As your new baby’s arrival gets closer, you’re doing all you can to prepare. You’re packing your overnight bag. You know the shortest route to the hospital. You know the signs of labor to watch for.

But chances are there’s at least one more big thing on your mind: How you’ll handle pain during labor and delivery.

Some people want to avoid pain medicine unless it becomes absolutely necessary. Others plan for an epidural, and some want to just wait and see how they feel.

However, even if your birth plan already outlines how you want to deal with labor pain, or you’ve given birth before, you’re still thinking about what this experience will be like. And because every birth is unique, it’s important to know all your pain management options so you feel more comfortable and confident when your contractions begin.

Below, we provide an overview of common ways to manage labor pain, from medications to natural pain relief techniques.

First, how painful is childbirth? (And how much labor pain can you actually handle?)

It’s true. Childbirth is painful. However, pain is subjective – and it’s also manageable. Your birth experience will be unique, so what you feel will be unique, too.

Braxton-Hicks contractions – those “practice” contractions as your body prepares for the big day – can give you a little taste of what the beginning stages of labor may feel like. You may feel tightening in your lower abdomen that comes and goes, or you may feel something similar to period cramps. A strong contraction may even take your breath away.

When real labor contractions start, intensity, frequency and regularity increase – as does the discomfort. And as labor progresses, the sensations you feel can continue to intensify in a range of ways. But the pain you experience (and what you feel like you can handle) on delivery day will greatly depend on how your labor goes and the pain management methods you’ve chosen.

Knowing your pain management options during labor and delivery

You may think your only pain management options are an epidural or natural birth. But there are a range of medical and natural pain relief options today – many that can be used together.

Depending on where you choose to give birth, your options can vary. For example, epidurals are not typically available at freestanding birth centers. But knowing your options can help you finalize your birth wishes and decide on where to have your baby.

Pain medications for labor pain relief

There are several medical pain management options during labor and delivery. They all work differently, but they’re all designed to provide noticeable pain relief.

Epidurals

Epidurals are one of the most common pain medications used during labor and delivery, because they’re usually the most effective way to relieve pain.

An epidural helps numb your lower body. You’ll still feel pressure and some discomfort, but more extreme labor pains are calmed. It’s delivered as a continuous flow or a repeatable dose through a small catheter placed in your lower back, which means the dosage can be adjusted as needed.

But because an epidural numbs your lower body, it’s important to know that your mobility will be limited. Specifically, you won’t be able to safely stand or walk until the medication wears off.

And like any medication, there is a risk of side effects such as a reaction to the medication, headache or a drop in blood pressure. Your care team will be able to answer any questions you have as well as take steps to minimize any potential issues.

Nitrous oxide

Nitrous oxide – which is often called laughing gas or nitrous – is a form of mild sedation that you inhale into your lungs through a mask. It’s a popular option for those who hope to use little to no pain medication during childbirth.

Nitrous oxide can help take the edge off pain temporarily as well as help you relax. In fact, many find the gas helps reduce their pain and fear, which can make the entire process less stressful. Plus, nitrous oxide is safe for your baby and has not been shown to affect breastfeeding.

The gas’s effects can come and go quickly, but you’ll be given control of the mask so you can use it as needed. That said, it’s important to know that too much nitrous oxide may make you a little drowsy, dizzy or nauseous at times. Usually taking a break from breathing the gas helps those side effects go away on their own.

Opioids

Opioids like fentanyl can help you relax and take the edge off your pain. However, opioids aren’t used that often, but when they are, it’s typically only used during early labor. If you’d like more pain relief than opioids provide, you'll likely need another pain relief method. And like other medications, there’s a small chance you could have a reaction like dizziness, nausea or vomiting.

Intrathecal narcotic (ITN)

Intrathecal narcotic – or ITN for short – is a lesser-known and rarely performed medical pain management option during labor. The medication is delivered through a shot in your lower back and is often described as an alternative to an epidural.

However, since it’s delivered as a single shot, pain relief and duration can vary. Also, ITN is most effective when given during the first stage of labor and isn’t recommended for first-time mothers.

Spinal blocks

If you’re planning to deliver vaginally, a spinal block won’t be on your list of pain management options during labor. But it’s still important to know about in case an unplanned C-section is needed.

Spinal blocks are sometimes used during non-emergency C-sections to block pain but keep you awake so you can see your baby being born. If an epidural is already in place before an unplanned C-section, the epidural is usually left in and medication is increased. If an emergency C-section is needed, you’ll likely be placed under general anesthesia.

Spinal blocks are also commonly used for planned C-sections. The block is delivered in a single dose, and because of where the injection is placed, the numbing effects are almost immediate. You may not be able to move your legs until it wears off.

Natural pain relief options during labor and delivery

For those who hope to have an unmedicated birth, there are many natural pain relief options that can be mixed and matched based on your preferences.

But natural pain management methods aren’t only for those who hope to have an unmedicated, “natural” birth. They can be used in combination with pain medications so you can have the birth experience you’re hoping for.

Continuous labor support

Having a support person with you from early labor through the birth of your baby has a proven, positive effect on childbirth. This can be your partner, a family member, friend or a doula.

What is a doula? A doula is a birth coach who provides physical and emotional support during the entire pregnancy. During labor, a doula may be with you to give support, but they do not deliver the baby.

Activity and movement

Being active and mobile during your labor is a great way to cope with labor pain. That’s because movement can help reduce pain by stimulating the receptors in your brain for pain perception. Movement also helps labor progression by encouraging baby to move and get into a good position for birth.

Unless you’ve received an epidural or been advised to limit your activity, plan to change positions in bed, walk around, stand up and gently sway from side to side or sit on a rubber birthing ball. You might 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.

Distraction

Finding a way to take your mind off the pain of each contraction can go a long way in helping you feel more relaxed and better equipped to handle pain in the moment.
Focused breathing – or organized breathing – is one way to help you focus and distract you from pain during contractions. How? It can provide a rhythm and promote oxygen flow so you feel stronger and more in control and relaxed.

Childbirth education classes teach different methods of focused breathing, and many books and resources provide good explanations. But some other ways to distract yourself from pain include:

  • Playing cards or a game
  • Watching TV
  • Listening to music
  • Taking a shower
  • Visualizing a special place or memory

Massage

Massage techniques are designed to release muscle tension, helping you relax and reducing pain. So it’s no surprise that massage can be a way to relieve pain during labor.

Having your support partner massage your back, neck, shoulders, arms or legs throughout the labor process can feel soothing. But a strong massage of your lower back muscles or applying counter pressure during contractions can provide some targeted back pain relief.

Hydrotherapy

Hydrotherapy involves being immersed in warm water during labor. Just like taking a warm bath, hydrotherapy can be comforting, helping you relax and soothing aching muscles.

Being in water can also make it easier to move and reposition. This helps you find the most comfortable position, and movement can help labor progress.
Hydrotherapy is not the same as water birth, so you won’t deliver your baby in water. As long as it’s safe, you can typically get in and out of your hydrotherapy tub until late stage labor. If you choose to have an epidural, tub time will come to an end.

Water birth

Water birth is becoming increasingly popular among those who wish to have an unmedicated birth. Like hydrotherapy, you can labor in the warm water. But the big difference is that you’ll also deliver your baby in water.

However, it’s important to know that water births are only recommended for low-risk pregnancies. There’s also limited research on the risks and benefits of delivering a baby in water.

Aromatherapy and essential oils

While more research needs to be done, there are several studies that suggest aromatherapy and essential oils during labor can have a positive impact on birth experiences. For example, essential oils such as bitter orange, lavender and peppermint helped laboring women with pain, nausea and more.

Acupuncture

Acupuncture is a key part of traditional Chinese medicine that involves strategically inserting very thin needles in your body to relieve stress, aches and pains. But can it really help during labor?

Studies show that acupuncture can be a good supplement to other labor pain relief methods. But it may not be offered at all birth centers and hospitals, and it may or may not be covered by your insurance plan. So if you’re interested in acupuncture, make sure to discuss it with your doctor or midwife, and get in touch with the hospital where you plan to deliver and your insurance company.

Additional FAQs on labor pain management

When do I have to decide which pain relief options I want?

Generally speaking, you don’t need 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 will review the risks and benefits of each option, so you can make a decision that’s right for you.

The one exception here is water birth. If you want to deliver your baby in a birthing tub, talk with your midwife before you’re ready to deliver.

Are all labor pain management options covered by my insurance?

Usually, yes. But you should always check with your insurance provider about what your individual plan covers if you’re concerned.

When you go into labor and start evaluating your pain relief options, the last thing you want to be concerned about is what is or isn’t covered by your insurance. The most important thing is that the hospital 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’re already dilated to eight or more centimeters, then you may be too far along to receive an epidural. In these cases, we make every effort to get an epidural placed in time to provide relief, but we just might not have time before baby comes.

The good news is that you’ve made good progress! And your health care team will work with you to determine what options you have. When you’re at the end of dilation, you’re often near the pushing stage and will soon get to meet your baby.

What if I’m having a vaginal birth after Cesarean (VBAC)?

If you’ve had a C-section before and you’re planning on a vaginal delivery this time, all pain management options are available to you, with the exception of a water birth.

If you’ve had a C-section before, you can still take advantage of hydrotherapy to labor in water. When it’s time to push, your care team will help you out of the tub and into a birthing bed.

Get ready for labor and delivery day

You want the kind of birth experience you hoped for. But flexibility is key – and that’s why it’s so important to know your pain management options. You don’t really know what your pain tolerance is until you start labor – and your unique situation can change rapidly.

Your health care team is there to help you plan for your ideal scenario as well as help you make any adjustments as you go through the labor and delivery process. As always, the ultimate goal is to deliver a healthy baby to a healthy mom, and to make this experience a positive one for you and your family.

Looking for a hospital-based birth center for your delivery?