Introduction

Many types of medication can ease pain during labor and delivery. Epidural and spinal blocks are common choices — but you have other options, too. Work with your health care team to make the best decision for you and your baby.

Use this guide to learn more about specific medications used during labor and delivery.

Epidural block

Description

An epidural block is a regional pain-blocking procedure that can be used during labor. An epidural block uses one or more pain medications called anesthetics injected via a catheter into a small space outside the spinal cord in the lower back (epidural space). This allows for repeated or continuous administration of medications. You might be given a test dose to make sure the epidural is positioned correctly. It takes about one to 15 minutes for the medication to take effect, depending on the type of anesthetic used. Your health care provider will discuss with you the best time to request an epidural during labor. You might not be able to have an epidural if you have had major surgery in your lower back, have low blood-clotting factors, have an infection in your lower back or are on certain blood thinners.

Pros

An epidural alleviates most pain in the lower body without significantly slowing labor. You'll remain awake and alert but you will still feel pressure and some stretching during delivery. A combined spinal-epidural block, which takes effect quicker than does an epidural and has lower doses of anesthetic medications, might leave you with more muscle strength.

Cons

You could experience an inadequate or failed epidural. An epidural might decrease your blood pressure, which might slow the baby's heart rate. You could develop a fever or itchiness or experience postpartum soreness in your back. Rarely, you might develop a bad headache. Even if you have a combined spinal-epidural block, sometimes called a walking epidural, you will likely not be able to walk during labor.

Spinal block

Description

A spinal block is typically used to block pain during a C-section. However, a single shot spinal block can be used as a regional analgesic if delivery is expected in a short time or if forceps or vacuum extraction is needed and there is enough time for the procedure. During a spinal block, the medication is injected into the fluid below the spinal cord in the lower back and takes effect right away. A spinal block is sometimes combined with an epidural block during labor (combined spinal-epidural block).

Pros

A spinal block provides complete pain relief in the lower body for about an hour or two. The medication is given only once and in a small dose. You'll remain awake and alert.

Cons

A spinal block might decrease your blood pressure, which can slow the baby's heart rate. You could develop a fever or itchiness or experience postpartum soreness in your back. Rarely, you might develop a bad headache.

Opioids

Description

Various opioids can be used to lessen pain during labor. They can be injected into a muscle or given through an intravenous (IV) catheter.

Pros

Opioids promote rest. Most take effect within minutes. An anesthesiologist is not needed to administer these medications.

Cons

Opioids don't completely eliminate labor pain and typically don't work for pain experienced during delivery. They commonly cause nausea, vomiting and drowsiness. These medications can affect your newborn's breathing and cause your baby to be drowsy, which might interfere with initial breast-feeding.

Local anesthetic injection

Description

A local anesthetic might be used to quickly numb the vaginal area if you need an incision to extend the opening of the vagina (episiotomy) or repair a tear after delivery. The medication is injected into the area around the nerves that carry feeling to the vagina, vulva and perineum.

Pros

Local anesthetics temporarily numb a specific area. Negative effects for mother and baby are rare.

Cons

Local anesthetics don't relieve the pain of contractions. An allergic reaction is possible. Rarely, injecting local anesthetics into a vein might produce a toxic reaction, affecting your central nervous system or heart.

Pudendal block

Description

A pudendal block might be used shortly before delivery to block pain between the vagina and anus (perineum). It can also be used to relieve pain during the repair of a tear after delivery. The anesthetic is injected into the vaginal wall near the pudendal nerve and takes effect in 10 to 20 minutes.

Pros

A pudendal block relieves pain in the lower vagina and perineum for up to an hour. Negative effects for the baby are rare.

Cons

A pudendal block might not work or might affect only one side of the perineum. An allergic reaction is possible. Rarely, a pudendal block can cause an infection at the injection site, and injecting the medication into a vein might affect your central nervous system or heart.

Nitrous oxide

Description

Nitrous oxide — an odorless, tasteless gas — is an inhalation analgesic that can be used during labor. You administer the anesthetic gas using a hand-held face mask. Nitrous oxide takes effect within a minute.

Pros

Nitrous oxide can be used intermittently or continuously during labor. You control the amount you use. You'll be able to walk during labor. If you become too drowsy, you'll be unable to continue holding the mask to your face and stop inhaling the anesthetic — a built-in safety mechanism. The effects quickly wear off when you remove the face mask. Nitrous oxide is believed to have little effect on the baby.

Cons

Nitrous oxide doesn't eliminate pain. To experience relief, you'll need to time inhalation of nitrous oxide so that it occurs about 30 seconds before you expect each contraction. You might experience nausea, vomiting, dizziness and drowsiness.

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May 06, 2020 See more In-depth