What is an epidural? What pain relief options are there for giving birth? We will cover what you can do to feel comfortable while giving birth. Most common options are anesthesia based so will come from an anesthesiologist working for you – make sure to research your specific location!
Common Options
Nitrous Oxide (sometimes not available, normally used in Europe)
Remifentanil (sometimes limited availability for patients who can’t get an epidural)
Epidural/Combined Spinal Epidural
Spinal
Non-anesthesia provided techniques (heat, cold, massage, etc.)
Nitrous Oxide
Nitrous oxide is a gas that is provided at bedside. It is commonly used in Europe and has been around as long as Epidurals. You might recognize it as the anesthesia used for dental work, but for dental work the dosage/concentration is much higher. During pregnancy, you will remain cognizant due to the differences in how it is administered and the concentration.
It can be easily self administered so that can be a good reason to use it. This is helpful as you may need more or less pain relief at different parts of labor – some women need more at the beginning of labor and some need it more later into the process. You also may use it while sitting on the bed, but then walk around and go to the bathroom, while the other options typically require you to stay in the bed once you are hooked up to them. However, when you are not using the nitrous oxide, you may experience pains (since with its effects dissipate quickly).
Nitrous oxide is good at reducing anxiety as well as pain.
It is safe for the baby – it has been used for a long time and is part of the natural environment.
You can use it in combination with an epidural. Many women opt to use nitrous oxide initially so they have the flexibility of moving around and how much they use, then switch to an epidural later in the labor.
More of an indirect pain reliever, so it may not be enough especially if you have a bad reaction to pain
Remifentanil
This is an ultra short acting intravenous opioid. Because it is short acting and dissipates quickly, it can possibly be good with timing for contractions. You self administer it, so if you can anticipate a contraction is happening, you can administer and get the pain relief during the pain and then it dissipates soon after. However, sedation does persist and it may cause nausea.
Typically this is only used if you medically can not get a epidural and you need more pain relief than nitrous oxide can provide.
Although this is an opioid, it is safe because it has such a low half life and hence disappears from your body very quickly.
Epidural/Combined Spinal Epidural
Epidurals is essentially a tube that is attached to your spinal cord to directly administer pain relief straight into your body.
Combined Spinal Epidurals (CSEs) are an improvement on the classic epidural. It is attached a bit different from the classical epidural. Because of how it is attached, it is much safer if you move around suddenly or something knocks the attachment around. It is also placed in a better position where it can reach throughout your body faster, typically relief in 3-5 minutes instead of 15-20 minutes compared to a classical epidural. It also uses less dose since it gets administered to the correct spot. It can also be confirmed that it is attached properly so it is much less likely for it to fail.
In order to get a better epidural insertion, it is ideal to do a “cat” pose like in yoga where you stretch your spine. This gives more space for the tube to be inserted easily.
In addition to the normal epidural introduction, typically the doctor will numb your skin with a tiny needle and you will get some anti bacterial, etc. which may make your skin orange. Then they will cover your back up.
Some negatives of an epidural include – mild itching (minor fentanyl in it), lowering of blood pressure, mild back pain in the site of the epidural for a short term afterwards (no long term pain), may cause a headache.
If you have bleeding issues or are at high risk for infections, you may not want to get an epidural.
Conclusion
Make sure you understand what pain relief you are going to use during your labor and communicate with your doctors about how you are feeling and how things are going. Good luck!
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