Managing Labor Pain
Childbirth and labor pain at a glance
- The primary goal of pain management during childbirth is to relieve labor pain while depressing the central nervous system as little as possible in order to have an alert and participating mother and an alert baby.
- Pain management during labor and delivery is different for each woman depending on her preferences as well as medical conditions that may warrant certain treatments.
- Managing labor pain involves two types of medications: analgesics to lessen pain and anesthesia to block all feeling.
- Nitrous oxide (laughing gas) to relieve pain and reduce anxiety is also available at the University of Colorado, and it’s one of the few area hospitals offering it.
Why we manage labor pain
There are many labor pain management options for women about to give birth.
The primary objective regarding pain management in labor and delivery is to relieve pain while depressing the central nervous system as little as possible in order to have an alert and participating mother and an alert baby. Alleviating labor pain involves administering medications.
“Natural childbirth” means using no medications. Focused breathing and other relaxation techniques alone get many women through labor and delivery pain. But there’s really no way to know how much pain a woman will experience and how she will react to the birth until labor comes.
Medications used to relieve labor pain
Managing labor and delivery pain involves two types of medications: analgesics and anesthesia. These are administered in two ways, local or regional (specific body area) and systemic (entire body). There are many combinations of these two types of pain relief administered in these two ways that we use for women in delivery.
Analgesics lessen pain without producing a complete loss of feeling so the woman can still control muscle movement. Anesthesia (anesthetics) blocks all feeling in general.
Analgesic acts on the whole nervous system, not just on one area of the body. These are usually used early in labor and are given as a shot or in an intravenous (IV) drip that the mother can control herself. Narcotic analgesics may be used in some instances to lessen the nerve sensitivity.
Local anesthetics are used to reduce pain in a specific area and are generally used right before delivery. Often, this is a shot that deadens the feeling in the nerves that travel to the vulva, vagina and perineum (the area between the anus and vulva).
Local analgesics and anesthetics act on a region of the body to reduce pain (analgesics) and block it (anesthetics). In labor and delivery, this involves the area below a woman’s waist. These include an epidural block, a spinal block and a combined spinal-epidural (CSE) block.
Used more than any other labor and delivery pain method in the United States, an epidural block (or an epidural) is administered through a tube into the woman’s lower back. It delivers a combination of drugs, often including narcotic analgesics, that blocks some of the feeling in that area while allowing the woman to be alert so she can push her baby out and respond to her birthing team.
It takes about 15 minutes for the epidural to take full effect. Epidurals are used in vaginal birth and in cesarean delivery, in which case the anesthetic portion may be increased to block all feeling in the lower part of the body.
Drugs are injected into the spinal fluid in a spinal block. It can involve both analgesics and anesthetics. A spinal block acts quickly to relieve pain but only lasts for a couple of hours at most. Spinal blocks, used on their own, are becoming less common, but may be used in more complex deliveries or cesarean cases.
Combined spinal-epidural block
Also known as a CSE, this procedure can provide the best of both of those worlds, delivering fast pain relief that lasts longer than a spinal block alone. Generally, lower amounts of medication can be used in a CSE compared with an epidural alone.
In some emergency situations, general anesthesia will be used. The woman will be unconscious during the labor so she feels no pain at all.
Nitrous oxide (N2O) for labor and delivery
Even though CU is the only hospital in the area to offer nitrous oxide to relieve labor and delivery pain, it’s not a new method and was used as far back as 1881. It’s used often in other countries but has taken a backseat in the U.S. to epidurals.
Nitrous oxide (laughing gas as it is commonly known) in low doses acts as an analgesic to relive pain and also as an anxiolytic, which is a drug that reduces anxiety. N2O’s benefits include:
- Easy to administer
- Can be self-administered by the woman
- Effects are short-lived (5 minutes), allowing women to switch to another pain relief method mid-labor
- Safe for mother, fetus and newborn
- Does not affect the alertness of the newborn in the early bonding period
- Does not affect breastfeeding
- Women are still aware of what is happening
- It does not affect the physical aspects of labor and delivery.
At the low doses used, it doesn’t pose much risk, though side effects can include nausea, vomiting, dizziness and sedation.
Of course, epidurals, spine-blocks and combined spinal-epidural blocks carry risks as well. These include (for each method):
- Blood pressure drop for the mother that may affect the baby’s heartbeat
- Difficulty breathing (very rare)
- Headaches due to spinal cord damage (also rare)
Get in touch with CU OBGYN today to begin planning the pain-management techniques for labor and delivery.