Pain Management During Labor

If your doctor needs to stitch any lacerations (cuts) or make an episiotomy during delivery, they’ll use a local anesthetic (numbing medication).

A narcotic medication called Dilaudid can help you relax and can decrease your perception of pain. You can get Dilaudid as an injection, through an IV line, or a combination of injection and IV dose.

In most cases, care teams use this medication during the early part of the active phase of labor. This is so both you and your baby can metabolize (use up) most of it before you deliver. Sometimes — when a person receives it too late in labor — Dilaudid may cause your baby to be sleepy at birth. If you decide you would like an epidural after receiving narcotics, it is usually not a problem.

During cesarean birth, your anesthesiologists will be present for you the entire time. They will consider your pain control for during and after delivery at the same time. They may use a long-acting pain medication that can last up to 24 hours.

Depending on your needs and situation, your anesthesiologist may use one or a combination of these pain management options:

• Epidural anesthesia (relieves pain but still feel pressure)
• Spinal anesthesia (numb from the chest down)
• General anesthesia (fully asleep)

A pudendal block numbs the area of the vulva, vagina and anus by injecting local anesthesia deep into the vagina. Care teams can use a pudendal block for pain control during the second stage of labor and during delivery.

The anesthesiologist may administer a spinal anesthetic during delivery if forceps are necessary. During this procedure, the anesthesiologist inserts a small needle into your back, then injects a local anesthetic into the sac below the bottom of the spinal cord. This anesthetic numbs your body from the waist down.

Another form of pain relief during labor involves placing a needle into the epidural space and inserting another very thin spinal needle into the sac that surrounds the spinal canal. The anesthesiologist injects a small amount of a morphine-like medication (Fentanyl) through the spinal needle. We remove the needle, and an epidural catheter remains in place.

This procedure provides fast pain relief that lasts for several hours. After the initial medication wears off, your care team can continue your pain relief by giving you epidural medication through the catheter.

At BIDMC, we offer ‘lite’ epidurals. This type of epidural offers pain relief during contractions while allowing you to retain all or most of your muscle strength. During labor and delivery, pain is caused by pressure on your nerves. An epidural involves injecting medication into the epidural space of your spine in your lower back in order to block the pain sensation.

While you are sitting up or lying on your side, the anesthesiologist numbs a small area on your lower back using a local anesthetic. The anesthesiologist inserts a needle into that area. They then thread a thin tube (catheter) through the needle. The anesthesiologist removes the needle and leaves the catheter in place. They then inject the anesthetic medication through the catheter. They tape the catheter to your back. It remains in place until after you deliver.

After you receive an epidural, you may feel the pressure of your contractions, but not the pain. With a lite epidural, you should be able to:

• Move your legs freely.
• Reposition yourself in bed.
• Fully assist when it comes time to push.

Epidural anesthesia does not affect your baby or the progress of your labor. It is safe for most laboring patients. We may recommend epidural anesthesia for you if you have complex medical conditions.