Analgesia (Pain Relief) in Labor: What Are Your Options?

Your birthing plan: you’ve spent hours planning it down to the littlest detail… 😵‍💫 Vaginal vs c-section. Medicated vs unmedicated. Home vs hospital. While planning is great, sometimes, nature takes its course and our plans go out the window. 🙃 So, when it comes to pregnancy and parenting, you just have to go with the flow mama — and ask for a helping hand along the way. ❤️ This is no different when it comes to pain relief during labor. Let us take you on a pain-free journey of all the labor analgesia (pain relief) available to mamas-to-be.
In this article: 📝

• Should I have a medicated birth?
• What is labor analgesia?
• What is the most effective analgesia in labor?
• What are the downsides of epidural analgesia?
• So, what about pethidine — does it affect baby?

Should I have a medicated birth?

It’s completely your call. And, whatever you decide, is the right choice for you. While no one should force this on you, there is no shame in using some medication to make the process just a little more comfortable. You’ve already made it months through pregnancy, you’re body has been through a lot… (we’re looking at you crunchy moms!) 💪 If you feel the pain is getting a little out of hand, ring that call bell and discuss your options. You don’t have to go straight for an epidural (equally, you can if you’d like) — there are other forms of pain relief, which we’ll go through with you here.

Why is labor so painful?

First off, what is up with labor being so painful?! 😭 Well, your uterus is a very strong muscle, and in labor, its main job is to get the baby and the placenta out. The pain felt during labor is usually from the contractions of the uterus… squeezing the baby, slowly pushing it down the vaginal canal, and out into the world! 👶 Contractions come in waves, but as labor progresses, they can get closer and closer together, leaving less time to recover between them. Comparing what labor will be like to other people’s experiences will not give you much insight into what you might expect. The degree of pain will vary between mamas! You’ve heard us say it before, and we’ll say it again — every woman’s body is unique. And, it can even differ between pregnancies. If this is baby no. 1, 2, or even no. 8, each labor process can differ. There’s no predicting what the contractions will actually feel like this time around.

What is labor analgesia?

So, put simply, labor analgesia is pain relief used in labor that has been deemed safe for the mother and baby. It can be inhaled, taken orally, as an intramuscular injection, or as a local anesthetic into the spinal nerves that carry pain impulses to the birth canal. And, there’s a whole bunch of options out there, so you can find the best one that works for you. [1]

What types of pain relief (analgesic) are used during labor?

Acetaminophen and codeine

Tylenol to relieve labor pain… are you sure? For mild labor pains, it might just do the trick. ✅ Pros:

• 4 doses can be taken of both over 24 hours
  
  
• Very few side effects are reported from the acetaminophen

❌ Cons:

• Allergies to either medication will be unsuitable for use
  
  
• Codeine can cause vomiting and nausea 🤢

Nitrous oxide

You might know this drug more by the name “laughing gas”… Medically known as nitrous oxide, it’s an inhaled form of pain relief through a handheld mouthpiece. It is mixed with oxygen and recommended just as a contraction comes on, usually taking 15-20s to work. ✅ Pros:

• You’re able to control how much gas you inhale and can make labor more manageable.
  
  
• This reportedly has no side effects for the baby

❌ Cons:

• It is quite short-acting, and won’t completely remove of all the labor pain
  
  
• Can make you feel light-headed, nauseous, or dizzy, but these will subside quickly once you stop using the gas

Pethidine

This is an injectable medication that’s usually given in your thigh or buttocks for pain relief. It takes roughly 20 minutes to work, but has favorable pain relief efficacy. ✅  Pros:

• Lasts for 2-4 hours

❌ Cons:

• Not recommended to be used if you are nearing the second stage of labor
  
  
• It can make you feel very nauseous so it is usually given with an anti-sickness medication
  
  
• Contraindicated if you have high blood pressure (pregnancy-induced hypertension or pre-eclampsia).

Epidural

Now, this one we reckon you might have heard of… Epidurals are an effective pain relief method that offers complete pain relief. So if you’re experiencing a particularly tough labour, or you simply want to avoid it getting to that point, an epidural will likely sort you out. But what medication is an epidural? An epidural is technically a local anesthetic medication that is injected into the epidural space of your spine, and acts on the nerves that innervate the birth canal. Meaning, the nerves that carry the pain impulses to your brain are blocked! Woohoo, no pain! 🥳 Epidurals can only be done by anesthetists, so it might mean there is a bit of a wait if they are tied up with other patients. If you know this is something you want, it’s best to flag it up to your midwife or OB early. After the plastic tubing (catheter) is inserted into your spine, the anesthetic dose is given via the catheter. If the anesthetic starts wearing off, a ‘re-dose’ can be given easily via the tube. ✅ Pros:

• Acts quickly
  
  
• It’s effective for moderate to severe pain
  
  
• Easy administration for re-dosing

❌ Cons:

• Involves inserting a needle into the spine
  
  
• Makes your legs feel heavy — so no walking around
  
  
• As you’re not mobile, a catheter will need to be inserted into the bladder to help with urination and regular fetal monitoring, so you will be attached to a monitor
  
  
• Some women report side effects such as headaches, back pain, and nausea

What is the most effective analgesia in labor?

“So, go on then… which one is the best?” Well, labor epidural analgesia is considered the best pain medication for labor, with over 60% of women opting for it in the USA. [2] It’s not only fast-acting but, in most cases, provides complete pain (not pressure) relief. However, in some cases, the epidural does not work effectively and will need to be topped up or re-inserted by the anesthesiologist. Plus, everyone is different — so it might work well for one, and not so great for another…

How many cms is too late for an epidural?

Anesthetists generally advise against epidurals after 9cm — not for any reason other than labor usually progresses very quickly by this point, and inserting an epidural takes precious time you don’t have. On average, insertion takes around 20-30 minutes, and pain relief kicks in after 15-20 minutes. So if you have 1 hour to go, you’re cutting it quite close. 😬 But again, it depends on the hospital policy and what the anesthetist deems appropriate.

Does pushing hurt with an epidural?

That’s the best part — if the epidural is working correctly, no, it doesn’t hurt to push. 🙏 But, epidurals aren’t always effective, and you might still feel pain. If the epidural slowly wears off, a top-up dose is easily re-administered via the catheter. If you do feel any pains creeping back in, let your midwife/OB know as soon as possible.

Can you feel baby coming out with an epidural?

Yes, but not in the same way. Epidurals don’t take away the sensation of pressure, so you might still feel your contractions, which will aid in pushing. You will likely feel your baby moving around your birth canal as your little babe comes out.

What are the downsides of epidural analgesia?

Alas, with any medication, there are always downsides…

• 🚶‍♀️Reduced mobility: As epidurals affect the sensation in your legs, making them feel heavy, this will affect your ability to stand and walk. So if you’re keen to remain mobile during labor, think again. 🤔
  
  
• 💉 Careful insertion: Epidurals also require remaining still during that 20-30 minute time window as it is being put in, which can be tricky if you’re already having contraction pains.
  
  
• 🩸 Blood pressure decreases: You will have regular blood pressure monitoring as epidurals can drop your blood pressure. To counteract this, IV fluids are given simultaneously.
  
  
• 👶 Fetal monitoring: To monitor your baby’s well-being, you will be strapped to a fetal monitor after your epidural to keep a close eye on baby’s heart rate and movements. But, it might not actually be that bad… your baby is getting closer monitoring, and it’s not like you can move anyways. 🤷‍♀️

You might have heard through the labor grapevines that epidurals actually prolong labor but this isn’t true. A scientific paper has provided us with strong evidence that epidurals do not prolong the second stage of labor, and it is likely more an association rather than a risk. [2] [3]

Why do midwives not like epidurals?

We can’t speak on behalf of all midwives, but they should not be discouraging you from choosing epidurals. Epidurals are deemed effective and safe to use during labor. So if you want one, you should absolutely have the right to have one, and not feel judged for making that choice. The only time you should be denied an epidural (other than lack of time) is for a medical contraindication, or the safety of yourself and the baby. Midwives have a powerful position to influence women during labor, so they might explain their views, but they should not sway you one way or another.

Does an epidural affect your later life?

Epidurals are not known to have lasting effects. Anesthesiologists are highly trained and can minimize adverse risks. In rare cases (we’re talking very rare cases) you could lose sensation in one or both legs. Epidurals might give you a headache the next day and some back pain after removal. But these only last a few days and should go away with some Tylenol and rest.

Are you more likely to tear with an epidural?

Many studies in medicine have drawn different conclusions about the likelihood of tears with an epidural. But it’s sometimes impossible to make a definitive conclusion based on the large range of research findings out there. We hear you… why can’t there be a clear answer? 🙄 What we can say is that epidurals have not been linked to reducing tears. It either has no effects on tearing or can increase the chances of tearing. [4] [5] This might be more down to the maternal and fetal factors of labor rather than the epidural itself.

How often do epidurals fail?

You will be happy to hear epidurals are 90% effective. So, this only leaves 1 in 10 mamas without adequate pain relief. [6] If it does fail, the epidural can be reinserted, or you might be offered an alternative pain relief method.

So, what about pethidine — does it affect baby?

Hopping back over to one of our earlier forms of analgesia, pethidine crosses the placenta, which means it can have effects on your baby, too. The main effects it can have on the baby are lowering heart rate and respiratory rate. [7] “Wait… what? That sounds scary!” We hear you, but that’s why your baby will be closely monitored. If you don’t like the sounds of pethidine, you’ve got plenty of other choices which you can discuss with your OB or midwife.

Does pethidine slow down labor?

Pethidine is not known to slow down labor. Especially if you’re already in established labor. It has been either linked to speeding up active labor by promoting cervical dilation. [7] [8]
Anddddd…. breathe. 😮‍💨 That was a huge dose of information. But, as they say… knowledge is power. If you want to get more of the insider scoop from mamas who have tried analgesia in labor, come join the conversation on Peanut. 🥜 You have questions, they might have the answers you’re looking for.