How do I plan for pain relief in labor?

To start, you don’t need to make this decision immediately. Each woman is different and has different needs and preferences when it comes to childbirth. You’re taking a great first step by starting to collect information on the pros and cons of various options and taking the time to think about what is important to you and your partner. You can download and use this tool to dive a bit deeper into how you feel about using pain medications during childbirth. Ultimately, how you want to handle labor pain depends on your personality, resources, past experiences and personal values and goals.

As you develop your plan, remember that many options can be used at the same time, and some can be used one after another. Also keep in mind that it is difficult to predict what your labor will be like, so it’s always good to have a back-up plan.

Here’s how you can start planning:

1. Learn about labor so that you have a realistic understanding of what it may be like. This website is a great resource to do just that. Media images of childbirth are often sensationalized!
2. Educate yourself about the various methods for relieving labor pain. This will help you decide which ones suit you best.
3. Consider whether you’d like to avoid or use pain medication. If you have a partner, discuss your preferences and try to reach agreement before labor. If you can’t agree, remember that ultimately, you are the one going through labor so it is your decision.
4. Choose a place of birth that is a good fit for your pain relief preferences. It’s ok if you need to change to a setting that is a better match.
5. Choose a care provider whose basic attitudes about pain relief agree with yours. Things may go more smoothly if you don’t feel like you have to defend your choice (for example, to avoid using an epidural). As with birth location, you may want to switch to a more compatible care provider. (Don’t delay if this is the case, as some care providers do not accept transfers later in pregnancy.)
6. Consider hiring a doula (a woman trained and experienced in providing labor support). An important part of a doula’s job is to help you achieve your goals for labor and birth. 
7. Take childbirth preparation classes, which can help you and your partner understand what to expect in labor and ways to cope with labor pain.

What do I need to do during pregnancy if I want to avoid pain medication?

In hospitals where epidural use is the norm, you may have fewer options to use comfort measures and mental strategies. You will want a hospital that provides comfort measures (showers, rocking chairs, birth balls, etc.), has policies that support you to use those measures (freedom to be up and around in labor, no routine IV, etc.) and has nurses who know how to help laboring women without epidurals.

Alternatively, you might consider giving birth in a freestanding birth center or at home so that non-drug methods will be the primary or only option.

Read more about how your choice of birth setting and care provider affect your options when it comes to pain medications in the Choosing a Maternity Care Provider and Choosing a Place of Birth sections of this site.

A doula or other experienced provider of labor support can help you avoid pain medications and work with other methods. Read more about labor support practitioners in this section.

How can I avoid medication once labor starts?

• Ask everyone on your birth team (including any companions who came with you and the nurses) not to promote pain medication. If you feel that you are far from needing medication and you’re offered an anesthesia consult, turn it down. Any promotion of pain medication might make you feel less confident about your ability to complete labor without medication.
• Before labor, tell your supporters (your spouse, partner or doula) how you would communicate a clear wish to use medication. For example, you can tell them you will use a code word that you agree upon ahead of time. This will help them understand when you just need more support or comfort measures, or when you really want to move to medication.
• Keep in mind that it can be hard for your spouse or partner to see you experiencing discomfort, even though you may be coping well and committed to continuing without medication.
• If you feel close to needing medication, wait for a fixed period before setting anything into motion. This may help you get through a difficult time.
• If you feel close to needing medication, ask your care provider to check the opening (dilation) of your cervix. It may show that you are close to the time of pushing and birth.
• If you are nearing the time to push, remember that pain during pushing is different from the pain during dilation. Pushing may be easier for you to tolerate.

What if I am in labor and think I need medications after all?

If you are wondering whether to use medications, you and your team should consider:

• Whether you felt strongly about avoiding pain medication before labor, and would appreciate continued help from your labor team to stay on this path.
• Whether having medications is your idea or others are pressuring you, subtly or overtly.
• How close you are to giving birth, and what medication options are open to you at the time.
• Whether you have more stamina or are becoming exhausted.
• Whether changing the tone in the environment can help you stay on the drug-free path. This might include making it more calm, quiet and private.
• Whether your support team has other drug-free measures to try.

You may have entered labor with a wish to avoid pain medication. Commitment, preparation and good support are important to achieving this goal. However, everyone has an “enough” point. If you reach yours, knowing in advance the trade-offs of the various pain medications will help you make a good decision.

What do I need to do in advance if I plan to use medication?

You will need to look at the options and think hard about your preferences. Narcotics and epidurals (and nitrous oxide, if it is available to you) pose very different benefits versus harms. If you choose pain medications, you may still need to cope with labor without medication. Things don’t always go as planned. For example:

• Pain medication may not be a safe option in your particular case.
• You may arrive at the hospital too late in labor to start medication.
• An anesthesia provider might not be readily available.
• The staff may encourage you to wait until your labor is better established before being admitted.
• You may find an epidural doesn’t work or leaves “windows” of pain.
• You may find that labor isn’t as hard as you thought it would be.

What do I need to do in advance if I plan to have an epidural?

If you think you will probably want an epidural, make sure you have chosen a hospital where anesthesiologists or nurse-anesthetists are on site at all times. Otherwise, you may not be able to get an epidural when you want it. Other factors may come into play (see previous Q&A) or you may wish to try drug-free measures first. So, it would also be wise to find out if your hospital provides comfort measures (showers, tubs, rocking chairs, etc.) and has policies that encourage their use (such as freedom to be up and around in labor and no routine IV — intravenous — drips).

Even if you expect to have an epidural, consider arranging for a doula or other labor support companion. This person can help with comfort measures and mental strategies until your epidural takes effect, and can provide critical help if the epidural doesn’t work for you. Many women find that a doula continues to be helpful after an epidural takes effect and as you experience other interventions that often accompany epidurals. Even if your pain is relieved, you will still benefit from emotional support, information or ideas to promote good progress and minimize negative effects. A doula can also be helpful to a spouse or partner, if you have one.

How can I minimize the likelihood of having problems with an epidural?

• Choose a care provider with low rates of cesarean section and of using vacuum extraction or forceps, and be sure that there is a clear medical reason before agreeing to any of these procedures (since epidurals can make pushing difficult and make labor take longer, it’s helpful to find a care provider who is comfortable waiting or trying other ways to move your labor along without extra interventions).
• Some women develop a fever as an epidural side effect. In this case, their babies need to be checked and treated for an infection. This can involve a procedure, antibiotics and mother-baby separation. To reduce your chance of developing a fever, wait to have an epidural until your labor is well under way (e.g., when your cervix is dilated, or opened, about 6 centimeters).
• Empty your bladder before having an epidural, as you may not be able to do so or sense that it is full after the medication takes effect.
• Stay off your back after having an epidural; try lying on your side or staying in an upright position.
• Try changing positions and, with the support of a health professional, moving about if you can. This might help move your labor along.

Make sure you tell someone if you are having difficulty breathing or feeling extremely groggy. These could be signs of a more serious problem that needs immediate attention.

What do I need to do in advance if I plan to use other pain medications?

You cannot expect as much relief from other labor pain medications as from epidurals. A doula or other labor support companion can help with remaining discomfort, as well as many other needs.

If you expect to use narcotics, they should be generally available in U.S. hospitals. If you have an interest in nitrous oxide, you will need to ask about its availability at local hospitals, as it might not be available. (In general, narcotic use in labor is declining, and nitrous oxide use is increasing in U.S. hospitals.)

How can I minimize the likelihood of having problems with narcotics?

Narcotics slow your breathing and decrease the level of oxygen in your blood. These could be dangerous in certain situations. Avoid narcotics in situations where the baby might already be in danger. This includes during preterm labor, if your baby is or might be underweight or if you have high blood pressure.

Narcotics may make it hard for your baby to breastfeed at first. This will pass as the baby’s body processes the drug, so try not to get frustrated or discouraged. Here are some things you can do to make breastfeeding easier:

• Start breastfeeding as soon as you and your baby are settled and ready.
• Have your baby stay with you at the hospital (“rooming in”) so that you can nurse on demand, including at night.
• Be sure that you have continued support from someone who is knowledgeable about breastfeeding, like a lactation consultant.