This is part 1 of 2 where we break down pain medication options in labor and the risks and benefits to each.

Before you have a baby, you’ll hear a lot about your pain management options. It’s hard to know, before you actually go into labor, how your pain will be, or what will work best for you. We think the best way to handle it is to know your options, including the pros and cons. Then, when you’re ready, you can figure out what makes the most sense for you. 

Please remember that a successful birth is one that minimizes trauma to you and your baby. There is no shame in making the decisions that work best for you.

There are two kinds of pain management in labor: medical and non-medical. Medical options include IV narcotics, epidurals, spinals, general anesthesia, and nitrous oxide. We’ll cover non-medical options in Part 2 of this post.

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IV Narcotics - Your medical team will inject pain medication directly into your bloodstream.

Pros: This method offers quick relief, though it will not completely relieve pain. It’s also less invasive than an epidural or a spinal.

Cons: Among other side effects, IV narcotics can make you drowsy or nauseous. These medications can also cross the placenta, which means that the baby may be affected.

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Epidural - Your medical team will insert a needle into your lower spine (in between the vertebrae), and inject pain relief medication there. The needle is removed, but a flexible tube remains, so that you can get a steady stream of medication.

Pros: You can stay conscious and feel contractions without a great deal of pain. You can also rest before you reach the stage for pushing. If a c-section is needed, you can receive your pain medication through the same port; no additional shots are needed. This medication does not cross the placenta, so the baby is not affected.

Cons: You cannot move around after the epidural is administered, which limits your options during labor. There is some risk for injury during the administration of the epidural.

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Spinal Block - Your medical team will inject pain relief into your lower back. Unlike with an epidural, once the needle is removed, you are no longer attached to a tube distributing medication.

Pros: Whereas an epidural can last for many hours, the spinal is short-term, lasting only an hour or two. It works well for c-sections.

Cons: The medication cannot be increased once it is given. Similar to an epidural, you cannot move around after you have a spinal. Also similar to an epidural, there is a risk during the injection process.

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General Anesthesia - This method is used exclusively for emergencies and some c-sections. Your medical team will administer an IV of strong medication along with inhaled drugs to make you fall asleep until the surgery is over. Although it was once common to use general anesthesia for c-sections, most hospitals prefer epidurals and spinals now. They’re safer.

Pros: No worries about anxiety or discomfort; you’re out until after the baby’s born.

Cons: You will not be conscious for the birth of your baby. There are also serious risks associated with the drugs reaching your baby, as well as increased risk of complications for you. 

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Nitrous Oxide - Often called “air and gas,” this is a common pain relief in other countries. If you’ve ever watched Call the Midwife, you probably saw it there. You breathe in the gas through a mask, and feel a sense of brief euphoria that clears quickly.

Pros: Very non-invasive and safe for the baby. You are clear-headed fairly quickly.

Cons: The relief is very temporary, and not as intense as more strong medications.