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Treating your pain during labor and delivery

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

During your pregnancy visits, you will be able to review your plans for managing your pain in labor with your physician or midwife. Together you will be able to review the advantages and disadvantages of the different types of pain relief available for labor and delivery as well as your preferences. Shortly after you arrive on the labor and delivery unit for the birth of your baby, your nurse and your doctor or midwife will review your medical history and discuss your plans for labor pain relief during labor. An anesthesiologist (anesthesia and pain management specialist) will review your medical history and talk to you about the risks and benefits of receiving neuraxial anesthesia (commonly known as an epidural).

Many women planning a vaginal delivery choose 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. At UI Hospitals and Clinics, you have the option of using medication to manage your pain in labor or choosing from a variety of non-medication options.

  • 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.
  • Patient remains awake and alert.
  • Pain relief begins 10-20 minutes after the injection is given.
  • Most people are still aware of contractions, but the contractions are not painful.
  • Patients are given a button to self-administer more epidural pain medication if extra pain relief is needed.
  • 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 planned cesarean births.
  • 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.
  • This approach is an option for those who can’t have or choose not to have an epidural.
  • The medications may make the patient 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. In some cases, a pump device is attached to the IV and the patient can self-administer the pain medication when needed. The device has a safety mechanism to prevent an overdose.
  • 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.
  • 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.
  • Ambulation (walking) is commonly used in early labor, or during a visit to the labor triage unit to determine if a patient is in labor.
  • Upright positioning may help the baby’s head apply more pressure to the cervix, which may make contractions more effective.
  • In early labor, walking may keep contractions more consistent and many people find that the pain of early labor contractions is less bothersome if they are up walking instead of lying in bed.
  • Hydrotherapy is immersion in a tub of warm water.
  • This approach can reduce pain caused by contractions and aid in relaxation between contractions.
  • Hydrotherapy may make it easier to move during and between contractions, due to the buoyancy of the water. 
  • While we do not offer waterbirth, many people use the hydrotherapy tub to relieve the pain of contractions during early labor and active labor. 
  • Most of the labor rooms at the University of Iowa Hospitals and Clinics have a large, private tub to use in labor.
  • At the University of Iowa Hospitals and Clinics, we have many labor aids available to help patients manage their pain without medication. These include items such as birthing balls, peanut balls and squat bars.
  • Many of our staff members have attended specialized training to learn how to help patients reposition or do special exercises to maximize their labor progress and help relieve pain.
  • Most labor aids and repositioning can also be used in combination with the medication options listed above.