Am Fam Physician. 2021;103(6):online
See related article on pain management in labor
How painful will my labor be?
There is no way to know what your labor will be like. Pain during childbirth is different for everyone. Some women need little or no pain relief. Others find that pain medicine gives them better control over their labor and delivery. Women who regularly take opioid medications may find it harder to control their pain during labor.
What are my choices for pain relief?
Pain can be managed with or without medicine. A trained personal labor assistant (also called a doula) can help you manage your pain without using medicine by offering encouragement and support. Other ways to manage pain without medicine include soaking your body in water (at body temperature) or changing your position during the first part of labor. Standing or sitting up may feel better than lying down.
If you choose to use pain medicine, there are many options. Some pain medicines, like opioids, go directly into your veins through an IV. If you have an epidural or spinal, the pain medicine is injected into your back.
When do I need to decide what kind of pain relief I want?
Knowing your choices ahead of time may help your delivery go more smoothly.
Your doctors and nurses during labor and delivery can help you decide which to use. Keep your options open. Some women plan to use pain medicine, but then decide they do not need or want it. Others plan not to have any pain management but change their mind during labor. You should not feel pressured to do one or the other.
What are opioids?
Opioids are a type of pain medicine that can be given during labor. They are usually given through an IV. They are given only in small doses and only early in labor to minimize side effects.
What is the difference between a spinal and an epidural?
A spinal and an epidural are used to relieve pain or numb the lower part of the body. For both, a needle is placed in the lower back.
A spinal is one shot of medicine, and the needle is taken out right away. The medicine makes you numb for a short time, and then wears off. It is usually used for short procedures when the doctor knows how long you will need pain relief, such as a planned cesarean (suh-SEH-ree-uhn) delivery (called a C-section for short).
An epidural is a catheter (very small tube that is soft and bendable) that is put through the needle into the area near the spine. The needle is then removed, leaving the tube. Medicine can be given through this tube continuously. Your doctor can give you more or less medicine as needed. An epidural is used when the doctor does not know how long pain relief is needed, such as during labor.
What if I need a C-section?
Some women have planned C-sections, and some are not planned. A spinal is usually used for a planned C-section. If you have an unplanned C-section, you may already have an epidural from labor, or you may get a new spinal. It is rare to need general anesthesia (go to sleep) for a C-section.
Does an epidural or spinal hurt?
The area where the epidural or spinal is given will be numbed, so there is only a little pain. You will probably feel some pressure. It can be uncomfortable, but most women find that the pain relief it gives during delivery is worth it.
Will I feel contractions, and will I be able to push?
If you get a spinal or epidural, you should still be aware of the contractions and be able to push. There is a small risk that you won't be able to feel when you have contractions. You may have to push for longer if you have an epidural or spinal. An epidural or spinal does not make it more likely that you will need a C-section or that the doctor will need to use a vacuum or forceps tool to get your baby out.
What are the side effects of pain medicines?
Less than 1% of patients get headaches after a spinal or epidural. The headache may last a few days, but it can be treated. Some women have low blood pressure for a short time after a spinal or epidural and might need extra medicine to bring the blood pressure back up. Opioids can make the mother or baby feel sleepy.
Will I have pain after my delivery?
It is common to have pain after delivery. Some women have more pain than others. After a vaginal delivery, many women still have some pain in their stomach, vagina, and breasts. After a C-section, many women have pain near their incision scar. Your doctor will treat your specific type of pain and will try not to prescribe unnecessary opioid medicines because they can be addictive.
Where can I get more information?
Your doctor
American College of Obstetricians and Gynecologists
