This brief discussion on medications that are commonly used for laboring women to manage discomfort in labor is meant to provide you with general information that you can use when discussing this with you physician or midwife.
There are pros and cons to each medication used. Please also read the SA article on “Comfort Measures in Labor” to review ideas that work to manage pain for many women even if they then go on to request medication.
- Opioids are either injected into a muscle or administered through an IV. They work very quickly and help women to rest in between contractions. They “take the edge off the pain” but do not take it away and can cause drowsiness. They can be given several times over a period of hours but are usually not repeated if birth is imminent because these drugs can cause your baby to be sleepy and not breathe well at birth if they have been given recently.
- Epidurals are a type of regional anesthesia administered by an anesthesiologist or certified nurse anesthetist. Medication is injected via a small catheter into a space outside the spinal cord in the lower back (the epidural space), it works fairly quickly, and usually alleviates most of the pain other than pressure. It is possible to have a failed or inadequate epidural and they can sometimes cause a drop in your blood pressure which may temporarily affect your baby’s heart rate. All the risks will be discussed with you before insertion. You will likely not be able to walk during labor after the epidural is placed.
- Spinal Blocks are similar to epidurals, used mostly for cesarean sections, and are placed below the fluid of the spinal cord.
- Local anesthetics are sometimes administered at the time of birth to numb the vaginal area in case of a tear or after birth to repair a tear.
- Nitrous oxide is an odorless and tasteless gas that can be administered by a face mask and is not available at all facilities. It is fast, quickly reversed, and safe for mom and baby. It can be utilized intermittently by the laboring women as needed, but it does not eliminate pain and in some women may cause nausea.
- Pudendal blocks are administered by either a physician or midwife shortly before birth to block pain between the vagina and anus. It is injected into the vaginal wall near a nerve and takes effect in 10-20 minutes.
It is good to know about the choices you have for pain management during labor and a little about each one. Because you will not know ahead of time how your labor will progress, it is good to also know that you can use multiple medications over time or usually change your mind if what you have chosen is not working. Your provider and your labor nurses will help give you information to make those decisions along the way.
