Your overnight bag is packed. You’ve practiced driving the shortest route to the hospital. And you’ve downloaded an app on your phone to track your contractions. You are ready for your baby’s delivery! But in all of your preparation, have you also thought about what type of labor and delivery experience you want to have?

In the weeks leading up to your due date, it’s important to create a birth plan and discuss all of the pain relief options with your doctor or midwife. As a certified nurse midwife, I’ve helped guide hundreds of moms through this. I can assure you that understanding all of your options is the first step in helping you feel more comfortable and confident when your contractions begin.

How much pain can I actually handle?

Your entire health care team wants to make your labor and delivery a rewarding experience for you. That can look very different for different women. Some women feel strongly that they want to avoid pain medicine unless absolutely necessary. Some know that they will choose an epidural as soon as it is an option for them. And many women approach their birth with the attitude that they will just see what they decide at the time.

The good news is there are a variety of options that range from non-medical techniques to medical pain relief. To put you at ease and help you focus on your delivery, consider these pain relief options:

  • Activity. Being active and mobile during your labor is a great way to cope with labor pain. It will also help your labor progress and your baby be in a good position for birth. Unless you’re receiving an epidural or you’ve specifically been advised to limit your activity, your labor and delivery team will guide you in using birthing balls and walking to alleviate labor pains. You may also have the option to use telemetry to wirelessly monitor your baby. This makes it easier for you to move freely without the hassle of cords.
  • Aromatherapy, acupressure or acupuncture. These types of therapies help you relax. Talk with your health care team to see which specific options are available for you.
  • Hydrotherapy. Water is a wonderful way to soothe the discomforts of labor. We can help you use the shower or tub for pain relief during your labor. This is different than a water birth because you can use the water to soothe your pains, but then get out of the water for your baby’s delivery. If you want to have a water birth, talk to your health care team to make sure this is an option for you.
  • Nitrous oxide. Commonly called laughing gas, this is a form of mild sedation that you inhale into your lungs. Because it doesn’t enter your bloodstream, your baby isn’t affected. Better yet, you are totally in control of your nitrous oxide, so you can give yourself more of the sedation if needed throughout your labor and delivery. And if you don’t like the effects, the sedation is out of your system once you take one or two breaths of clean air. For many women, nitrous oxide helps decrease their fears and pains, making the entire process less stressful. If your blood pressure rises at the thought of getting an IV, this is also a helpful option.
  • Fentanyl. This narcotic is the next step up in providing a heavier dose of pain relief. It goes into your blood through an IV but is quickly metabolized so it has minimal effects on your baby. Fentanyl lasts for about an hour and helps take the edge off of your contraction pain. Your contractions will feel shorter and not so intense. When I talk with moms, I remind them that it’s safe for both you and your baby, and your health care team is monitoring your dosage all along the way.
  • Epidural. If you don’t want to feel much pain at all, then getting an epidural may be a good option for you. An anesthesiologist will place a thin tube (about the size of a fishing line) in your spinal column. The tube is connected to a pump that delivers the medicine that will give you pain relief. You’ll be numb from your mid-back and down through your legs. Your baby won’t be affected either, because the epidural doesn’t go into your bloodstream. Some hospitals offer a low baseline dose of epidural. This means you will still be able to move around within your bed to maintain a feeling of control. And it means that, during the contraction, you will feel pressure (but not pain!) so you can push effectively. If the pressure is too much, we’ll show you how you can easily increase the dose of the medication on your own so you feel less pressure. Depending on the amount of the drug in your system, you’ll have feeling back within 1-2 hours after your delivery.

When do I have to decide what pain relief I want?

Generally speaking, you don't have to decide anything until you get to the hospital. In the excitement of the labor process, you may forget all of your pain relief options, but your health care team will be there to help. We are happy to review the risks and benefits of each option, so you can make a decision that’s right for you. The exception is a water birth. If you want to deliver your baby in the tub, you need to discuss this with your midwife before you are ready to deliver.

Is it all covered by my insurance?

Usually, yes, but you should always check with your individual plan if this is a concern for you. When you are starting your labor and delivery and begin evaluating your pain relief options, the last thing you want to be concerned about is what is covered by your insurance. The most important thing is that the hospital or clinic where you’ve chosen to deliver your baby is in your insurance network. Don’t hesitate to call your insurance company to learn more about your specific policy details.

Can I be too far along to receive an epidural?

Yes. If you arrive at the hospital and you are already dilated to 8 or more centimeters, then you may be too far along to receive an epidural. Often in these cases, we can make every effort to get your epidural placed but we just don’t have time before your baby would come. Your health care team will work with you to determine what other pain relief options you have. The good news is your baby is coming fast!

What if I’m having a VBAC?

If you’ve had a C-section before and want to have a vaginal delivery the next time, all of these pain relief options are available to you. The exception is water birth. If you have had a C-section before, you can still labor in the water but will have to get out when it’s time to push.

Although you want everything to go according to your plan, flexibility is the key when it comes to your labor and delivery. Your situation can change rapidly. And you don't really know what your pain tolerance is until you start your labor. Your health care team is there to help you plan for the best case scenario and make adjustments as needed to meet your labor and delivery wishes. Our goal is to deliver a healthy baby to a healthy mom, and to make this experience a positive one for you and your family.