Labor Pain Relief: Epidural, Nitrous Oxide and Other Options

Your choice, in your own time

• Wanting strong medical pain relief is a reasonable choice, and so is wanting to avoid it. You can change your mind at any time.
• You don't have to reach a certain dilation before you get an epidural.

Coping without medicine

• Continuous support from a partner, doula or nurse.
• Moving and changing positions: walking, swaying, a birth ball, hands-and-knees, leaning forward.
• Warm water: a shower or tub. Laboring in water can lower pain; giving birth in water is more debated, so ask your setting.
• Massage, counter-pressure on the low back, warm or cold packs.
• Breathing patterns, hypnosis or meditation practice, music, dim lights.
• A TENS unit (mild electrical pulses on the back) helps some people in early labor.
• Sterile water injections in the low back can ease back labor for a while, where offered.

Nitrous oxide (laughing gas)

• You hold a mask and breathe it in just before and during contractions.
• Takes the edge off and eases anxiety rather than removing pain; wears off within minutes.
• You stay in control and can move around. Some people feel dizzy or sick.

IV or injected opioids

• Short-acting pain medicine through a vein or shot. Dulls pain for an hour or two.
• Can cause sleepiness and nausea, and if given close to birth can make the baby sleepy, so timing matters.

Epidural

• A thin tube is placed in the low back, delivering numbing medicine continuously. It's the most effective option.
• You stay awake. Legs feel heavy, so you'll usually stay in bed, with a urinary catheter and continuous monitoring. Some hospitals offer lighter "walking" doses.
• Possible effects: a drop in blood pressure, itching, fever, a longer pushing stage. A severe headache afterward is uncommon, roughly 1 in 100 or fewer.
• It does not raise the chance of cesarean, and it doesn't cause long-term back pain.
• A combined spinal-epidural works faster. A spinal alone is used for most planned cesareans.
• Some conditions, such as low platelets or blood thinners, can limit epidurals. Ask for a visit with anesthesia before labor if you have these, past spine surgery, or worries.

Other numbing

• Local anesthetic for stitches, and a pudendal block (numbing near the vagina) for a forceps or vacuum birth or a tear repair.
• General anesthesia is only for urgent cesareans when there isn't time for a spinal or epidural.

Planning ahead

• Ask your hospital or birth center which options they offer and whether an anesthesiologist is always available. Birth centers and home births don't offer epidurals.
• Practice coping skills in a class even if you plan an epidural; you may need them before it works.
• Note your wishes in your birth plan (see the birth plans and where to give birth guide).

When to check in

• Book an anesthesia consult before labor if you have a bleeding disorder, take blood thinners, or have had back surgery.
• After an epidural, tell your provider about a headache that's worse when sitting or standing; it is treatable.