Uterine muscle contractions — from pressure on your cervix, pressure of the baby on your bladder and bowels, and from the stretching of your birth canal and vagina — cause pain during labor. Pain relief options include analgesic medications, local anesthesia, regional anesthesia and general anesthesia.
Everyone’s labor is unique, and everyone experiences labor pain differently. How much pain you feel during childbirth depends on several factors, like the size and position of your baby, how strong your contractions are and your general tolerance for pain.
Pain during labor happens because your uterus contracts (tightens and releases) to help move your baby down the birth canal (vaginal canal). This puts pressure directly on your cervix, which is opening (dilating) and thinning (effacing) in preparation for birth. You may also feel pain from the pressure of your baby on your bladder and bowels. Later, you may feel pain when your vagina stretches as your baby passes through and out of your vaginal opening.
Contractions typically cause the most pain during labor. The way a contraction feels is different for everyone. It may even feel different from one pregnancy to the next. Labor contractions cause discomfort or a dull ache in your back and lower abdomen, along with pressure in your pelvis. Some people describe contractions as strong menstrual cramps, while others describe them as strong waves that feel more like diarrhea cramps.
The strength of labor pain isn’t always why people seek pain relief. Often, it’s the repetitive nature and length of time the pain persists. There are two options for labor pain relief: medicated and non-medicated.
Talk to your pregnancy care provider about your options for pain relief during labor and delivery, including the risks and benefits of each type. It may be helpful to discuss your options long before labor begins so you’re ready to make a decision.
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Most people will experience some pain during childbirth, even if they use pain relief. The type of labor pain, how long the pain lasts and where you feel pain varies from person to person and from pregnancy to pregnancy.
It’s important to learn what pain relief options are available during childbirth. Please discuss your options with your pregnancy care provider before your due date. Knowing what to expect ahead of time and the risks and benefits of each type of pain reliever will help you make a decision when the time comes.
Remember, your options for pain relief may be affected by certain circumstances of your labor and delivery. Throughout your labor, your healthcare provider will assess your progress and comfort level to help you choose a pain relief technique.
Your pregnancy care provider might ask an anesthesiologist (a provider who specializes in pain relief) to talk with you about pain relief options such as epidural or spinal anesthesia. The anesthesiologist will be happy to answer your questions.
The common types of pain relievers for childbirth include:
Providers inject analgesics into a vein or a muscle to dull labor discomfort. Analgesic medicines don’t completely stop pain, but they do lessen it. Because analgesic medicines affect your entire body and might make both you and your baby sleepy, they’re mainly used during early labor to help you rest and conserve your energy.
Analgesics are pain relievers you get through an IV (intravenous) into a vein or through your muscle using a shot. It makes you unaware of pain by blocking your response to it, but doesn’t make the pain go away. Analgesics are a type of opioid.
Using opioids for labor pain can have a negative effect on your baby’s breathing and cause them to be tired or “out of it” shortly after birth. Talk to your provider or anesthesiologist to make sure you understand the risks and benefits of analgesics.
Local anesthesia numbs a small area of your body like your vagina and vulva. Providers give it to you just before delivery (or when they need to give you stitches after delivery).
Local anesthesia blocks pain in a small area of your body during labor. An anesthesia provider inserts the medication into the nerves that carry feeling to that particular area. For example, local anesthesia may block pain in your vagina, vulva and perineum (space between your vagina and anus). It’s helpful during procedures like an episiotomy or when your obstetrician needs to repair a vaginal tear after delivery. Local anesthesia rarely causes side effects.
A pudendal block is a type of local anesthesia that involves placing an injection into your pudendal nerve. Providers usually give a pudendal block just before delivery. It relieves pain around your vagina and rectum as your baby comes down the birth canal and out of your vagina. Providers usually prefer using lidocaine for a pudendal block because it lasts longer than alternative medications.
Regional anesthesia is the most common and effective pain relief during labor. It greatly reduces or eliminates any pain you feel below your waist. It can also be used if a C-section becomes necessary. There are three types of regional anesthesia: spinal, epidural and combined spinal/epidural. With each type, an anesthesiologist places medicine near the nerves in your lower back to “block” pain in a wide region of your body while you stay awake.
The best time to receive regional anesthesia varies depending on your and your baby’s response to labor. If you request regional anesthesia during labor, your pregnancy care provider will contact an anesthesiologist. An anesthesiologist will come to your hospital room to give you anesthesia. Because regional anesthesia wears off, the timing is important. Your provider will want to make sure your labor is at a point where anesthesia is necessary. However, waiting too long for an epidural may mean you can’t get one. This is why it’s a good idea to know what options are available for anesthesia before labor begins. There are no strict rules, so even if you think you want to have your baby naturally and you change your mind, an epidural is always an option.
If you request regional anesthesia, you might receive epidural or spinal anesthesia, or a combination of the two. Your providers will select the type of regional anesthesia based on your general health and the progress of your labor.
An anesthesiologist will place an epidural while you’re either sitting up or lying on your side. First, they’ll numb an area on your lower back with a local anesthetic. Then, they insert a special needle into this numb area to find the exact spot to inject the anesthetic medicine. After injecting the medicine, your anesthesiologist removes the needle. A tiny plastic tube called an epidural catheter stays in place after the needle is removed to deliver medication as needed for pain throughout labor.
Considerable research has shown that regional anesthesia is safe for you and your baby.
Epidural anesthesia starts working within 10 to 20 minutes after an anesthesia provider inserts the medication. Pain relief from epidural anesthesia lasts as long as your labor, since more medicine can always be given through the catheter.
Spinal anesthesia starts working immediately after your provider injects the medication. Pain relief lasts about two hours. If your labor is expected to last beyond this time, your provider will insert an epidural catheter to deliver medicines to continue your pain relief as long as needed.
Although you’ll feel significant pain relief, you might still be aware of pressure from your contractions. You might also feel pressure when your healthcare provider examines you. In most cases, you’ll be unable to walk. You’ll remain alert and awake and should still be able to feel yourself pushing when it’s time to deliver your baby.
Not necessarily. Your anesthesiologist can tailor the anesthesia to allow you to sit in a chair or walk. Walking or sitting might even help labor progress. If you’re interested, ask your anesthesiologist about a “walking epidural.”
In some people, contractions might slow after regional anesthesia for a short period of time. Most people find that regional anesthesia helps them to relax and actually improves their contraction pattern while allowing them to rest.
Yes. Regional anesthesia allows you to rest comfortably while your cervix dilates. When your cervix is completely dilated and it’s time to push, you’ll have energy in reserve. Regional anesthesia shouldn’t affect your ability to push. It should make pushing more comfortable for you.
Your anesthesiologist takes special precautions to prevent complications. Although complications are rare, some side effects might include:
You may not be able to have an epidural or spinal block if you’ve had major surgery to your lower back or if you have certain health conditions. Talk to your pregnancy care provider about the risks of an epidural or spinal based on your health history.
General anesthesia causes you to go sleep. Although safe, general anesthesia prevents you from seeing your child immediately after birth. It’s most common during emergencies.
General anesthesia involves being put to sleep during delivery. It works quickly, but is usually only an option for emergency C-sections or other urgent issues like excessive bleeding during delivery.
A risk for general anesthesia is aspirating (breathing in) food into your lungs. This means food in your stomach comes out your mouth and gets inhaled while you’re asleep. This is the most common risk of general anesthesia for any surgical procedure, not just during childbirth.
Nitrous oxide (laughing gas) is an odorless, tasteless gas that you inhale through a mask. It helps to reduce anxiety during labor, but doesn’t eliminate pain.
Laughing gas (nitrous oxide) isn’t as common in the U.S. as it is in other countries. It’s a gas you inhale through a mask just before a contraction. While it works quickly, it also wears off quickly. Healthcare researchers are studying the long-term effects of laughing gas. Nitrous oxide may affect your breathing and cause nausea, vomiting and dizziness.
There are many ways to manage your pain during childbirth without medication. Natural childbirth typically involves no medication. Instead, people rely on breathing exercises or relaxation techniques to get them through labor and delivery.
Examples of pain relievers that don’t involve medication include:
Often, the company of your spouse or partner, birth doula or a friend can offer support and positive reassurance during labor. This is known as continuous labor support. Some people even choose to use natural methods alongside medicated options.
This is hard to answer because there are so many factors to consider. Some of these factors include how big your baby is, how wide your pelvis is, if you’ve given birth before and what method of delivery you’ll need.
While it’s good to know all of your options for pain relief long before labor begins, childbirth can be unpredictable. Discuss your concerns with your provider and they can help you decide what’s best.
Certain narcotics (opioids) may reduce your sensation of pain during labor. While they don’t eliminate pain, they help control your response to pain. Your provider injects these through an IV or with a shot, typically early in labor (this is safest). Discuss the side effects of opioids with your provider, as they’ve been shown to cause side effects like drowsiness and changes in breathing patterns.
A completely pain-free birth probably doesn’t exist. However, there are many options available to reduce or manage your pain during childbirth. Everyone experiences pain from labor differently. The best thing you can do is discuss your options with your pregnancy care provider or an anesthesiologist. While labor and delivery are often unpredictable and you may need to be flexible, knowing what you may want before delivery is helpful.
An epidural is the most common and widely talked about medication for pain relief during labor. If you don’t think you want an epidural, there are other options available that can reduce your pain. Medicated options like a pudendal nerve block or acetaminophen may be helpful if you don’t like the idea of an epidural. Or you can look into medication-free methods, like a birthing class.
A note from Cleveland Clinic
Labor can be painful. It’s helpful to learn all the different options for pain relief so you can make an informed decision on what works for you. Ask your pregnancy care provider to explain how each one works and what they recommend based on your health history. Knowing what to expect and having a plan in mind for how you want to handle the pain and discomfort of childbirth are good ways to prepare yourself.
Last reviewed by a Cleveland Clinic medical professional on 03/10/2023.
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