Pain management options in labour

The amount of pain you have in labour can vary greatly from one person to the other. The pain you have depends on the size and position of your baby, the size and shape of your pelvis, the strength of your contractions, the length of your labour and your previous experiences. Your care team is here to support you during your labour and birth, and in your choice of comfort measures and pain relief.

There are many types of pain relief to choose from. For more information, please go to the Society of Obstetricians and Gynaecologists of Canada website: www.pregnancyinfo.ca/birth/labour/pain-management/

Newborn sleeping on mom's belly

Drug-free comfort measures

The comfort measures listed below can help reduce pain and make you feel calm and relaxed.  Ways of coping through labour that do not include medication can work very well.

Water Therapy (Hydrotherapy)

  • Shower or Bath
    • The feeling of running water or being in water can provide relief

Heat/Cold

  • Place warm or cold packs on your lower stomach or back

Massage and Touch

Some massage techniques can be comforting in labour. Having your support person massage or provide pressure to your lower back can be helpful. Ask your care team to show you different techniques that you can try.

  • Light or firm rhythmic stroking over shoulders, neck, back, abdomen or legs
  • Firm pressure on your back or hips, especially during contractions
  • Acupressure
    • Pressure on your back, hands or feet

Movement and Repositioning

Moving and repositioning your body during labour allows you to use gravity to help the baby change positions and move lower in the birth canal.

  • Walking, with periods of rest
  • Standing, leaning forward on a support person or bed, or slow dancing movements
  • Squatting or a supported squat position
  • Being on your hands and knees
  • Pelvic rocking, from side to side or front to back
  • Birthing balls are tools that can help support different positions and movements that would be hard to do on your own

Distraction Therapy

  • Listen to music
  • Focus on images or thoughts
  • Guided imagery or meditation
  • Focus on breathing

Patterned Breathing

Using different breathing techniques can help you stay focused and in control of your labour.

  • Concentrate on slow, deep breathing and on relaxing your muscles during and between contractions

Continuous labour support

  • Having a continuous labour support can provide you with confidence and help you feel relaxed and less anxious through your labour. It has shown to be associated with less labour interventions.

Using medications to manage pain

Nitrous Oxide Gas

This is sometimes called laughing gas. This type of medication is a mixture of oxygen and nitrous gas that you breathe in. This gas may dull or lessen pain.

  • It is a gas given through a mask that you hold yourself over your nose and mouth. Holding the mask can give you a focus that distracts you from the pain and allows you to control how much gas you breathe in.
  • The effect of the gas passes quickly and it does not affect your baby.
  • Nitrous oxide may make you feel dizzy, light-headed, or have nausea and vomiting

Narcotics

Narcotics can be used in labour to help with pain relief. They work well, but do sometimes have side effects for both you and the baby. Narcotics given during labour work quickly and can lessen pain and help you cope with painful contractions.

  • The main types are Morphine and Fentanyl.
  • They are given by injection into a large muscle in your leg or buttocks or can be given into a vein through an IV (intravenous) using a Patient Controlled Analgesia (PCA) pump. A patient controlled pump that delivers the narcotics (through an IV) with a button you press may also be an option.
  • Narcotics can reach the baby. After birth a team member will watch your baby closely for any signs of breathing issues.
  • Side effects can include nausea, vomiting, lower blood pressure, slow or fast heart rate and slower breathing than normal.

Pudendal Block

A pudendal block is a freezing medication that is injected though the wall of the vagina to numb the area between the vagina and the anus. The freezing works quickly to lessen pain in the area it is injected into during birth and during repair of any tears after birth.

  • The medication given with a pudendal block does not affect the baby.
  • It does not relieve the pain from contractions and not all providers are trained to do this

Epidural

Epidurals are given by a physician called an Anesthesiologist. It is a type of pain relief that numbs the nerves that make you feel labour pain.

  • An epidural involves an injection of freezing in your back and the placement of a small tube that will continuously give you pain relief until after your baby is born.
  • It is usually a quick pain relief option that allows you to move around a little bit with little to no medication that reaches your baby.
  • Side effects can include a drop in blood pressure, sore back and sometimes a headache.

Spinal Analgesia

Spinal analgesia is given by a physician called an Anesthesiologist. It includes a needle inserted into your back and a small amount of medication is injected.

  • Quick and effective with little to no medication that reaches the baby.
  • Lasts one or two hours and is usually only given once during labour (in most cases for a Caesarean section).
  • Side effects can include a drop in blood pressure and sometimes a headache.