There are many pain management options to consider when preparing for birth. These include drug and non-drug options, such as epidurals, pethidine, and breathing techniques.
Some pain management options are not suitable for everyone, and others only work at certain stages of labor. Some may also depend on the healthcare facilities available nearby.
A doctor or midwife can help advise on the options, but ultimately, the pain management a person chooses to use during birth is personal and will vary based on their needs and priorities.
This article discusses different options for pain relief during the first, second, and third stages of birth and tips for how to decide between them.
There are many different options when it comes to pain relief during birth. Understanding the different options can help a person make an informed decision. They include:
| Method | Duration | Pain relief level | Factors to consider | |
|---|---|---|---|---|
| Drug | nitrous oxide (laughing gas) | a few minutes | mild to moderate | available for home births does not numb pain but makes contractions easier to cope with |
| pethidine or diamorphine | 2 to 4 hours | moderate to high | affects the whole body given via injection or IV line may not be available in the hour before delivery | |
| local anesthesia (pudendal block) | 30 minutes to 1 hour | high | hospital only numbs the vagina, vulva, and perineum only given via injection just before delivery does not numb contraction pain | |
| spinal block | 1 to 2 hours | high | hospital only | |
| epidural block | throughout labor and birth | high | hospital only | |
| Non-drug | transcutaneous electrical nerve stimulation (TENS) | duration of use | mild | available for home births usually only effective in the first stage of labor |
| breathing techniques | duration of use | mild to moderate | results may vary between different techniques |
The first stage of birth starts when the individual begins to have strong and regular contractions spaced
To begin with, an individual may still be managing their pain at home without a healthcare professional. Some of the options for pain relief may include:
TENS machine
A TENS machine delivers mild electrical currents through electrodes attached to the skin. This may reduce the nervous system’s ability to send pain signals to the spinal cord and brain. It may also boost endorphins that act as natural pain relievers.
While TENS machines may not be effective for the stronger contractions of second stage labor, a
A person can use a TENS machine at home, in a hospital, or in a birthing center.
Breathing techniques
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In previous studies, people have reported that breathing techniques worked better for them than other non-drug methods, such as acupressure, relaxation, or massage.
These techniques may involve breathing slowly and deeply between contractions or, in some cases, taking slow and shallow breaths during contractions.
Breathing techniques have few risks and may reduce the need for other types of pain management.
Nitrous oxide
Nitrous oxide (Entonox), also known as laughing gas or gas and air, is a tasteless and odorless gas that can help reduce anxiety and reduce pain from contractions at any stage in labor.
People use nitrous oxide by inhaling the gas 30 seconds before and during contractions. It does not entirely numb the pain, but it can make it easier to cope with.
Possible side effects include:
- nausea
- dizziness
- sleepiness
However, these are short-term effects that should wear off in a few minutes if a person stops using the gas.
Pethidine
Pethidine is a
A healthcare professional can administer this medication via an injection in the thigh or buttock. This can provide pain relief for 2 to 4 hours and allow an individual to rest and relax.
There are possible side effects associated with pethidine, including:
- nausea
- dizziness
- confusion
- drowsiness
If given close to the time of delivery, it is possible for this medication to affect a baby’s breathing for a short time. The parent or baby may also be drowsy when trying to feed for the first time, but this wears off.
Epidural block
An epidural block is the most common type of pain management used for childbirth in the U.S. It involves delivering an anesthetic into the back, which then numbs the lower body. This can also include an opioid.
A person can have an epidural at any point during labor, but it is best to avoid giving an epidural either very early or very late in labor. If possible, healthcare professionals will aim to deliver an epidural during active labor before delivery.
To give an epidural, a specialized healthcare professional will insert a hollow needle into the lower back. They then insert a very thin tube through the needle and remove the needle, leaving the tube in place. Through this, they can administer the medication.
It takes around 10 minutes to set up an epidural and 10 to 15 minutes for the drugs to take effect. However, it does require health professionals to continuously monitor the baby’s heart rate, which means a person needs to wear a belt around the abdomen. Medical professionals may also attach a clip to the baby’s head.
Epidurals can cause side effects such as:
- difficulty moving around due to heavy or numb legs
- headache
- a sore back for a few days after labor
- tingling in one leg after labor
- decreased blood pressure, although this is rare if a person also receives IV fluids
The second stage of labor may take longer. The medical professional delivering the baby may need to tell the parent when to push, as it can be more difficult to feel contractions.
The second stage of labor begins when a person is fully dilated and ends with the birth of their baby. This is the stage where a person needs to push the baby out during contractions.
People can keep using breathing techniques, TENS machines, or nitrous oxide during this stage, but some may choose to change their pain management to cope.
Local anesthesia (pudendal block)
A pudendal block is a type of local anesthesia that blocks the nerves that signal pain to the vagina, vulva, and perineum. This significantly reduces pain and feeling in these areas.
If a person wants or needs to have a pudendal block, this will happen just before delivery or if they need an episiotomy.
This medication is unlikely to cause side effects, but in rare cases, it is possible to have an allergic reaction.
Spinal block
Spinal blocks are similar to epidurals, but instead of delivering medication through a tube, health professionals administer it with a single injection in the back. They work quickly, which is why doctors primarily use them in emergencies or for C-sections.
The needle is thinner than with an epidural, but the side effects and risks are the same. However, spinal blocks work for less time than epidurals, lasting around 1 to 2 hours. Doctors may administer it right before birth.
The third stage of labor begins after the delivery of the baby and ends after the delivery of the placenta.
During this stage, a person may want pain relief if they did not use much before the birth or if the pain relief they used earlier in labor is beginning to wear off.
What options a person has available to them will depend on what other methods a person has used already and whether they want to breastfeed. Health professionals may suggest:
- warm compress
- pain medications such as acetaminophen (Tylenol)
- breathing or relaxation techniques
- massage
Health professionals may also offer pain relief if some or all of the placenta does not come out on its own. They may need to perform an examination, and in some cases, a person may need surgery, which will require an anesthetic.
There are many other methods of relieving pain during labor. Some examples include:
- massage
- hypnobirthing
- water baths or water birth
- aromatherapy
There are many factors that can affect a person’s choices when deciding which pain management methods to use during birth. A person may find it helpful to think about:
- their personal pain threshold
- past experiences with pain relief medication
- the facilities that are available to them
- any allergies or preexisting medical conditions
- religious beliefs or customs
In some cases, one type of pain relief may not be effective, and the individual may need to consider another option.
It is also okay for a person to change their mind. People may decide to ask for more or less pain relief once labor begins or as it progresses.
It is important for the individual to discuss their options with their medical team.
There are many options for pain management during each stage of birth. This includes pain relief medications, anesthetics, and non-drug options, such as TENS machines and breathing techniques.
The options a person can choose from may vary depending on where a person gives birth, what facilities are available, and their own unique situation. Not all options work for every stage of labor or for every person.
An individual should communicate with their medical team and any birthing companions to ensure they are informed and prepared to manage their pain during birth.