CWC Article - Exercise In Pregnancy

cwc_title.gif (11129 bytes)

Epidurals, and Other Pain Relief During Labor

By: Bradley G. Goldberg, M.D.

Many women find it difficult to decide on which method of pain relieving therapy they will use during labor. After years of treating laboring patients, I am a strong proponent of epidural pain relief. However, epidurals are not the only tool we have to deal with the pain of labor.

Some women chose to undergo labor and childbirth with no pain medication at all. This may be the proper choice for some, but I feel that the patient who chooses this method should be properly prepared, and should have come to this decision based on their own research. While I always support participation in childbirth classes, I think that women who are planning this type of “natural” childbirth should especially attend these important classes to learn important breathing methods, as well as to mentally prepare for the birthing process.

For those who decide to use pain-relieving medications, there are several choices. First is the use of intravenous (I.V.) narcotics. These are administered during labor on a time-based schedule, such as every 4 hours as needed by the patient. These medications can be quite effective, but they do cause significant drowsiness, and can suppress the baby’s respirations if given too close to the time of delivery. Therefore they cannot be used throughout the entire labor process.

Another less well-known option is the ‘pudendal block’. This is used near the end of the labor process to relieve pain from the pressure of the baby’s head descending. It is given as an injection in the vagina in order to anesthetize the pudendal nerves. This can work well, but some patients do not experience adequate relief from this method alone.

Of course, there is the epidural. This is administered via an injection that is given into the space that surrounds the nerves at the bottom of your spinal cord. This can be done as a one-time dose, or the doctor can leave a tiny catheter in place to continuously supply medicine over a longer period of time.

The epidural is an excellent way to relieve the pain associated with labor. As with any medical treatment, there are some risks involved, most of which are minor and will be discussed with you by the anesthesia physician. Most patients who have had an epidural say it was no more painful than having their blood drawn or having an I.V. started. My wife had one when she was in labor, and she was very glad she did.