There are many ways to lessen the pain a woman feels during labor and delivery of a baby. Several kinds of medication can relieve the pain. Also, various methods of relaxation called prepared childbirth help some women have a baby with no or minimal medication.

The type of pain relief that is right for each woman depends on her physical condition, her training for childbirth, the length and stage of her labor, the amount of labor pain, and the condition of the baby. During prenatal visits a woman should discuss with her doctor the various methods of pain relief and the kind of childbirth experience she would like to have. She should also discuss any fears she has about labor and delivery.

What types of medications are used for pain relief?

When labor is especially painful or when the baby is in an abnormal position, medications can ease the pain. Pain- relieving medications are also used if a cesarean section is necessary. These medications may remove all sensation in a specific region or in all of the body, or they may relieve the pain without a total loss of sensation. The type of medication used depends on the stage of labor, the progress of labor, and the condition of the mother and the baby. In each case, the doctor tries to provide maximum pain relief for the mother without harming the baby.

Narcotics (such as Demerol and morphine) and sedatives (such as Phenergan) may be used during the first stage of labor to help the mother relax. Narcotics are usually given as an injection. They enter the bloodstream and affect the entire body. They do not cause a complete loss of sensation, but they do lessen the pain. Sedatives do not lessen the pain, but they can help the mother feel less tense or anxious.

Regional anesthesia lessens or blocks completely the pain in a specific area of the body. It works like the shot a dentist gives to numb a tooth or the shot a doctor gives to numb a cut that requires stitches. The epidural block is a commonly used type of regional anesthesia.

With either narcotic pain relief or regional anesthesia, the mother can stay awake and play an active role in the birth.

General anesthesia is another form of pain relief. It numbs the whole body and causes a loss of consciousness, which means that the mother is asleep. This type of anesthesia is commonly used for many surgical procedures, but it is not used for pain relief during labor. However, general anesthesia may be necessary for a cesarean delivery or a difficult vaginal delivery (for example, if the mother is bleeding too much or the baby is having problems).

What is an epidural block?

In an epidural block, pain-relieving medicine is injected into the mother's lower back. Usually a small tube is inserted into this space through the needle. Then the needle is removed. This makes it possible to give medication again or continuously through a catheter instead of another injection.

In small doses, an epidural block numbs the birth canal and the area surrounding the baby during labor and delivery. It eases the pain of contractions and the episiotomy (an optional procedure in which a small cut is made by the doctor to make the opening bigger). In higher doses, an epidural may be used for cesarean sections.

The mother may still be aware of her contractions. With low doses of medication, most women are able to help deliver the baby by pushing. If the mother is very numb, delivery by forceps or vacuum extraction may be necessary, or the medicine may be turned off or the dosage reduced to allow the mother to push the baby out.

Other types of blocks to relieve pain are sometimes used: pudendal block, spinal block, saddle block, and paracervical block. The injection sites and areas that are numbed differ for each type of block. For example, a pudendal block is given just before delivery of the baby. It relieves pain around the vagina and rectum as the baby comes down the birth canal. It is also helpful just before an episiotomy. The medication is injected inside the vagina. Pudendal blocks are one of the safest forms of pain medication.

Epidural blocks are usually used instead of spinal, saddle, or paracervical blocks.

What are the risks of using medications for pain relief during labor?

Because narcotics and sedatives affect all of a mother's body, both the mother and the baby may have side effects from these medications. The mother may feel drowsy or dizzy. She may have trouble concentrating and it may be harder for her to push during delivery. More serious possible side effects are a slowing of the mother's breathing or heart rate or a slowing of the baby's reflexes and breathing at birth. To reduce such complications, narcotics and sedatives are given in small doses and are usually not used when the baby is about to be delivered.

The medications used in most methods of regional anesthesia are less likely to pass to the baby and affect the baby because the medication does not enter the mother's bloodstream. However, regional anesthesia can make it more difficult for the mother to push or may cause the baby's head to not turn normally during delivery. In these cases the doctor may have to use forceps or vacuum extraction to guide the baby out of the birth canal.

An epidural or spinal block can cause a mother's blood pressure to drop, which may slow the baby's heartbeat. To help prevent this from happening, the mother is given fluids through her vein (an IV) before she is given the medication. Other side effects that the mother may have include difficulty breathing and headache.

How can pain during labor be relieved without medications?

Some techniques that help a woman cope with labor pain without medication are:

• Lamaze or Bradley methods of prepared childbirth: Pregnant women and their partners take classes to learn about childbirth, bodybuilding exercises, and methods of relaxation. Breathing exercises are an important part of the Lamaze method. Forms of meditation are emphasized in the Bradley method. Many mothers who use these methods are able to go through labor and delivery with less or no medication for pain.
• Hypnosis: The usefulness of this procedure varies from person to person.
• Acupuncture: This procedure uses small needles applied to special areas of the body to lessen the pain of contractions.
• Transcutaneous electric nerve stimulation (TENS): This method of pain relief uses mild electric impulses to stimulate the nerves and block pain.

All of these techniques can be used with other forms of treatment for labor pain.