With the advice of her doctor or midwife, a woman usually plans an approach to pain relief long before labor starts. She may choose one of the following:
Natural childbirth, which relies on relaxation and breathing techniques to deal with pain
Pain medications injected in or near the vagina
Pain medications given intravenously
Pain medications given through an injection near the spinal cord (spinal or epidural), called regional anesthesia
After labor starts, pain relief plans may be modified, depending on how labor progresses, how the woman feels, what she prefers, and what the doctor or midwife recommends.
A woman’s need for pain relief during labor varies considerably, depending on many factors. Attending childbirth preparation classes helps prepare the woman for labor and delivery. Preparation and emotional support from healthcare professionals and chosen labor-support people can help women know what to expect and make choices about how to manage pain during labor and delivery.
Regional anesthesia usually numbs a large area from the abdomen to the legs and feet. It is used for women who want more complete pain relief. The following procedures can be used:
Epidural anesthesiacesarean deliveries.
Spinal anesthesia involves injecting an anesthetic into the space between the middle and inner layers of tissue covering the spinal cord (subarachnoid space). A spinal injection is typically used when a rapid onset of pain control is needed, but the effect only lasts for about 1 to 2 hours. Spinal anesthesia is often used for cesarean delivery when a woman does not already have an epidural catheter in place.
Occasionally, use of either an epidural or a spinal injection causes a fall in blood pressure in the woman. Consequently, if one of these procedures is used, the woman’s blood pressure is measured frequently.
Local anesthesia numbs the vagina and the tissues around its opening. This area can be numbed by injecting a local anesthetic through the wall of the vagina into the area around the nerve that supplies sensation to the lower genital area (pudendal nerve). This procedure, called a pudendal block, is used only late in the second stage of labor, when the baby’s head is about to emerge from the vagina. A less effective procedure involves injecting a local anesthetic at the opening of the vagina. This procedure is used in limited circumstances, for example, when a woman has pain even with a pudendal block in place. With both procedures, the woman can remain awake and push, and the fetus’s functions are unaffected. These procedures are useful for deliveries that have no complications.
Analgesics are pain relievers, including opioids immediately after birth.
General anesthesia makes a woman temporarily unconscious. It is rarely necessary and infrequently used because it may slow the function of the fetus’s heart, lungs, and brain. Although this effect is usually temporary, it can interfere with the newborn’s adjustment to life. General anesthesia is typically used only for emergency cesarean delivery in women who do not have an epidural catheter in place, because general anesthesia is the quickest method to provide the anesthesia needed for surgery.
Natural childbirth
Natural childbirth uses relaxation and breathing techniques to manage pain during childbirth.
To prepare for natural childbirth, a pregnant woman (with or without her partner) take childbirth classes, usually 6 to 8 sessions over several weeks, to learn what happens in the various stages of labor and delivery and how to use the relaxation and breathing techniques.
The relaxation technique involves consciously tensing a part of the body and then relaxing it. This technique helps a woman relax the rest of her body while the uterus is contracting during labor and relax her whole body between contractions.
The breathing technique involves several types of breathing, which are used at different times during labor. During the first stage of labor, before a woman begins to push, the following types of breathing may help:
Deep breathing with slow exhalation to help the woman relax at the beginning and end of a contraction
Fast, shallow breathing (panting) in the upper chest at the peak of a contraction
A pattern of panting and blowing to help the woman refrain from pushing when she has an urge to push before the cervix is completely open (dilated) and pulled back (effaced)
The most well-known method of natural childbirth is probably the Lamaze method. Another method, the Leboyer method, includes birth in a darkened room and immersion of the baby into lukewarm water immediately after birth.
