Pain medication: What's best for your labour?

In her book The Birth Partner, Penny Simkin describes a continuum of feelings expectant women may have about pain medication in labour. Some women want to feel no pain at all, and want heavy medication as soon as labour begins. Others are very strongly opposed to the use of medication and want to avoid it, no matter what.

Read more: Guide to labour pain management>

Both of those extremes, Simkin points out, are unrealistic. Using enough medication to make an entire labour pain-free can be risky for the baby and the mother. And there are situations when pain medication is necessary to deliver the baby safely.

Your goal may be to use pain medication only if you really need it. Or maybe you intend to use medication to help you through labour. Either way, you will be better able to make good decisions about the use of these drugs if you are well informed about them.

Begin your research by asking your physician about the medication available at the hospital where you are planning to give birth. Some smaller hospitals, for example, may have to “call in” an anaesthetist to administer epidural anaesthesia. Some hospitals have nitrous oxide gas available, while others don’t offer it.

Early labour medication Sedatives can be given in early labour to help a mother rest. If labour speeds up suddenly, though, the mother may be groggy and have trouble dealing with contractions, and the baby might be born with the sedative in his system.

Narcotic pain relievers can be used in early to middle labour. They eliminate some (but not all) of the pain, and cannot be given too close to the time of birth because they can cause problems for the baby, including difficulty breathing and sucking. The mother may also suffer some side effects, such as nausea and grogginess.

Read more: Birth plan checklist>

As labour advances Sterile water is not really a medication, but when it is injected just under the skin on the mother’s lower back, it can relieve or reduce back pain when the baby is in a posterior position. The effects seem to last about an hour, and then it can be repeated. The needle does sting when the injection is being done, but otherwise there are no side effects.

Inhalant anaesthetic (nitrous oxide or “gas”) is used to take the edge off labour pain. The mother holds a mask to her face and breathes in the gas as the contraction begins. She will feel a bit dizzy, but the effect is short-lived, and risks to the baby are minimal. Some mothers find the gas helpful, while others find it difficult to coordinate holding the mask and breathing in during hard contractions, or find the effect unpleasant. This option is not available in all hospitals.

Epidural anaesthetics involve injections into the mother’s back, and can completely eliminate all feeling in the abdominal area and (usually) legs. Newer methods give greater control over the dosage and timing of the epidural, and it can sometimes be arranged for the medication to wear off to allow the labouring mom to push the baby out, if she wants. Possible risks include “spinal” headaches for the mother, lowered blood pressure, slowing down of labour, increased use of forceps for delivery, and incomplete pain relief. Recent research also suggests that babies born after epidural anaesthesia, especially if it has been given over a long period of time, are more likely to have difficulties initiating breastfeeding. The “walking” epidural is offered at a few hospitals. It is a lighter dose that allows some women to remain mobile during labour. Walking around isn’t always possible, but this type of epidural may allow the mother to sit up and move around on the bed more easily.

For the birth A local anaesthetic may be given by injection, either near the cervix or at the vaginal opening, as the baby is being born. This can make a difficult pushing stage more comfortable for the mother and prevent her feeling any pain if an episiotomy is done. It will also numb the area if a tear has to be stitched after the birth. If a Caesarean section is needed, epidural anaesthetic can usually be used. However, in an emergency situation a woman may require a general anaesthetic because it can be administered more quickly. She will then be unconscious during the birth. This is a riskier form of medication and the baby may be sleepy, have some sucking difficulties, or experience breathing problems.

Originally posted in January 2011.