Know Your Options: Pain Management - Part 3

Welcome to the fourth post of the Know Your Options series! This is the third part of three on Pain Management. They're better read in order so check out the first one here and the second one here. Thanks for reading!

You're a pain expert now! You're familiar with methods to reduce that pain without medication or before (and after) you utilize any pain medications during labor and birth. If you're reading on this far, perhaps it because you plan on utilizing these medications, perhaps it's because you're unsure about what you want yet, or maybe you're just curious. No matter your reason, I'm here to help you explore those options!

Narcotics

The most common opioids during labor are Morphine, Fentanyl, Nubain, Stadol, and more recently Remifentanil.  Usually these are given in one time intramuscular injections, often the thigh. Or via an IV, with or without a pump that has button for you to push when you feel you need relief). 

Some things to note: 
Research shows they don't give as reliable pain relief to the mother as an epidural does.
Can be given during early or active labor but most providers try to leave time for the drug to wear off somewhat before the baby is born in an effort to minimize the effects of the drug on the baby. 

Some things to note: 

• Advantages - May take "the edge" off the pain, no considered harmful to the mother/baby when given at the proper time and dosage. 
• Disadvantages - May cause drowsiness and/or nausea in the mother, the mother also may feel a loss of control, risk of a temporary decrease in the strength/frequency of contractions, risk of respiratory depression in the mother and baby, etc.

For more info see: 

• Effects of IV Opioids during Labor
  

Nitrous Oxide

​Nitrous oxide is a mixture of nitrous oxide, N2O, and oxygen. Often called "laughing gas" it’s used around the world most commonly in dental procedures. It's not currently a very popular option used in the USA but it is gaining ground. To use this tasteless, odorless gas during labor the laboring person is given a mask that the they hold over their nose and mouth. Simple enough, but there is a bit of a learning curve. The mother should start inhaling about 30 to 45 seconds before your contraction begins so that the drug peaks at the same time your contraction is peaking. The mother's oxygen levels will be monitored continuously while receiving nitrous oxide.

Things to note: 

• Advantages - While still less effective for pain relief than an epidural, nitrous oxide does provide similar relief as IV narcotics without the same risks to the newborn. 
• Disadvantages - May give a sense of detachment, like feeling as though you’re not really present, may make you feel sleepy, dizzy, nauseous, may make you feel a sense of claustrophobia. 

For more info see: 

• Nitrous Oxide During Labor 
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The Epidural

"The epidural" is a form of regional anesthesia. It's goal is to numb the mother from the waist down thus completely eliminating the pain of contractions. This is done by injecting an anesthetic into the lumbar area of the spine in the space between the spinal cord and the dura, called the epidural space (hence the common name!). An epidural is usually done by first numbing the area of the back where the epidural will be placed. Then a longer, thin, hollow needle is used to place a thin catheter tube that is left in the epidural space so that medication can be continuously given during labor through a control pump. This tube is taped to the mother's shoulder and out of the way.

Some things to note:

• The epidural is typically given in active labor and you may need to use non-medicated coping techniques discussed in part 2 of this series until you reach active labor. 
• Advantages include - good pain relief without sedation, may shorten labor, medication can be turned up or down as desired
• Disadvantages include - possible side effects such as itching and low blood pressure, restricted mobility, risk of infection, increased risk of vacuum or forceps delivery, postpartum spinal headache, etc.

For more info see: 

• Epidural during Labor for Pain Management 
• Effects of Epidurals on the Second Stage
• Effects of Epidurals on Breastfeeding
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Spinal Block

Spinal anaesthesia, also called spinal block, is a form of regional anaesthesia where a local anaesthetic or opioid is injected into the spinal cord, generally through a long, fine needle. Unlike an epidural where a thin catheter is left in place, a spinal block is medicine administered only once to numb the mother from the waste down for several hours. Usually given for Cesarean surgery, thus continuous medication isn't needed. 

Some things to note: 

• Advantages - allows the mother to be awake during a Cesarean, is effective immediately. 
• Disadvantages - may experience a spinal headache, may experience itching, possible risk of infection, blood pressure may drop and requires monitoring, etc. 

For more info see: 

• Risks and Benefits of Regional Anaesthesia​

Pain Medication

Free printable handout on common drugs used during labor!