Epidurals, Etc.: Understanding the Role of Pain Medication in Labor

When it comes to pain medication in labor, most women instantly think of the epidural. And for good reason: the Centers for Disease Control and Prevention (CDC) reports that the majority of American women have an epidural at some point during their labor.

Despite how common the epidural is, there are other pain medications that your OB/GYN might recommend. The recommendation will depend on what stage of labor you're in and your personal desires about the role you want medication to play.

Continue reading to understand what medications are available, when and how they're used, and their benefits and limitations.

Opiates

Opiates are systemic pain relievers, meaning they are absorbed by the blood stream. They do not completely remove pain, rather they "take the edge off" by lessening the body's pain response. Opiates are usually effective for a couple of hours.

There are several opiates that anesthesiologists frequently use:

Demerol
Stadol
Nubain
Morphine

An anesthesiologist will administer a small amount of one of these medications, either through an IV or a shot in the leg, arm or buttocks.

Opiates may be best for women who:

Want to labor naturally but who need some rest to continue on
Want to labor out of bed, since opiates don't cause muscle weakness
Want pain relief but can't yet have an epidural

There are some limitations of opiates:

Opiates can only be used in early labor. Using opiates too close to delivery can cause your baby to have slower reflexes initially
Opiates do not provide compete pain relief. Instead, they offer pain reduction

Epidural Blocks

Epidurals are a regional anesthetic, meaning they numb the section of your body below your chest, providing complete pain relief. An anesthesiologist administers an epidural by numbing a small area of your lower back near the spine and inserting a catheter. The catheter allows the slow flow of medication to your lower half.

An epidural takes about twenty minutes to administer and twenty more minutes to take effect. Once an epidural takes effect though, its medication can provide continuous relief for the rest of labor. There are a couple of types of epidurals, and include:

Patient-controlled epidurals allow the patient to control the flow of medication
Walking epidurals are a combination of an epidural and a spinal block that allows enough muscle strength for you to walk during labor

Epidurals are best for women who are ready for long lasting, complete pain relief.

There are some limitations of epidurals:

Epidurals can't be administered late in labor. If you wait and ask for an epidural while pushing, you probably won't get one –there's likely not enough time for the anesthesiologist to administer the epidural and for it take effect before the baby is born.

Epidurals usually require you to stay in bed and may require a catheter for your urine. They aren't the best choice for women who want to labor out of a bed.

Your OB/GYN may recommend you wait until you are dilated to a certain point before you have an epidural. Each doctor is different so be sure to ask ahead.

Spinal Blocks

Spinal blocks are another type of regional anesthetic that is given in a one-time dose through a shot into the spinal fluid in the lower back. Spinal blocks provide instant pain relief from the chest down.

Spinal blocks are often used if you:

Are about to undergo a C-section
Must deliver by forceps or vacuum extraction
Are expected to deliver within the next two hours

Limitations of spinal blocks include:

They only last for about two hours
They require you to stay in bed and usually require a catheter for urine

Spinal-Epidurals

Some hospitals offer a combination of a spinal block and an epidural block –called a spinal epidural. This involves only one procedure in which the catheter is placed for an epidural. The shot for the spinal block is given through the epidural catheter.

This procedure provides the immediate pain relief of a spinal block for up to two hours. When it begins to wear off, the anesthesiologist can begin the epidural through the catheter that's already in place.

Spinal-epidurals are ideal for women who are looking for as much pain relief as possible.

Spinal-epidurals are not for women who wish to labor out of the bed since they require you to stay in bed as soon as the procedure occurs. Spinal-epidurals aren't available everywhere.

Side Effects of Spinals and Epidurals

There are a few possible side effects that you should be aware of with regional anesthetics:

A feeling of itchiness (most common side effect)

A brief sensation of being unable to breathe

A drop in your blood pressure and baby's heart rate, usually a short-term effect

Low maternal blood pressure, which might drop baby's heart rate, usually a short-term effect

A severe headache occurring the day after the anesthetic, called a spinal headache. These are rare, but if they do occur, treatment is available

Talk To Your OB/GYN

The American College of Obstetricians and Gynecologists asserts that a laboring woman should be given pain relief upon request. Knowing what pain medications are available and when you can and can't have them should help you better understand the recommendations of your care provider. Talk to your OB/GYN about which approach might work best for you ahead of time.

If you have questions about epidurals or other concerns related to pregnancy and birth, browse around our blog and knowledge center to learn more. And don't hesitate to contact OB/GYN physicians at Gainesville and Lake City's All About Women today.