Labor and Delivery Tips

Pain Relief Options in Labor

I have been part of the labor and delivery biz for well over a decade, and one of the questions I am asked most frequently by my patients is, “What will I be able to have for pain management?”

That question is one that could be answered dozens of ways. Pain management options change as labor progresses, meaning some medications are not appropriate in latent labor (the uncomfortable cramping that sometimes occurs before the first stage of labor), while other forms of pain management are inappropriate as a woman hones in on a fully dilated cervix.

Likewise, for some women, medication of any sort is not part of their plan, so pain management takes the form of massage, counter pressure, water immersion, meditation, hypnosis, etc.

With the plethora of available options, my advice to all women remains the same:

Regardless of what your “plan” might be, keep an open mind. Labor is different for everyone, and varies from one pregnancy to the next. The last thing you want, is for your birth experience to feel like a failure because the use of pain medication became your path when you dismissed all possibilities of it’s use before your labor began.

Regardless of how your baby enters the world, it is never a failure. “Healthy baby, healthy Mom” is the goal, and getting there safely is what matters. There are no medals or financial gain to be won if you walk out of the hospital having received no analgesia. Your friends and family care about seeing you and your new baby and don’t give a crap about the dose(s) of morphine or fentanyl you received.
With that being said, I would also like to comment that analgesia used in labor differs from hospital to hospital and medication administration of each particular drug will differ within each facility. I have worked at two hospitals on either side of the country in Canada, and pain management is managed very similarly at both hospitals.

Enough with the blabbing and let’s get to it. My intent is to inform you of some of the pain management options available, and I will not be explaining the pharmacokinetics of the following drugs in this discussion.

In early labor, patients are often encouraged to rest. Tubs (if your water has not yet broken), showers, and oral acetaminophen are commonly suggested to uncomfortable patients. Morphine can also be administered during this phase of labor, but bear in mind, this narcotic may not be an available option at all facilities.

Once active labor begins (this is determined by a variety of components), more pain management options become available to a laboring mom. Nitrous oxide (aka “laughing gas” or Entanox) can be inhaled by the patient during contractions. Despite entering the blood stream via the lungs, nitrous oxide is one of the least invasive forms of analgesia and has little to no effect on the baby. Keep in mind that throughout her entire labor (with the exception of pushing, or epidural analgesia), women are encouraged to use the shower or bath (while abiding by facility specific policies) alone, or in combination with medications, assuming a healthcare professional is supervising.

Fentanyl is a medication given intravenously (IV) to women in active labor. The administration of it must first be physician ordered due to possible side effects. Like any narcotic, one side effect of fentanyl is decreased respiration. Since the drug is administered directly into the blood stream, some of it does make its way to the baby. The risk is that if the baby is born within minutes of administration, they may require some help breathing for their first few minutes of life following delivery. As frightening as that may seem, the beauty of fentanyl is that it has a short half life, meaning it is metabolized very quickly in the body and makes the risk to your baby very minimal. For this reason, may hospitals use this form of pain medication extremely frequently because of it’s effectiveness in relieving pain.
*In recent years, patients frequently shutter when the administration of fentanyl is suggested. Fentanyl administered in hospital, is not the fentanyl that is found on the streets. The fentanyl used in hospitals is carefully measured and safe doses are administered to patients.

Epidural pain management is often administered after a patient has has little success with the above mentioned analgesics. Like the other forms of pain management discussed, epidural pain management may not be available at your facility, or you may not be a candidate. During epidural placement, a tiny, flexible, plastic tube (catheter) is fed into your lower back by an anesthesiologist (yes, they numb the spot first—yes, with a small needle). Through this tiny tube your anesthesiologist will administer a cocktail of medications to numb the pain from approximately your belly button, down. The medication is placed on a pump and will be slowly infusing into your lower back until the pump is turned off, usually after your bundle of joy is in your arms! Epidurals also have little to no effect on baby, which is why it can be used right up until delivery! Ask your nurse to help you change positions often to help your baby descend into your pelvis, since you will be less mobile because of numb or weak legs. Don’t worry! Usually within an hour after epidural shut-off you can walk around again.

With all of the available options, my recommendation to all patients is to use as many medication-free options as you can before moving onto drugs. The first dose given is often the most effective, and therefore, you don’t want to waste it’s effect on contractions that you can tolerate in a shower or with breathing. In addition, the less drug administered, the better for your body and for your baby. Utilize your nurse and her recommendations. This is her (or his) world, and this is what they have trained for. Do not be scared to trust them.