There are a few things in life that you can never really understand from an emotional perspective without experiencing it. The pain associated with labor is one of those things. This is probably why it can be such a source of anxiety for most pregnant people. Many may understand that it is an intense and unique pain, but there is often some fear about just how bad it will be.

If you’re asking, “Can I make labor less painful?” The answer is absolutely yes, there are pain control options for labor. The hope is that pain management will also help with the emotional process as you prepare for and go through labor—and we recommend finding a labor support person to encourage whichever choice you make.

What does labor pain actually feel like?

The uterus is a powerful muscle, and when it contracts, two processes cause intense cramping pain: stretching and pulling of muscle fibers and lack of oxygen to the muscle fibers (called ischemia).

The uterus has a tremendous blood supply. When a contraction occurs, it temporarily closes down the blood vessels carrying this oxygenated blood. This lower oxygen level causes pain, just like when you get a side ache from running. The pain is transmitted by “visceral nerves,” a special kind of nerve fibers that send a crampy pain signal from the uterus to the brain.

As labor progresses and the baby descends, other tissues become involved. The stretching of the tissues in the pelvis (vagina, pelvic floor muscles, pelvic ligaments and perineum) sends a different kind of pain signal to the brain. These signals are sent by “somatic nerves,” which send a more specific signal of burning, poking or searing sensations.

How can I manage pain during labor and delivery?

There are a range of pain relief options for childbirth, and there really isn’t one that is better or worse than the other. It is a highly individualized choice!

Your pain management options for labor include:

  • No medical intervention
  • Intravenous pain medicine
  • Regional anesthesia (epidural or spinal anesthesia)
  • A pudendal nerve block
  • Nitrous oxide

What if I want to labor without medication?

Medical intervention for pain control is not a necessity. If you desire to labor unmedicated, you should not feel pressured to receive anything you do not desire. After all, people have been successfully laboring for thousands of years without it.

Choosing to labor without medical intervention is a proactive approach focused on utilizing your body’s natural physiology. Beyond mental preparation methods like Lamaze, Bradley, or Hypnobirthing, there are several active tools used in the hospital to manage labor intensity:

  • Hydrotherapy: Using warm water in a shower or labor tub to promote relaxation and buoyancy.
  • Movement and Positioning: Using birthing balls, peanut balls, and frequent position changes to help the baby descend and relieve pelvic pressure.
  • Continuous Support: Working with a labor support person or a Doula to provide physical comfort measures like counter-pressure and rhythmic breathing.

How does IV medication work for labor?

The main intravenous medicine used in hospitals for labor pain is fentanyl. This is a narcotic medicine similar to morphine, but it has a more rapid effect and doesn’t last as long. It can make people a little sleepy, which can be annoying to some (or helpful to others).

A small amount of the medication does cross the placenta, but it is safe for the baby in both the short and long term. It is an effective medicine, but it usually doesn’t completely relieve the pain. Patients have described it as “taking the edge off.”

How do epidurals and spinals differ?

There are two types of regional anesthesia: epidural and spinal.

An epidural anesthetic is when an anesthesiologist or nurse anesthetist passes a small tube through a needle right next to the “dura” or membrane that surrounds the spinal cord and spinal fluid. Medication is dripped through this tube and numbs the nerves coming from the uterus just before they enter the spinal cord. Often, the patient is given a button to push for more medicine, if needed, so they can control the amount of pain they are feeling. This is called “Patient Controlled Epidural Anesthesia.”

A spinal anesthetic is when a very narrow needle is placed through the dura into the spinal fluid, and a single dose of medication is delivered. This medication lasts for 1-2 hours. Since the length of labor is unpredictable (and usually much longer than two hours), epidurals are much more commonly used than spinals for labor pain. Spinals are most commonly used for planned cesarean sections.

Regional anesthetics are safe for both the birthing person and the baby and have become quite popular. Epidurals typically allow patients to feel their contractions without experiencing the associated pain. The delivery of the medicine near the spinal nerves allows the total medication dose to be much lower than with intravenous medication. This reduces side effects, including sleepiness.

The medication that reduces the pain also causes weakness in the legs (which resolves once the epidural is stopped). Those who choose epidurals typically stay in the labor bed after being given the anesthetic or only get out of bed with assistance.

It used to be common for providers to withhold regional anesthesia until the body reached a certain cervical dilation (often four centimeters). This is not recommended anymore because studies have shown earlier epidurals provide safe pain control without increasing the rate of C-sections or other delivery problems. Now, those in labor can have regional anesthesia whenever they want it. The indications are that they are in labor, having pain and request it.

What if I only want numbing at the very end?

Without medication, the very end of labor is marked by an extremely intense burning pain associated with the stretching (and sometimes tearing) of the perineum as the baby’s head is delivered. This pain signal is sent to the brain through the pudendal nerve, which can be accessed safely by a numbing injection called a pudendal block. Placing a pudendal block just before delivery inhibits sensation in the vulva, reducing or preventing this pain from occurring.

This can be an effective and useful option for those who want to experience the contraction pain of labor but not the perineal pain from delivery. It can also be quite useful after delivery for those who have not had an epidural.

Most lacerations caused by delivery need to be repaired with stitches. A pudendal block can numb the entire area and allow the provider to repair the laceration without causing more pain for the birthing person.

Is “laughing gas” an option for me?

Many people have questions or preconceptions about nitrous oxide–a.k.a, laughing gas. While it doesn’t eliminate pain, it can take the edge off, help you relax and lessen anxiety. It is self-administered using a hand-held breathing mask, fast-acting and short duration–meaning you would need to use it fairly continuously to have a constant effect. Nitrous oxide doesn’t inherently inhibit mobility–but side effects can include dizziness, lightheadedness and nausea.

In Portland, nitrous oxide isn’t available in all hospital birthing units. Talk to your provider and check with your intended delivery hospital to see if they offer it. It’s probably also a good idea to check with your insurance company to see if they cover it as part of your benefits.

Can I change my mind once labor starts?

Your choice for pain management is yours. Our role as your care team is to provide the information and support you need to make the best decision for your unique needs and desires. We respect the strength and focus required for unmedicated labor, just as we value the relief that medical options can provide. Our priority is that you feel empowered to lead your birth experience and comfortable changing your plan at any point if your needs evolve during labor. And if you just change your mind, please don’t view it as a failure of any kind.

There are more details to pain control in labor. If you have questions about these, don’t hesitate to ask your obstetric provider at one of your prenatal care visits. They can help you better understand your pain control options in labor and be as prepared as possible.