Treating your pain during labor and delivery

Jul 6, 2017

All members of your health care team are focused on you and your baby’s safety and your comfort during labor and delivery.

Shortly after you arrive on the labor and delivery unit for the birth of your baby, an anesthesiologist (anesthesia and pain management specialist) will review with you your medical history and discuss options for labor pain relief during labor. Together you will review the advantages and disadvantages of the different types of pain relief available for labor and delivery as well as your preferences.

The pain relief option and the anesthesia plan you and your anesthesiologist choose will be discussed with other members of your healthcare team (obstetrician, midwife, family practice physician, and nurses), so that everyone on your team knows the plan tailored to you.

Many women planning a vaginal delivery chose an epidural for pain management. A tiny plastic tube is placed in the epidural space, just outside the spinal cord in the lower back. Through that tube, the anesthesiologist delivers medicine that provides pain relief throughout labor and delivery.

It eases the pain of the strong uterine contractions during childbirth.
It leaves you alert and able to move and sense the amount of pushing you need to do at the appropriate time.
It has minimal effects on your baby, meaning your baby is alert and ready to breathe normally once delivered.
If, after planning a vaginal delivery you end up needing a cesarean delivery, stronger medication can be injected into the epidural to provide anesthesia for the cesarean.

If you are undergoing a planned cesarean delivery, the anesthesiologist and obstetrician will work with you to determine whether you receive a spinal injection of pain medication (making the whole lower part of your body numb) or general anesthesia (in which you are asleep).

The spinal injection has certain benefits to consider:

Your baby will be less affected by it compared to a general anesthesia.
Spinal anesthesia usually allows for immediate mother-baby bonding after delivery.
For most women, it is a safer form of anesthesia than general anesthesia.
It allows for your spouse, partner, or support person to be with you in the operating room during the delivery.

As part of your care team, the anesthesiologist works with the obstetrician and/or midwife to determine the course of action that’s safest for both you and your baby.

At major birthing centers like University of Iowa Hospitals & Clinics, anesthesiologists are on hand 24/7 to provide the most appropriate anesthesia care when it is needed.

Pain treatment options for labor and delivery

Here is a list of pain relief options used in vaginal deliveries by UI Hospitals & Clinics delivery teams.

Epidural block

This approach causes pain relief rather than a total lack of feeling.
Patients feel decreased sensation in lower half of the body.
Usual local anesthetics include bupivacaine and ropivacaine.
Fentanyl, a narcotic, is usually added to the local anesthetic.
Mother remains awake and alert.
Pain relief begins 10-20 minutes after the injection is given.
Most women are still aware of contractions, but the contractions are not painful.
Mothers are given a button to self-administer more epidural pain medication if extra pain relief is needed.

Spinal block

This approach relieves pain almost immediately and lasts just one to two hours.
Spinal medications are usually bupivacaine, fentanyl, and morphine.
Spinal blocks are most commonly used for elective cesarean births.

Combined spinal-epidural (CSE) block

This approach is the most commonly offered pain relief technique used at the UI Hospitals & Clinics.
The combination provides benefits of both epidural and spinal blocks.
The spinal part acts quickly to relieve pain.
The epidural block provides longer pain relief throughout labor.

Intravenous pain medications

This approach is an option for those who can’t have or choose not to have an epidural.
The medications may make the mother drowsy and nauseated.
Some medication will enter the baby’s system and may make the baby sleepy after delivery.
Typical opioid (narcotic) medications used for labor pain relief at the UI Hospitals & Clinics include fentanyl, Nubain (nalbuphine), morphine, and Stadol (butorphanol).
The pain medications can be given by the labor nurse or a pump device is attached to the IV and the mother can self-administer the pain medication when needed. The device has a safety mechanism to prevent an overdose.

Pudendal block

The pudendal block may be given during the pushing stage of labor.
It does not relieve the pain of contractions but rather numbs the birth canal.
It is usually used in combination with other pain measures.
It cannot be used if the baby’s head reaches a certain point in the birth canal.
Local anesthetics used include lidocaine and chloroprocaine.

Paracervical block

This approach can reduce pain caused by contractions and stretching of the cervix.
It is rarely used for deliveries in favor of an epidural or CSE block.