Yay, you’re pregnant! Let the good vibes roll, at least for the first eight months or so until the reality of giving birth crashes over you in a wave of panic, like how is this physically even possible? Staring down childbirth has a way of stirring up some unpleasant emotions—with a fear of pain sitting pretty high on the list.
Not going to sugarcoat it, you are probably going to experience some pain with labor. But, you get to decide—and change your mind about—the type of pain relief you’d like to have during the wildest ride your body (and brain) may ever experience.
Where you decide to give birth factors in, too. Home births won’t have the same pain relief options as a birthing center, which won’t necessarily have all the bells and whistles of the hospital. (It is possible to transfer to the hospital if you need more pain relief1 than either of those two settings can offer, though). Being aware of all the pain management options available will help you make the best in-the-moment decisions possible, because labor has a funny way of surprising you. Your pain relief plan for birth is completely personal, but it’s also a good idea to stay flexible.
So, here is our comprehensive labor pain relief guide, with expertise from a doula, a midwife, and an ob-gyn. As you put together your birth plan, remember: there are no value judgments on how you give birth, and being a good mom has nothing to do with how much or how little pain you felt during labor.
Medical Options
Nitrous Oxide
How it works: Nitrous oxide is best known as laughing gas at the dentist’s office, but it can also be used during labor for temporary pain relief. “It’s usually a 50/50 blend of oxygen and nitrous, and it’s inhaled through a mask,” says certified nurse-midwife Lucy Chapin. “Ideally 30 seconds before you need to feel relief.”
Nitrous oxide may help take the edge off your pain and is often used to help women who have opted out of an epidural to get through the last stage of labor called transition, which is known as the most intense and painful period, says Chapin. “You can use nitrous oxide up until birth because it’s out of your system so quickly.”
Things to consider: Nitrous oxide is a mainstay of treatment in Europe, but its use is a bit more controversial in the U.S., says Dr. Robin Elise Weiss, a doula and president of DONA International. Where it’s available also depends on state laws, so make sure to ask your birthing team if this is available to you, whether you’re planning a home birth, a birth at a center, or a hospital birth.
IV Pain Medication
How it works: Hospitals and some birthing centers (depending on state laws and whether it’s associated with a hospital) can provide IV pain medication, typically in the form of opioids, says Dr. Amanda Flicker, an ob-gyn and chair of the department of obstetrics and gynecology at Lehigh Valley Health Network. “Obviously there are lots of reasons why we are careful about using those medications in labor, but they are still a mainstay of therapy for intermittent use or to bridge the time gap for people.”
Opioids that are commonly used for labor2 pain relief, like Demerol, Stadol, and fentanyl, work by blocking pain receptors in the brain, but they also have more side effects, says Dr. Flicker, primarily making you feel sleepy or out of it.
Things to consider: Your birthing team will be cautious with opioids. First, if you have any kind of allergy to these meds, they’re a no-go. Second, if you have substance use disorder, Dr. Flicker notes that they can still be used to control pain, but your provider will have to be extra careful about which types of opioids are okay to use so as to not trigger withdrawal symptoms.
Your labor progress will also be monitored very closely when taking IV pain meds because opioids can cross the placenta and sedate the baby, which would require extra care. “You really need your pediatric team to be present to support the baby if labor progresses faster than you think,” says Dr. Flicker.
Epidural
How it works: An epidural is probably the most famous pain relief option for labor, and for good reason. An anesthesiologist at a hospital is needed to place an epidural, which involves inserting a needle and a thin, flexible catheter into the epidural space in your spinal cord. The needle is removed, but the catheter stays in place to provide continuous numbing medication (with or without opioids) to the lower half of your body. According to the American College of Obstetricians and Gynecologists3 guidelines, you can receive an epidural at any time during labor, all you need to do is ask. “The pain relief you get from an epidural, and obviously the spinal block, are the most effective methods,” says Dr. Flicker.
Things to consider: Epidurals stay mostly local, which means they’re much less likely to cross the placenta, unlike opioids, says Dr. Flicker. Of the medications, an epidural is the best option to stay present during your delivery, according to Dr. Flicker.
If you do want an epidural, be aware that timing matters. “If someone rolls in nine centimeters dilated and wants an epidural, it may be too late,” says Dr. Flicker. Why? By the time you get an anesthesiologist in to place the catheter and you start feeling relief, the baby will likely already be born, says Chapin, particularly if this isn’t your first child.
Sometimes epidurals get a bad rap for stalling out labor, says Dr. Flicker, but in her 24 years of delivering babies, she has found the opposite to be true. ”They actually help expedite labor,” she says, because it allows the body to relax and make way for the baby’s head to descend.
Pudendal Block
How it works: If you did miss your opportunity for an epidural, don’t worry, you still have options. Aside from nitrous oxide, there’s also the pudendal block, which is a local anesthetic that’s injected into the pelvis through the vagina. Yes, that sounds terrifying, but you probably won’t even notice, and it will work to numb the pelvic floor, labia, and outer part of the vulva. “It won’t take away the contraction pain, but if you’re fighting pressure and pain in your pelvis, it will numb that,” says Dr. Flicker.
Things to consider: Pudendal blocks can also be used after a vaginal delivery to repair tears and lacerations, says Dr. Flicker.
Spinal Block
How it works: This is an injection of local anesthesia into the spinal space. It’s different from an epidural, because it’s a one-and-done injection, and it’s typically used for a scheduled C-section, says Dr. Flicker. It’s known for working quickly and effectively.
Things to consider: If you’ve already received an epidural while you were laboring, but you then have an unplanned C-section, the anesthesiologist will increase the dose of the epidural rather than give you a spinal block.
Non-Medical Options
Emotional Support
How it works: It might sound a little woo-woo, but having an attentive caregiver, who is solely focused on your well-being—whether that’s a partner, family member, friend, or doula—can actually help relieve pain. “What I’ve found is that if someone is really tense, they’re unable to release and surrender to the process, or if they don’t feel safe, their pain is ratcheted up,” says Chapin. “Sometimes a doula or support person may not even realize that they’re helping someone’s pain by being calm and holding space for them.”
Things to consider: The benefits of having a doula as your support person in addition to your partner or other loved one really can’t be overstated, says Dr. Weiss. “I like to think of it as putting everybody in a little protective bubble,” she says. “Do you want a party atmosphere? Great, we’ll have a party! Or do you want a calm, quiet environment? I can be the DJ or the bouncer depending on what you want.”
Touch Techniques
How it works: In early active labor, light touching of the skin can be calming in between contractions, says Weiss. That can involve stroking of the arm or the back or even acupressure. “One of the big ones is to take two combs and hold them in your hands,” which applies pressure to specific areas, she says.
The idea is that the pressure can distract your brain from the pain, particularly if you've spent weeks practicing a particular technique. “Your body will go ‘oh, we’re just doing what we do on Tuesday night’s childbirth class,’” which has a calming effect, says Dr. Weiss.
Things to consider: Once you’re in labor, you may find that any touching gives you the ick, and you’d prefer hands-off emotional support instead. Or, as you start to have more intense contractions, you may crave firmer touch in the form of counter pressure, says Dr. Weiss. “If you’re feeling a lot of pain in your lower back, there are certain ways we can press around the sacrum and the hip area to help alleviate some of that discomfort,” she says.
Positioning
How it works: Being able to get up and move around into different positions—like standing, squatting, or sitting on a birthing ball—is another way to manage pain during labor, but it’s important to know when to squat, when to stand, and when to get on all fours and let out a primal scream. You’ve probably heard that squatting will open your pelvis and help the baby come out, says Dr. Weiss, but that may not be the right position depending on what’s going on with your labor. If your baby is sitting high up, squatting down to open the pelvis isn’t going to feel great, she notes.
Things to consider: Your labor and delivery nurse, midwife, or doula will understand the nuances of where the baby is located and pick the best position to keep labor progressing, says Dr. Weiss.
Hypnobirthing and Breathwork
How it works: You can use free downloadable mantras, purchase a program, or work with a provider who is trained in hypnobirthing, all with the aim of programming your nervous system to be cued to certain mantras and music that promote deep calm and relaxation, says Chapin. “You’re really internalizing those messages so that if those same things are played when you’re in labor, you can go to that place.”
There are also pattern-paced breathing techniques, such as Lamaze or the Bradley methods which can help you focus inward and help you manage pain during contractions.
Things to consider: Hypnobirthing and breathwork are two things you can do no matter where you plan to give birth, says Chapin. They can be used throughout an unmedicated home birth, while you’re waiting to get an epidural, or in combination with other pain relief options. Just know that you may need more than hypnobirthing and breathing techniques to get you through to the other side—and that’s okay.
Hydro Birthing
How it works: Whether you plunk a kiddie pool in your bedroom or you make sure your birthing center or hospital room has a tub, hydrotherapy is a pretty popular way to relieve pain during labor. “When the belly is fully submerged and you have the warm water on you, it helps to relax the tension in the uterus,” says Chapin, who leaned on water therapy for the births of her two kids. “Hydrotherapy really does make a difference in the perception of pain.”
Things to consider: If you have a high-risk pregnancy that requires continuous fetal monitoring, the tub probably won’t be an option since you’ll need to be hooked up to a machine, says Dr. Flicker. Same goes for people with preeclampsia who need to be on a magnesium infusion to reduce the risk of seizures.
TENS Machine
How it works: This is yet another tool that can be used to distract you from labor pain by using a different kind of sensation. In the case of the TENS machine, you’ll have four electrodes placed on your back, which send small, electric pulses. “So you’ve got the pain of the labor, and then you’ve got the pain of the TENS, and they sort of cancel each other out,” says Dr. Weiss.
Things to consider: You can’t just pick up any old TENS machine when you’re in the throes of labor, as there are certain obstetrics units made for this purpose. The good news is your doula may be trained in this therapy, and they can bring their unit to your home, birth center, or the hospital, says Dr. Weiss. Some birthing centers and hospitals may even have them available, but it’s a good idea to ask well before you need it (like weeks or months before).
Acupuncture
How it works: Acupuncture can also be used to relieve pain, says Chapin. You can even have an acupuncturist come to your home or birthing center while you’re in labor to give a treatment. “I think it can be incredibly helpful, and it’s probably underutilized,” she says.
Things to consider: Many U.S. hospitals do not allow acupuncture needles to be used during labor and delivery, so you may have to stick with acupressure, in that case.
