What is labor and delivery pain management options?

Your pain relief choices for childbirth may include medical and nonmedical treatments. Medical choices can include I.V. medicines or epidural pain relief. Massage and focused breathing are some of the nonmedical options. Sometimes both kinds of pain relief are used. Knowing your options can help you prepare for childbirth.

You have many choices to relieve pain during childbirth. These include medical and nonmedical options. You may use more than one of these choices.

Nonmedical

Nonmedical options may help reduce pain and help you feel a sense of control during labor. These techniques include:

• Support. Having a support person with you through childbirth may help you manage your pain better. This person could be your partner, a loved one, or a friend. Or you may use an experienced birth assistant, like a doula, whose only job is to give you constant support.
• Distraction. During early labor, you can walk, play cards, watch TV, take a shower, or listen to music to help take your mind off your contractions.
• Massage. Massage of the shoulders and lower back during contractions may help ease your pain.
• Changing positions during labor. Walking, kneeling, or sitting on a big rubber ball (birth ball) are good options. The position that feels best may change as you move through labor.
• Focused breathing techniques. Breathing in a rhythm can distract you from pain and relax your muscles and your mind. Childbirth education classes can teach you different methods of focused breathing.
• Imagery. This involves using your imagination to decrease your pain. For instance, you could imagine your contractions as waves rolling over you. Picture a peaceful place, such as a beach or a mountain stream, to help you relax between contractions.
• Laboring in water. Some hospitals and birthing centers offer tubs or whirlpools for labor. Soaking in warm water may help ease the stress of labor.

Other techniques that don't use medicine to control pain include hypnosis and acupuncture.

Medical

Your options for pain relief with medicine may include:

• I.V. medicines. Examples include fentanyl and hydroxyzine. These medicines are used to help reduce anxiety and partially relieve pain. But they aren't usually used when you are close to delivery, because they can affect a newborn's breathing.
• Spinal and epidural pain relief. This is a shot (spinal) or an ongoing supply (epidural) of pain medicine near the spinal cord. It partially or fully numbs the belly and lower body.
• Pudendal block. This is a shot of pain medicine to numb the vagina and perineum. It can help relieve pain from the second (pushing) stage of labor. It works quickly and usually doesn't affect the baby.
• Nitrous oxide. You can give yourself nitrous oxide through a mouthpiece or mask when you need pain relief during labor. You can decide when to use it.

Tell your doctor about your health history. Let them know if you or a family member has had problems with anesthesia in the past. You can also talk to the doctor about medical and nonmedical pain relief options for childbirth. Plan for what you want. But be aware that things can change during labor.

Depending on your health conditions, your doctor may want to have an epidural catheter placed early in labor. This would only be used if needed. For example, you may plan to use nonmedical pain relief but then decide later that you want medicines. Or the catheter would be used to give you anesthesia if you need a cesarean (C-section) for your or your baby's health and safety.