Pain Management Options in Labour

The amount of pain you experience in labour varies greatly from one person to the other. The pain that you have depends upon the size and position of your baby, the size and shape of your pelvis, the strength of your contractions, the length of your labour and your previous experiences. Your care team is available to support you during your labour and birth and in your choice of comfort measures and pain relief.

There are many types of pain relief to choose from. For more information please go to the Society of Obstetricians and Gynaecologists of Canada website:

https://www.pregnancyinfo.ca/birth/labour/pain-management/

Drug-Free Comfort Measures

The comfort measures below can help reduce painful sensations and make you feel calm and relaxed. Coping techniques through labour that don’t include medication can be quite effective.

Water Therapy (Hydrotherapy)

  • Shower or Bath - Sensation of running water can provide relief

Heat/Cold

  • Place warm or cold packs on your lower abdomen or back

Massage and Touch

  • Light or firm rhythmic stroking over shoulders, neck, back, abdomen or legs
  • Firm pressure on your back or hips, especially during contractions
  • TENS machine (you can rent or buy one, GRH does not supply)
  • Acupressure - Pressure on your back, hands or feet can help with pain relief

Certain massage techniques have been found to be comforting in labour. Having your support person massage or provide pressure to your lower back can be helpful. Ask your healthcare provider to show you different techniques that you can try.

Movement and Repositioning

Moving and repositioning your body during labour allows you to use gravity to help the baby change positions and move lower in the birth canal.

  • Walking, alternating with rest periods
  • Standing, leaning forward on a support person or bed, or slow dancing movements
  • Squatting or a supported squat position
  • Being on your hands and knees
  • Pelvic rocking, from side to side or front to back
  • Birthing balls are tools that can help support different positions and movements that would be difficult to do on your own.

Distraction therapy

  • Listening to music
  • Focusing on images or thoughts
  • Guided imagery or meditation
  • Focusing on breathing

Patterned Breathing

Using different breathing techniques can help you remain focused and in control of your labour.

  • Concentrating on slow, deep breathing and on relaxing muscles during and between contractions

Continuous labour support

Having a continuous labour support can provide you with confidence and help you feel relaxed and less anxious through your labour. It has shown to be associated with less labour interventions.

Using Medication to Manage Pain

Opioids

Opioids are used throughout labour to help with pain relief. They are quite effective but do sometimes have side effects for both you and the baby. Opioids given during labour work quickly and can lessen pain and help you cope with painful contractions.

The main types are Morphine and Fentanyl.

  • Opioids are given by injection into a large muscle in your leg or buttocks or can be given into a vein through an IV (intravenous). A patient controlled pump (PCA) that delivers the opioid medication (through an IV) with a button you press may also be an option.
  • Opioids can reach the baby. After the birth of your baby a clinical team member will watch your baby closely for any signs of breathing issues. If your baby needs assistance with their breathing they will require admission to the Neonatal Intensive Care Unit (NICU).
  • Side effects of opioids include nausea, vomiting, lower blood pressure, slow or fast heart rate and slower breathing than normal.

Pudendal Block

A pudendal block is a freezing medication that is injected though the wall of the vagina to numb the area between the vagina and the anus. The freezing works quickly to lessen pain in the area it is injected into during birth and during repair of any tears after birth.

  • The medication given with a pudendal block does not affect the baby.
  • It does not relieve the pain from contractions and not all providers are trained to do this

Epidural

Epidurals are given by a specialized physician called an Anesthesiologist. It is a type of pain relief that numbs the nerves that you feel labour pain with.

  • An epidural involves an injection of freezing in your back and the placement of a small tube that will continuously give you pain relief until after your baby is born.
  • The epidural is usually a quick and effective pain relief option that allows you to move around as much as possible with little to no medication that reaches your baby.
  • Side effects of an epidural include a drop in blood pressure, sore back and occasionally a headache.

Spinal Analgesia

Spinal analgesia is given by a specialized physician called an Anesthesiologist. It includes a needle inserted into your back and a small amount of opioid medication is injected.

  • Spinal analgesia is quick and effective and little to no medication reaches the baby.
  • This analgesia lasts two or more hours and is usually only given once during the advanced stage of labour. It can also be used for a Caesarean section.
  • Side effects of a spinal are similar to those of an epidural and include a drop in blood pressure, occasionally a headache and occasionally a decrease in fetal heartrate that is benign and of short duration.