Pain Management Options During Labor and Delivery

Medical Expert: Susan Rothenberg, MD, IBCLC, FACOG, FABM

There’s no way to sugarcoat it, delivering a baby comes with some pain. Expecting parents are usually well aware of this fact going into pregnancy, but what many aren’t as clear on are the different methods of pain relief that are available to them during labor and delivery. 

For first-time expectant parents, especially, at some point in the months leading up to your baby’s due date, you’ll likely be encouraged to attend a birthing class. Oftentimes, this is where you’ll learn all about what you can anticipate during labor and delivery, including medicated and unmedicated pain management options. Then, as you get closer to your baby’s arrival, your health care provider will talk to you about making a birth plan—which usually includes how you’d like to handle your pain or discomfort during labor. 

There are a lot of advantages to making a birth plan, but according to Susan Rothenberg, MD, IBCLC, FACOG, FABM, an assistant professor in the Raquel and Jaime Gilinski Department of Obstetrics, Gynecology, and Reproductive Science at Mount Sinai Hospital in New York City, when it comes to pain management it’s important to still go into labor with an open mind. 

“Regardless of how much you learn about labor before it happens, it’s hard to know how you’ll experience it,” she says. “You never know what it’s like until you’re living through it. We’re lucky to live in a time and place where there are safe and effective options for how to have a baby.” 

Still, you can be open-minded about different pain relief options while also wanting to be as informed as possible about each choice ahead of time (after all, when you’re in the throes of painful labor probably isn’t the best time to try to take in all this information). To help you mentally prepare, here are the common methods of pain management that are typically available to laboring parents. 

Non-Pharmacologic Pain Control 

For some expecting parents, having an unmedicated birth is really important. This is absolutely an option for most people (assuming there are no complications), but you’ll still need to use healthy strategies to help get you through the intensity of labor contractions and delivery. And Dr. Rothenberg says the best place to start here is childbirth education. 

“Fear makes it harder to cope with pain; having high-quality information about what to expect in labor can minimize fear and enhance our ability to manage the pain.” 

In addition to simply preparing you for what to expect during labor, she says birthing classes often teach “non-pharmacologic pain control interventions, including distraction, breathing techniques, movement and position changes, massage, and the use of birthing balls,” which can be particularly helpful during early labor at home (but are still useful as you get closer to delivery). Additionally, she notes, “Some people who are especially motivated to have an unmedicated birth will get special training to use self-hypnosis, acupressure, or TENS (transcutaneous electrical nerve stimulation)” to help them manage their pain. 

Wanting to have an unmedicated birth is absolutely reasonable, but experts advise it’s important to remain flexible. “I see so many pregnant people put so much pressure on themselves to have a natural delivery to the point that they feel like they’ve failed if they get an epidural or end up needing a C-section,” says Dr. Rothenberg, adding, “This breaks my heart!” 

In the event your unmedicated birth doesn’t go according to plan and you end up with some kind of medicinal intervention, know that your baby’s health will not be at risk. According to the American Academy of Obstetrics and Gynecology (ACOG), “the medications used to relieve pain during labor and delivery have no long-term effects on the baby. They also have no effect on a child’s later development.”

Here are some common methods of pain relief to consider before your due date.

Epidural 

One of the most well-known and the most common pain management options for childbirth is the epidural. It’s administered through a tube that’s placed in the lower back by an anesthesiologist (don’t worry, you are given local anesthesia and will barely feel a thing). Once it’s in place, it numbs the lower areas of the body while you remain conscious. For a vaginal delivery, you can still push the baby out without feeling the pain of contractions or delivery. For a cesarean section (C-section), the dose may be increased to fully numb the lower part of the body for surgery. 

“Most people, especially for a first labor, will at some point opt for pharmacologic pain control,” says Dr. Rothenberg. “I consider epidural analgesia to be the gold standard; in most cases, it provides excellent pain relief without drowsiness, so you can still be present and experience the process. It can be attached to a pump to give continuous pain relief for as long as it’s needed.”

You may have heard that in order to get an epidural, you have to request one within a certain time frame, but Dr. Rothenberg says this isn’t necessarily true. “In my practice, people can get an epidural whenever they want,” she explains. “We offer epidurals when people come in to have labor induced before they have any pain at all. If someone comes in fully dilated and doesn’t want to push without an epidural and can tolerate sitting upright and relatively still while it’s being placed, we go ahead and do it. So anywhere from 0 to 10 centimeters is fine in my book.”

That being said, not every hospital is this flexible, and as you get closer to being fully dilated, whether or not you can get an epidural before you have to push often depends on the anesthesiologist’s availability. Be sure to discuss timing with your OB so that you are fully aware of the limitations of your specific hospital. 

Nitrous Oxide

Nitrous oxide is the least invasive pain management option because it’s administered through a mask that you hold, giving you the power to decide when and how often you “take” it. Nitrous oxide, commonly known as “laughing gas,” is “a tasteless and odorless gas” that “reduces anxiety and increases a feeling of well-being so that pain is easier to deal with,” according to the ACOG. This method of pain management does not numb any part of the body, and it is safe for both the parent and the baby. 

“[Nitrous oxide] can be great towards the end of labor, in the transition phase, to help get through that last intense period until it’s time to push,” says Dr. Rothenberg. “It’s less effective for prolonged use over many hours of labor since it doesn’t really take the pain away, it just makes you sleepy, so you mind [the pain] less.” 

Opioid Analgesics

The word “opioid” might trigger an alarm in your brain—because isn’t the use of opioids during pregnancy dangerous? 

For the record, yes, it is, but there is a big difference between regular use throughout pregnancy and a health care provider administering it during labor and delivery. 

“In certain specific circumstances, I might use opioid analgesics,” Dr. Rothenberg explains. “If someone has had back surgery, for example, or is on blood thinners, or has some other reason why they can’t get an epidural, our anesthesiologists might set them up with a very short-acting opioid (Remifentanyl) that the patient can control themselves with a pump connected to their IV. This allows them to have some pain control with less risk of the baby getting sedated from the medication.” 

According to the ACOG, opioids “reduce your awareness of pain and have a calming effect” but they “will not cause you to lose consciousness.” When used during labor and delivery, they can affect the baby’s breathing and heart rate for a short time and the newborn may be a bit drowsy, which can make breastfeeding a challenge for the first few hours after birth. Additionally, the ACOG notes that many doctors will not administer these drugs within the hour before delivery. 

“I only give [the opioid] morphine very early in labor because it can cause sedation in the baby if it’s given too close to delivery,” notes Dr. Rothenberg. “Every once in a while, if someone has been [on and off] in very early labor for days and is exhausted, but doesn’t want their labor stimulated with medication, I’ll give some morphine so they can get a few hours of sleep. Most people will wake up in active labor, or the contractions will peter out so they can go home and wait for true labor to kick in.” 

Spinal Anesthesia

Spinal anesthesia, or a spinal block, is what someone will get if they are undergoing a planned C-section birth. It’s similar to an epidural, in that it numbs a localized area (the lower half of the body), but it does not require a tube to be inserted because it’s given in a single shot that lasts an hour or two, rather than being slowly administered over the course of labor. 

Additionally, Dr. Rothenberg says post-operative pain relief is typically added into the spinal block as well, to keep the birthing parent comfortable after the procedure. 

In the event the C-section isn’t planned, however, and the patient hasn’t already had an epidural placed, they will likely only get a spinal block if they aren’t in an emergency situation. “If there’s a problem with the baby’s heart rate and there’s no time to give the spinal [block], we’ll put the parent to sleep (under general anesthesia). In most hospitals, this will mean that the birth partner can’t be present in the operating room.” 

Whether you hope to have an unmedicated birth, or your birth plan is essentially “safety first, but give me all the meds,” the choice is ultimately yours—and you should never feel any shame for what you decide. Dr. Rothenberg puts it perfectly: “You’re the one feeling the pain, so you get to call the shots about how to manage it. Childbirth is not a competitive sport!”