Many types of medications can ease pain during labor and delivery.
Ideally, the drugs used are safe for mother and baby, don't interfere
with labor and delivery, and provide good pain relief with few side effects.
This is a guide to medications used during labor and delivery. Work with
your health care team to make the best decision for you and your baby.
Epidural block
An epidural block can be given in the labor room. Block placement
usually isn't painful, although there might be some discomfort from
numbing the skin before the block. Small tubes (epidural catheters)
placed in the low back allow a pump to drip pain medicine into the lower
body.
A test dose might ensure the epidural is in the right place. It takes up
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 ask for
an epidural during labor — either soon after your labor starts or as
labor goes on. 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 eases most pain in the lower body without slowing labor
much. You remain awake and alert, but you still feel pressure and some
stretching during delivery. The epidural's effect on the baby is minimal
to none. A combined spinal-epidural block relieves pain faster than a
regular epidural and might use less medication.
Cons
In a few instances, epidurals might not provide enough pain relief. An
epidural can decrease blood pressure. There's a small risk that the drop
in blood pressure could slow the baby's heart rate. Other possible side
effects include fever, itchiness or back soreness after giving birth. A
bad headache is a rare side effect.
Some women with an epidural can't walk during labor.
Spinal block
A spinal block is typically used to block pain during a C-section.
However, a spinal block can be used to relieve pain if delivery is
expected shortly or if forceps or vacuum extraction is needed.
During a spinal block, the medication is injected into the fluid below
the spinal cord in the lower back. It takes effect quickly. It can
provide only a couple of hours of pain relief. A spinal block given
during epidural placement is called a combined spinal-epidural block.
Pros
A spinal block provides complete pain relief in the lower body for about
an hour or two. You'll remain awake and alert.
Cons
A spinal block might decrease blood pressure. Infrequently, this can
slow the baby's heart rate. Side effects include itching or back
soreness after delivery. A rare side effect is a bad headache.
Opioids
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 can help you relax. Most take effect within minutes.
Cons
Opioids don't offer great relief from labor pain. They typically don't
work for pain during delivery. They can cause nausea, vomiting and
drowsiness. These drugs can affect the newborn's breathing and cause the
baby to be drowsy, which might hamper the first breastfeeding.
Local anesthetic injection
A local anesthetic might be used to quickly numb the vaginal area to
prepare for an incision to make the opening of the vagina bigger
(episiotomy) or repair a tear after delivery. The drug is injected into
the area around the nerves that carry feeling to the vagina, vulva and
perineum.
A pudendal block is a type of local anesthetic injection that 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 local anesthetic is injected into the vaginal
wall near the pudendal nerve and takes effect in 10 to 20 minutes.