidural

“By far, the most common and most effective method of pain medicine is to get an epidural,” Robinson said. An epidural is regional anesthesia delivered to your back through a catheter. “Because it’s continuous, it’s long-term,” she added. “It can be there for hours and does not affect the baby or the course of delivery.”

Some people think that an epidural will prolong the labor and delivery process. “Studies have shown that it does not increase the chance of C-section and it does not affect the labor course in a significant way,” Robinson explained.

Your doctor may recommend an epidural if a C-section is looking likely. “We can move much faster and more safely in an emergency to deliver with regional anesthesia, meaning an epidural or combined spinal/epidural,” Robinson explained. “The other option is general anesthesia where the mom has to go to sleep, and thus the baby has to be delivered very quickly to minimize the anesthesia effects on the baby.”

If general anesthesia is required, a support person cannot accompany you to the operating room. One person can accompany you if you have an epidural or combined spinal/epidural.

An epidural can also be beneficial in the case of a complex vaginal tear. Repairs are easier to tolerate with epidural anesthesia because you won’t be able to feel the stitching process, Robinson noted. Local anesthesia, such as lidocaine, is used for laceration repair if an epidural is not in place.

Intravenous pain medications during labor

Your care team can provide labor analgesia, such as a narcotic, via an IV. Often IV pain meds are given in early (latent) labor or when a patient requires a procedure, such as the placing of a Foley balloon, a method used to induce labor.

The use of narcotics is avoided when close to delivering. “That’s because they can make mom and baby a little bit drowsy,” Robinson explained.

Nitrous oxide

Nitrous oxide is a short-acting inhaled gas that provides temporary relief and is available at certain hospitals and The Vanderbilt Birth Center. It is self-administered via a face mask. “You can breathe that in during the contraction itself,” Robinson said. “Then in between contractions, you’re not using anything.”

How to choose

Your doctor or midwife and care team will go over all your options along with the pros and cons. You can plan based on your goals. However, you don’t have to decide until something is needed, Robinson explained. And you can switch between pain options. For example, some people choose IV medications and then nitrous oxide and then an epidural.

Expert care for you and your baby

Each pregnancy and delivery is unique and yours should be too. Learn more about how Vanderbilt Health’s obstetrics and maternal fetal medicine teams bring together nationally ranked expertise and personalized care from your first prenatal visit to delivery and beyond.

To learn more, call 615-343-5700 or schedule an appointment online.

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