Pain Medicine

The three main options for pain management during labor include natural childbirth, IV pain medications, and epidural. The epidural is very safe and for most women will take away all the pain.

Natural childbirth typically means no pain medication. People use breathing techniques, positioning, heat, hypnosis, and many other things to try to help with the pain. The truth is labor hurts. These devices help distract from the pain but there is still going to be pain. Pain is not dangerous so if this is your choice the doctors and nurses are happy to support you through your labor.

The advantage of natural childbirth is to avoid potential side effects from medications. The disadvantage is a greater chance of a bad vaginal tear or a larger episiotomy when the delivery is less controlled. This is often the case with natural childbirth.

IV pain medication is another choice for pain management. There are several drugs that are commonly used. Stadol and Nubain are narcotic agonist/antagonists. Fentanyl, Demerol, and Morphine are narcotics. These are all administered in you veins through an IV. The drugs do get into the baby’s blood stream and can affect the baby, they are considered safe. If you deliver very quickly after receiving the IV medication the baby’s breathing may be temporarily affected. There is a reversal medication that can be given to the baby in this situation and take away the negative affects of the pain medicine. The IV medication will make most people sleepy. Some people will have a sensation of feeling strange, this can be uncomfortable for some people. The IV medication will not take away all the pain but it will make it less intense.

Epidural anesthetic is medicine that is given in the back. It is not put into the the area with the spinal cord but just outside of the sac that holds the spinal fluid. The medication is numbing medicine that bathes the nerves as they exit the spinal canal. This will make the women numb from the abdomen down. Most women will have no pain after the epidural is used. A plastic catheter, like very thin IV tubing is left in the back and removed after delivery. This allows for as much numbing medication to be given throughout the labor so it will not wear off.

The medication from the epidural does not get into the women’s blood stream so it will not go to the baby. The medication can sometimes cause a drop in the women’s blood pressure, this can be treated with increased fluids or medication if needed. There is no worry about this medication affecting the baby when it is born, it will not. Epidural is by far the safest and most reliable form of pain medication in labor. Another benefit of the epidural is that if an emergency cesarean section needs to be done, the epidural can usually be used saving the women from other forms of surgical anesthesia.

For an anesthesiologist perspective see here.