Pain options: from breathing to epidural

Pain relief in labor runs from breathing and water to nitrous and the epidural. None is the right one. Here is what each does and costs you.

What it is

Pain relief in labor is a menu, not a test. At one end are things you do: breathing, movement, water, heat, massage, and a steady person. In the middle is nitrous oxide, a gas you breathe through a mask you hold yourself. At the other end are IV medication and the epidural. Most mothers use more than one. An unmedicated or natural birth is a real choice. So is an epidural at 2 centimeters. ACOG says your request alone is reason enough for pain relief.

About 7 in 10 mothers who give birth vaginally in a United States hospital have an epidural. In birth centers and at home there is no epidural, so the menu is the first half.

What's typical

An epidural is placed by an anesthesiologist in about 10 to 20 minutes and takes another 10 to 20 to work. You stay in bed with a monitor, an IV, and often a bladder catheter. It can lower your blood pressure, cause itching or a fever, and make pushing take a little longer. Studies find more assisted births with an epidural but no rise in cesarean. About 1 in 100 get a headache afterward that eases lying flat. It is rarely too late for one unless the baby is about to be born. Nitrous takes the edge off within a minute and clears in minutes. IV opioids work for an hour or two and can make a baby sleepy if given close to birth. A warm tub in active labor lowers epidural use in studies.

What's known

The Cochrane reviews are the backbone here. Water, continuous support, and upright movement lower the use of medication. Epidurals give the best pain relief and are safe for the baby. Relaxation, hypnosis, and massage help many mothers, but the evidence is thin. Many traditions lean on warmth, upright positions, and women surrounding the mother. The science has mostly caught up with them.

What helps

Learn three comfort tools before labor: a breath you can hold on to, hip pressure your partner can do, and one position that opens your pelvis.
Ask your hospital what it has. Tubs, wireless monitors, nitrous, and peanut balls are not on every unit.
Decide your rough plan, then give yourself permission to change it. Both directions count.
If you get an epidural, ask for the peanut ball and a position change every 30 to 60 minutes.

When to call someone

Nowafter an epidural, trouble breathing, numbness that climbs toward your chest, or a sudden severe headache. Tell the nurse at once.
Now, at home after the birth: a headache that is bad sitting up and better lying flat, or a fever with back pain at the needle site. Call your provider now.
Todaya numb patch or weak leg that is still there a day after the epidural wore off.
At your next visitback pain at the site that lasts past 2 weeks, or questions about what happened and why.

Who helps

Doula MidwifeOB-GYN

Tools: Birth Plan Generator · Birthworker Directory

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Sources

American College of Obstetricians and Gynecologists — Practice bulletin on obstetric analgesia and anesthesia
American College of Obstetricians and Gynecologists — Patient FAQ on medications for pain relief during labor and delivery
Cochrane — Pain management for women in labour: an overview of systematic reviews
Cochrane — Immersion in water during labour and birth

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