Epidural - series

Pain Relief During Labor And Delivery

Childbirth classes can teach you breathing and relaxation techniques to help you cope with pain experienced during labor and delivery. The amount of pain felt during childbirth is different for every woman. For some women, the techniques learned in the childbirth classes are enough to relieve their pain, and medication is not necessary. For other women, the option of having pain relief medication available to them during labor and delivery is appealing and, when used, may help them experience a more comfortable childbirth.

Discuss The Options

In weighing your options about pain relief during labor and delivery, educate yourself on all the different types available by talking to your doctor or other health care professional. There may be one type that is recommended for you specifically over another. Many women make the decision before going into labor to have natural childbirth and later change their mind. It is always best to know your options before you go into labor.

Systemic Analgesics

A "systemic analgesic" is a pain-relieving medicine that is injected into your vein or muscle. This medicine acts on your entire nervous system rather than just a certain part of your body. The pain may be dulled, but may not be eliminated completely. These medicines usually do not slow down labor or interfere with contractions, but may cause drowsiness to you and your baby. With analgesics, some women have an easier time coping with labor and it helps them to feel more relaxed. On the other hand, some women complain of an unnerving feeling of loss of control.

Epidural Block

An "epidural block" numbs or causes a loss of feeling in the lower half of your body. A specialist physician or anesthesiologist injects the block into the lower back. The injection is made into a small space outside the spinal cord, and a small soft tube (catheter) is inserted into your back. The needle is withdrawn, and the numbing medicine can be given continuously or in small doses through the tube for as long as desired. This lessens the pain of the uterine contractions and the delivery of the baby through the vagina. (View an illustrated presentation of an epidural.)

Usually, low doses are given because it is safer for you and the baby. Once the medicine takes effect (10-20 minutes), you should feel better, but you may still feel some back or rectal pressure as the baby's head descends during contractions.

The relative safety of an epidural block is attested to by many large clinical studies. There have been many recent reports indicating that an epidural block is not associated with excess cesarean deliveries.

While it is common practice not to initiate an epidural block prior to 3 to 5cm cervical dilatation - in fear of increasing the risk of either operative vaginal delivery (forceps/vacuum) or cesarean delivery - a recent study suggests that getting an epidural block at or before 3cm dilatation does not increase the risk compared with later administration.

While rare, there are some risks associated with epidural blocks:

• Blood pressure may drop temporarily, which might cause the baby's heart rate to slow down. Fluids are given intravenously through a vein to help keep your blood pressure stable. You also may need to lie on your side to help keep your blood circulating.
• If you are very numb, the epidural may make it harder to bear down and push the baby through the birth canal.
• Some women experience a short period of decreased uterine contractions, but many are comfortable and their labor progresses as expected -- or even faster.
• A headache may occur, but this is unusual.
• Medicine could enter the spinal fluid and cause temporary dizziness, difficulty breathing, or a seizure, but this is unusual.
• Shivering may occur, although shivering often occurs during labor even without an epidural.

Spinal Block

A spinal block is similar to an epidural and also provides good relief. The difference is that the medicine is only given one time in your back and it lasts only 1-2 hours. A spinal block is often used for women who are giving birth vaginally, and when the baby needs to be helped out of the vaginal canal with forceps or vacuum extraction. The possible side effects of a spinal block are the same as for an epidural. Both epidural and spinal blocks may be given for c-sections.

Another form of spinal block is a "saddle block," which is used to numb the area of the buttocks, perineum, and vagina. This is used more for the actual delivery than the labor.

Combined Spinal/Epidural Block

The spinal/epidural combines both a spinal and epidural block and may provide pain relief much faster. There is less numbness with this block. This method of pain relief is sometimes referred to as a "walking epidural," because some women are still able to walk around after it is administered.

Local Anesthesia (Pudendal Block)

Local anesthesia is a numbing medicine injected in the vaginal and rectal areas by your obstetrician at the time of delivery. This is usually done to lessen the pain as the baby is being delivered and numb the area for an episiotomy, if necessary.

The Best Choice

Whether you choose to use medication for pain relief or not, it is useful to prepare yourself for natural childbirth -- the breathing and relaxation techniques may be very helpful in addition to receiving any pain relief.

The key is to become educated on your choices. Remain flexible and open when you are planning for your labor and delivery, because often things change when the actual day arrives. It is important to know that you have NOT failed if you decide to seek pain relief instead of going through it "naturally." Women have different pain thresholds and sometimes the pain is worse than anticipated. Most importantly, your health and that of the baby should always come first.

Review Date: June 29, 2001
Reviewed By: Peter Chen, M.D., Obstetrics and Gynecology, University of Pennsylvania School of Medicine. Review provided by VeriMed Healthcare Network.


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