Labor Pain Relief Options Compared: What Each One Does

Why it helps to sort this out before labor

Maybe you have a friend in Scarsdale who swears by her epidural, a sister in Brooklyn who labored in the shower, and a coworker who wants to know your "plan." It is a lot of opinions to carry into your third trimester. The good news is that you do not have to settle it today.

The American College of Obstetricians and Gynecologists (ACOG) suggests talking about pain relief with your ob-gyn during a prenatal visit. ACOG also says you do not need to decide about medication until you are actually in labor, but it helps to learn which types your hospital or birth center offers and to think through your options ahead of time.

ACOG is clear that no one should pressure you into a particular option, whether that is your partner, your family or a health care professional. Only you know how you feel and how you handle pain, and it is OK to change your mind. Some health conditions, such as heart disease, certain blood disorders, liver disease or previous spinal surgery, can affect your choices, and you may be scheduled to meet an anesthesiologist before or during labor.

The medication options in plain words

ACOG sorts labor medications into analgesia, which lessens pain without taking away all feeling or movement, and anesthesia, which blocks most feeling, including pain. Here is what ACOG says about each option you are likely to hear about.

• Epidural block: the most common type of pain relief for childbirth in the United States. Medication goes through a thin tube placed in your lower back. You stay awake and alert, you can move but may not be able to walk, and ACOG says relief should begin within 10 to 20 minutes after the medication is started.
• Spinal block: a single shot into the fluid around the spinal cord. It works quickly but lasts only an hour or two, and it is commonly used for cesarean birth.
• Combined spinal-epidural (CSE): a spinal for fast relief, then an epidural catheter for continuing relief. ACOG says lower doses can be used than with an epidural alone.
• IV or injected opioids (systemic analgesia): these reduce your awareness of pain and have a calming effect without making you unconscious. They can make your baby drowsy for a short time, and you may not be able to get them within the hour before delivery.
• Nitrous oxide: a gas mixed with oxygen that you inhale through a mask you hold yourself. ACOG says some hospitals use it. It does not numb pain; it eases anxiety so pain is easier to deal with.
• Pudendal block: a local numbing shot given just before delivery. General anesthesia is usually used only in emergencies.

Comfort measures without medication

ACOG guidance for clinicians says that multiple nonpharmacologic and pharmacologic techniques can be used to help women cope with labor pain. For patients, ACOG says nonmedical approaches can be used alone or along with medication. Its list includes breathing and relaxation techniques from a childbirth class, firm pressure or massage on your lower back or feet, changing positions often, a shower or bath if permitted, warm or cold packs on your back, cool cloths, and picturing a favorite place.

In an ACOG article on preparing for birth without pain medication, an ob-gyn suggests asking your hospital or birth center what tools it has, such as birthing balls or stools and warm baths or showers. The same article notes that labor may not go as planned and that needing medication later is OK.

If you want ideas to practice now, our post on easing labor pain naturally walks through comfort measures, and the water birth post covers laboring in water. Run any of them by your provider first.

What a labor doula does with each choice

ACOG describes doulas as trained support people who can offer comfort and encouragement but not medical care. A doula never gives you medication, never checks how labor is progressing, and does not tell you which option to pick. What a doula can do is help you prepare questions, practice comfort positions with you and your partner, and stay with you through whatever you choose.

With an unmedicated plan, that may mean counter-pressure, position ideas and steady encouragement. With an epidural, it may mean keeping you company while it is placed where your hospital allows, then helping you change positions in bed with pillows or a peanut ball. Our post on having a doula when you plan an epidural goes through that support step by step.

At Northeast Doulas, labor doulas come "with no agenda" and support "an unmedicated birth, an epidural, an induction, or caesarean," which you can read more about on our labor doula page.

Questions to bring to your prenatal visit and hospital tour

Whether you plan to give birth in Westchester, Fairfield County or Manhattan, the answers depend on your health and on the place you choose. Write these down and bring them with you.

• Which pain relief options does this hospital or birth center offer, and is nitrous oxide one of them?
• Is there anything in my health history that could change my options, and should I meet with an anesthesiologist ahead of time?
• Are tubs, showers, birthing balls or peanut balls available in labor rooms?
• How many support people can be with me, and are doulas counted among them?
• If I get an epidural, what will I be able to do afterward, such as change positions?
• If I am induced, does that change which options make sense? Our induction guide has more questions on that path.

When a doula is not what you need

If your question is medical, such as whether an epidural is safe with your back surgery or how a medication may affect you, the right person is your ob-gyn, midwife or anesthesiologist. A doula can help you write the question down, but cannot answer it for you.

If what you want is continuous support from someone who knows your wishes, a doula may be a good fit no matter which pain relief you choose. When you are ready to compare doulas, our guide on how to choose a doula in Westchester, Fairfield County or NYC walks through the questions to ask.