Choices of Labor Analgesia

There are different choices to manage the pain of labor and childbirth. They include natural methods, IV medications such as narcotics or narcotic analogs, epidural analgesia, and intrathecal or “one shot spinal” analgesia. The term analgesia is used rather then anesthesia because none of these methods take all of the feeling away. Analgesia helps decrease the pain without completely blocking all feeling. These techniques perform this to varying degrees.

Natural methods include breathing techniques, massage, positioning techniques, shower or hot tubs, walking, etc. These techniques can be very effective for some women and be adequate in many cases to provide pain management during labor and delivery. These methods can be particularly beneficial when labor is moving quickly.

IV pain medications include narcotics and narcotic analog medication. Examples of narcotic analogs are Stadol and Nubain. Examples of narcotics are Morphine and Fentanyl. These medications tend to “take the edge off” of the pain but usually do not relieve all of the pain associated with labor and delivery. They also tend to make the patient sleepy which can be beneficial, allowing some women to rest between contractions. These medications are safe for both the mother and the baby.

Epidural analgesia involves using a needle to place a plastic catheter into the back. Medication is then given through this catheter into the epidural space, just before the spinal canal. The medication numbs the nerves as they exit the back and provide pain relief. The medication is titratable  meaning it can be increased or decreased to give the amount necessary for pain relief throughout the process of labor and delivery. Epidurals are very safe for both the mother and the baby. They are very popular because they provide the most pain relief of any of the options.

An intrathecal injection or “one shot spinal” can be given late in labor to provide pain relief. It will last about two hours. This involves placing a needle through the back into the spinal fluid. Medication is then injected into the spinal fluid to provide pain relief. This is most commonly used in patients that desire the pain relief of an epidural but are not epidural candidates due to conditions such as previous back surgery.