Medically reviewed by Dr. Mark Zakowski, MD, August 8, 2024.

Labor Pain

You’re having a baby! You’re likely excited and no doubt nervous about several things—including the hard work and pain of labor and giving birth. Fortunately, there are many ways to ease labor pain and help you relax, including medications and breathing techniques.

Each person’s pain during labor is different. Talking with your health care providers, including your anesthesiologist, will help you decide which pain management methods will help you have the best possible labor and delivery experience. You may decide to use no medication, or you may choose from different types and levels of medication. Depending on how your labor progresses, you may choose to change your pain management plan or use a combination of methods. Whatever you decide, your anesthesiologist is available to help you.

There are many ways to ease labor pain and help you relax, including medications and breathing techniques.

How can you ease labor pain?

Here are some of the most common options for managing labor pain:

• Epidural: Used in about 77% of deliveries in the U.S., this is the most common type of pain relief used during labor. A study of over 575,000 women with a vaginal delivery in New York hospitals between 2010 and 2017 showed that the use of neuraxial analgesia, which includes epidural, spinal, and combined spinal epidural techniques, was associated with a 14% decrease in the risk of severe maternal complications. If you choose to have an epidural, an anesthesiologist will insert a needle and a tiny tube, called a catheter, in the lower part of your back. An epidural numbs only the lower part of your body, usually below your belly button, and allows you to be awake and alert throughout labor, as well as to feel pressure. You will be able to push when it’s time to give birth to your baby. It can take about 15 minutes for the pain medication to work, and you can continue to receive it as needed. Epidurals are very safe; however, as with all medications and medical procedures, there are some potential side effects to be aware of.
  • Decrease in blood pressure – The medication may lower your blood pressure, which may slow your baby’s heart rate. To make this less likely, you will be given extra fluids through a tube in your arm (IV line), and you may need to lie on your side. Your anesthesiologist may also give you medication to maintain your blood pressure.
  • Sore back – Your lower back may be sore where the needle was inserted to deliver the medication. This soreness should last no more than a few days.
  • Headache – In about 1% of procedures, the needle pierces the covering of the spinal cord, which can cause a headache that may last for a few days if left untreated. Tell your anesthesiologist if you develop a headache or have a persistent headache.

People sometimes ask if an epidural can slow labor or lead to a cesarean delivery, also known as a C-section. The best evidence shows that it does neither.

• Spinal analgesia: This can be used alone or in combination with an epidural. For the combination, which is referred to as a combined spinal epidural (CSE), an anesthesiologist provides medication through a needle inserted in the lower back and into the spinal canal. The relief from pain is almost immediate and lasts from one to three hours. You will be warm and tingly from around your belly button to your toes and feel no pain. A spinal anesthetic can be used for vaginal childbirth as well as for a planned C-section.
• Analgesics: These pain medications are delivered through an IV line into a vein or injected into a muscle. Analgesics can include both opioid and non-opioid medications and temporarily reduce pain but do not eliminate it.
• General anesthesia: This is the only type of pain medication used during labor that makes you lose consciousness. With general anesthesia, you will not be awake for the birth of your baby. It works quickly and is typically used only if you need an emergency C-section or have another urgent medical problem (such as bleeding).
• Additional and complementary pain management methods: There are also ways to help you cope with labor pain without medication or in combination with medication:
  • Massage – Have your partner massage your back or feet.
  • Breathing – Deep, slow breaths and grunting are two examples of the many different ways to breathe through the pain of a contraction.
  • Visualization – You may find it helpful to picture yourself somewhere enjoyable, such as on a beach or walking through a forest.
  • Water – Soak in a tub or take a shower to soothe some tension.
• Nitrous oxide – Often referred to as “laughing gas,” this option has not traditionally been used in the U.S. for labor and delivery but is becoming more common. It may help reduce anxiety but does not eliminate pain. Nitrous oxide may potentially affect your breathing, decrease awareness, or cause nausea, vomiting, and dizziness. More research is needed to determine how effective nitrous oxide is, what potential complications it could cause, and whether it might produce any long-term side effects for you or your baby.

  

How can you ensure your safety before, during, and after labor?

Thanks to the miracles of modern medicine, more people are giving birth in their late 30s and 40s. But older age and conditions such as diabetes, high blood pressure, and obesity increase the risk of complications for you and your baby. If you are an expectant parent, you should talk with your obstetrician and your anesthesiologist to develop a plan that ensures the safest possible pregnancy, childbirth, and recovery.

Birth Plan Template

This birth plan template focuses primarily on pain management, provides questions for you to ask your health care providers and prompts you for information that can help you make important decisions.

Download

Here are some of the things you can do:

• Take care of yourself. If you are older or overweight, or if you have diabetes, high blood pressure, or other health conditions, work closely with your physicians to address your condition prior to labor and delivery so you understand all possible complications and have a plan. About halfway through your pregnancy, ask if you can meet with an anesthesiologist, who can answer your questions and explain how the anesthesiologist in the labor and delivery room will work with you to develop an optimal labor, delivery, and recovery plan to help keep you safe.
• Express your concerns. If you have had a bad experience with anesthesia or have any fears about childbirth, let your physicians know. Never brush off your concerns—if something doesn’t feel right, tell your obstetrician and anesthesiologist. Be sure to ask about other issues of possible concern, such as whether having a slipped disk or a lower back tattoo would prevent you from having an epidural.
• Ask about an emergency plan. Your physicians will always prioritize your safety as well as your baby’s. But it’s important to know that your obstetric team has an emergency plan in place. Anesthesiologists have extensive critical care training and are experts in treating emergencies such as postpartum hemorrhage (bleeding) and preeclampsia (high blood pressure).
• Know that experts are working to improve care. Anesthesiologists are leading the way to develop protocols that improve safety during and after childbirth. Efforts include:
  • “Safety bundles”—collections of best practices for managing common problems, including postpartum hemorrhage and high blood pressure, which can lead to preeclampsia and, if not treated, to seizures, coma, brain damage, blood clots, and death.
  • Early warning systems that trigger an immediate evaluation if a patient’s health declines rapidly.
  • Refinement of labor and delivery pain management techniques and of anesthesia care for cesarean delivery, including the use of combined spinal epidural, which has led to a significant reduction in maternal deaths.
  • Multidisciplinary review committees at the state level to examine maternal deaths and identify the causes, determine preventability, and implement prevention efforts.
• Plan your pain management. Untreated post-delivery pain (after vaginal as well as C-section birth) can lead to post-traumatic stress disorder in some patients, so don’t downplay your pain. If you have had a prior bad experience or past trauma related to delivery or anesthesia, let your health care team know so they can help you have a better experience. Reach out to your anesthesiologist if you have questions about how to manage pain after birth. Ask whether opioids are an option or should be avoided.
• Talk with your health care team if you’re feeling down or depressed. A study from the Centers for Disease Control and Prevention found that about 1 in 8 women with a recent live birth reported symptoms of postpartum depression. Symptoms of postpartum depression may include crying more often, feeling distant from your baby or doubting your ability to care for them, or feeling angry. Your care team, including your anesthesiologist, can help you get connected to the appropriate support so that you can navigate these feelings and start feeling better.

Anesthesiologists are committed to patient safety and high-quality care, and have the necessary knowledge to understand and treat the entire human body.