Dulling the Pain of Labor: Your Guide to Epidurals and Other Pain Killers

“I’ve been told that birthing is unlike any other pain that a human can experience,” says Katherine Barnwell of Clinton Township, Michigan, when asked whether she’s nervous about birth of her first child. While Barnwell likes the idea of delivering her baby naturally, she’s considering her options before her September due date. Like many women, Barnwell’s waiting until her third trimester before discussing medications with her OB-GYN. However, doctors and midwives suggest that you talk about pain management with your provider in early pregnancy.

Knowing what kind of medications are available helps you voice your desires to your OB-GYN or midwife and feel more in control when it comes to a very vulnerable time—the delivery of your baby.

The Pain You’ll Feel

Every woman experiences labor and childbirth pains differently depending on factors such as the baby’s position and weight, and the length of the delivery. In general, there is a shared experience of a progression of pain working up to the birth of the baby. In the first stage, the contractions help open the cervix until it has almost dilated completely. During this stage there may be pain in the abdomen, back, upper legs, or sides.

In the next stage, when the cervix is fully dilated, the baby begins to descend from the uterus into the vagina. “This creates an increasing pressure in the rectum and lower vagina,” explains Dr. Christopher Viscomi, MD, Director of Acute Pain Medicine and Co-Director of Obstetric Anesthesiology at the University of Vermont.. There is often a burning sensation as pelvic and vaginal tissues are stretched and pushed aside to make way for the baby.

Types of Pain Medications Used for Labor and Birth

Anesthesia (Epidurals)
In the US, epidurals are the most common form of medication used to alleviate pain during labor and childbirth. Epidurals work by blocking pain and two-thirds of women receive epidurals, according to Dr. William Camann, MD, and Kathryn J. Alexander, authors of Easy Labor. The medication, inserted into a woman’s lower spine, works on nerves and prevents pain messages from reaching the brain. Commonly used medications administered in epidurals are Lidocaine and Nesacaine. Low doses allow women to remain mobile while higher doses take away mobility.

To receive an epidural, a woman lies on her side, her body curled. The anesthesiologist then numbs the skin before placing a thin tube or catheter into the epidural space between the spinal bone and the spinal cord. This tube remains in place so that pain medication can be administered as needed.

“The drawbacks to [epidurals] are not inconsequential,” says Dr. Viscomi. “They include a risk of severe headache after the childbirth (approximately one-percent risk), and a remote risk of nerve injury from the technique (approximately a one in 20,000 risk),” reports Dr. Viscomi.

Analgesics (Narcotics)

Instead of offering localized pain relief, analgesics work on the entire body. Demerol, Nubain, and Stadol are the commercial names of narcotics sometimes given to relieve labor pain. These medications travel through the body in the bloodstream. “The effectiveness of these drugs is somewhat variable, but on average decrease pain by 25 to 30 percent,” cites Dr. Viscomi. (Analgesics are most often injected into an IV or a major muscle, such as your bottom.)

All About Epidurals

Perhaps the most significant change in pain relief has taken place with epidurals. “When I first started practicing 22 years ago, the amount of medication used in the epidural left the woman’s legs paralyzed for the entire labor. Today we use about a fifth to a tenth the amount of medication that we used to,” says Dr. William Camann, Director of Obstetric Anesthesia at Brigham and Women’s Hospital at Harvard Medical School.

There is a variety of epidurals available. Here’s a rundown of the most commonly used:

Traditional or Basic Epidural

Medication injected into the lower spine takes effect in 10 to 20 minutes, numbing the body below the waist. The legs can sometimes become numb to the point of being immobile.

Spinal Block

Instead of requiring a tube in the back to administer pain relief, a spinal block involves one injection into the lower spine for instant pain relief that will last for several hours. A spinal block may cause immobility.

Combined Spinal Epidural (CSE)

A CSE brings together the instant relief of a spinal block with varying medication amounts of an epidural. The anesthesiologist inserts a tube in the back as with a traditional epidural, but the laboring woman is given a spinal injection first for instant pain relief. Lower dosages of pain relief can then be administered as needed.

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