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Giving Birth Pain Management

Reviewed by James Brann, M.D.

Labor Pain Mangement

Learn the different ways to manage pain in labor.

Pregnant women choose to manage labor pain associated with giving birth in different ways. I have patients that do not want any pain medicine, to women who would rather not feel one contraction.

There is not a universal way to manage labor pain that will works for everyone. The right type of pain management is a personalized decision between you and your physician. You need to research what labor pain control is available and talk to your physician about the one that is best for you.

Although, it is very helpful to discuss labor pain management ahead of time, you must realize that the best plans can always change. That is, because almost always your expectations of pain will be more or less than you thought.

You may choose to give birth without any pain control, “natural childbirth”. This means that you will not use any pain medications while in labor and giving birth. Instead, you will have to use breathing and relaxation techniques as well as other things to lessen the pain. Or, instead you may choose to use "labor pain medicines" to help ease the pain of giving birth.

The pain of labor and delivery is different for every woman.
The amount of pain you experience while laboring and giving birth is different for every woman. In fact, the intensity of the labor pain can be different between each one of your own births. The pain also depends on the size of your baby, the position of your baby and if this is your first delivery. The amount of discomfort also depends on if you are in the early part of labor or closer to giving birth.

Labor pain management involves both you and your physician.
You can do the following:

  • Change your body position often; do not remain in one position for an extended period of time.

  • Use your relaxation or breathing techniques that you learned in your prenatal classes.

  • You find relief by taking showers or baths during the early part of labor.

  • Lower back pain can be reduced with a good old fashion lower back massage.

  • Use heat or cold packs on your lower back

  • Listen to soothing and relaxing music.

  • During early labor walking will give you some relief.

  • Make sure a support person stays with you to give support and reassurance.

Your physician can prescribe medicines:
Despite your best efforts, pain medicine may be needed to help with your labor pain. If you want to use medicines all you have to do is ask *. Doctors can order many different types of medicines to help decrease your pain in labor. Some of the medications are used just to lessen the amount of pain you feel, but you will still feel pressure. Other types of pain medicines block the pain and pressure sensation. These two types of medicines are given to you differently.

  • Medicine can be given through your IV or as a shot - Opioid medicines are used in this way to lessen labor pain, but you will still feel discomfort at the peak of the contraction and pressure. The opioid medicines will cause nausea or vomiting and can make you feel sleepy. The baby will also be sleepy too, so these medicines are not used close to delivery.

  • Medicine can also be given through an epidural block - The epidural medicine is giving through a thin tube that is placed in your back. An epidural will remove all of your pain and will take 10 to 20 minutes to work. After the epidural takes affect you will need to stay in bed and will not be allowed to walk around. This is because your legs will be weak and not support your body weight.  Also, you may not have the sensation to push with an epidural, because the epidural block will takes away your urge to bear down and push. Epidurals can also decrease your blood pressure, given you a lightheaded sensation or a feeling that you are going to pass out. Another rare complication is an epidural headache after delivery.

Pain from vaginal tears and/or episiotomy
The pain associated with an episiotomy and/or vaginal tear can be bothersome for weeks after giving birth. The pain can be so intense that patients do not hesitate to call in the middle of the night for help. Here are a few tips to help with the discomfort:

  • Application of ice packs helps, especially if there is swelling

  • Application of 5 percent lidocaine ointment

  • Take a “sitz” bath – a shallow tub of warm bath water twice a day

  • Take acetaminophen (Tylenol) or ibuprofen (Advil, Motrin)

  • Analgesics with codeine

Afterbirth Pains
Afterbirth pains are very common and occur frequently after giving birth. They are caused by strong contractions of the uterus. The pain is more of a problem for moms that have given birth before and that are nursing. Nursing will cause the release of a hormone called oxytocin which causes the uterus to contract strongly. The prolonged cramping of the uterus is similar to a strong menstrual cramp.

Afterbirth pains usually stop at the end of the first week after delivery. You can find considerable relief from the pain with short acting non-steroidal anti-inflammatory drugs (NSAIDs), such as ibuprofen (Advil or Motrin).

Being Prepared for Child Birth Considerably Reduces the Use of Pain Medicines
The fear of giving birth and being unprepared potentiates the amount of labor pain. If you are not fearful, and have confidence in your physician you will usually require less amounts of pain medicine. This was demonstrated by Read in his book (Childbirth without Fear. New York, Harper, 1944, p 192).

Lamaze (Lamaze F: Painless Childbirth: Psychoprophylactic Method. Chicago, Henry Regnery, 1970) concluded the pain of giving birth often can be decreased by teaching pregnant women relaxing breathing techniques and labor partners support techniques. His techniques reduced the use of pain medications need during child birth.

In conclusion, if you are motivated and prepare yourself for child birth, the associated labor pains has been shown to be reduced, and the actual time in labor is even shorter. In addition, having a supportive spouse or partner, a conscientious labor nurse, and a physician who you trust have all been found to be of considerable benefit in reducing your labor pain.

*The American College of Obstetricians and Gynecologists (2002)  with the American Society of Anesthesiologists re-stated their joint position "that a woman’s request for labor pain relief is sufficient medical indication for its provision".

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