Pain Management for Vaginal Childbirth

This information is useful for adults
Why Yale Medicine?
  • Around-the-clock anesthesia care for labor and delivery
  • Experts in managing complex, high-risk obstetric cases
  • Offering a variety of pain-relief options for vaginal deliveries

As your due date approaches, it's only natural for mothers-to-be to feel concerned about feeling pain during delivery. Childbirth preparation classes can help pregnant women to prepare for vaginal birth, and there are many medical options available to help manage pain if needed.

Yale Medicine anesthesiologists use every safe pain management option available and are skilled in helping women through routine as well as highly complex vaginal births. If you are planning a vaginal birth, it's important to know which pain management methods are available to you. “Each patient has the choice,” says Ferne Braveman, MD,  director of obstetric and gynecological anesthesiology at Yale Medicine, and professor of anesthesiology and of obstetrics, gynecology and reproductive services at Yale School of Medicine.

Most women who have a vaginal delivery choose to have some form of pain relief. Here are some options:

Epidural: Many women giving birth vaginally are given an epidural, according to Dr. Braveman. In this procedure, the anesthesiologist inserts a needle into the lower back, putting the tip into the epidural space, which is in the outermost part of the spinal canal. Next a catheter is threaded into the space through the needle, the needle is removed and the catheter is taped in place.

The doctor administers pain medication, usually a combination of an opiate and a local anesthetic, through the catheter for as long as it’s needed, even if labor lasts for many hours. The medication diffuses slowly into the spinal space to reach the relevant nerve receptors. The goal of the epidural is to take away the patient’s pain,but not her ability to move.

“The epidural is the best pain relief in terms of quality, but not all patients need that level of pain relief and not all patients want it,” Dr. Braveman says. She notes that women with certain medical problems such as blood clotting abnormalities cannot have an epidural.

Spinal (subarachnoid block): A spinal provides pain relief even faster because pain medication is injected directly into the spinal space; but it will wear off within two hours. During this procedure, the anesthesiologist inserts a needle through a patient’s lower back to deliver a combination of an opiate and a local anesthetic into the spinal fluid bathing the spinal cord. In rare cases, a catheter is placed in the spinal space.

The pain medication quickly reaches the nerve receptors transmitting the pain signals and provides relief. After the spinal wears off, another injection is required for additional pain relief. “We don’t typically use a single dose of spinal medicine for a vaginal delivery unless we have a good sense that the patient is going to deliver quickly,” Dr. Braveman says.

Spinal/epidural: A combination of the above pain relief methods, the anesthesiologist will insert the epidural needle into the patient’s back, then advance a spinal needle through it to deliver a small dose of medication into the spinal fluid, which provides immediate pain relief. Then, the doctor advances a catheter through the epidural needle, removes the needle and delivers a continuous infusion of pain medication into the epidural space.

Nitrous oxide: Also known as laughing gas, the analgesic commonly offered for dental procedures, nitrous oxide makes patients feel euphoric and more physically comfortable. “It’s a bridge for many patients in early labor who haven’t decided yet if they want an epidural,” Dr. Braveman says. Yale Medicine obstetricians order nitrous oxide which is then administered through a mask. Many women who start with nitrous oxide opt to go on to have an epidural.

Injected or intravenous medications: Yale Medicine obstetricians can give pain medication, typically an opiate, through an intramuscular injection or intravenously. This approach is best for women who can’t have, or don’t want, a spinal or epidural but would like some form of pain relief.