Options for Pain Control
Pain management is an important consideration during labor and delivery, and we are supportive of each patient's choices around pain control in childbirth.
When you arrive to deliver at BIDMC, our experienced staff is ready to help make you as comfortable as possible. We understand that your comfort level can change as labor progresses; you do not have to make final decisions regarding pain management before your labor begins.
Throughout your stay with us, our team of providers will listen to you and provide the best possible solutions to meet your medical needs.
Natural childbirth, or unmedicated labor, is an important option available for patients at BIDMC who do not wish to use anesthesia or medications in their pain relief plan. Birthing balls and showers are helpful tools for pain management and are available in our state-of-the-art delivery rooms.
Our flexible, family-centered policies allow patients and their partners to include doulas and other helpers as part of their birthing experience. Our nurses and other members of your support team will work with you to make your natural childbirth experience as comfortable as possible.
Our goal is for you to have a positive childbirth experience, and to provide you and your family with the highest level of patient care in a supportive environment.
Obstetrical anesthesiologists at Beth Israel Deaconess Medical Center are key members of the labor and delivery team. Our philosophy of care focuses on the needs of the individual patient, offering a complete range of anesthesia options — from the minimum to the very latest that modern medicine has to offer. When you begin labor, our anesthesiology team will be available to discuss all of your pain relief options. The choice is yours.
Making the Choice for Pain Relief
Several types of pain medication may be given to a patient who is delivering vaginally. It is important to recognize that each labor, and each patient's need and desire for pain relief, is different. Our bodies make their own pain relievers, called endorphins, and most patient seem to make enough endorphins for several hours of active labor. For others, analgesics or anesthesia may be helpful, and will not hurt the baby.
You do not have to make a final decision about pain relief at any particular time before or during labor. As labor progresses, let your primary nurse know how you are feeling. If you decide you would like pain relief, your primary nurse, your provider, and an anesthesiologist can help you choose the best option.
Medication for Relieving Pain (Analgesics)
A morphine-like pain medication called Numorphan can help relax you and decrease your perception of pain. Numorphan may be given as a shot or through an intravenous line. It enters your bloodstream, which means that some of the medication passes through your placenta to your baby. This medication is usually given during the early part of the active phase of labor so both you and your baby can metabolize (use up) most of it before you deliver. Sometimes, when given too late in labor, Numorphan may cause your baby to be sleepy at birth. If you decide you would like an epidural after receiving Numorphan, it is usually not a problem.
The "Lite" Epidural
At BIDMC, we offer lite epidurals, a type of epidural that offers pain relief during contractions while allowing you to retain all or most of your muscle strength. During labor and delivery, pain is caused by pressure on nerves. An epidural involves injecting medication into the epidural space of your spine in your lower back in order to block the pain sensation.
While you are sitting up or lying on your side, a small area on your lower back is numbed with a local anesthetic. A needle is inserted into that area and a thin tube, called a catheter, is threaded through the needle. The needle is removed and the catheter, through which the anesthetic medication is injected, is left in place. The catheter is taped to your back and remains in place until after you deliver.
After you receive an epidural, you may feel the pressure of your contractions, but not the pain. With a lite epidural, you should be able to walk or sit up in a chair. Epidural anesthesia does not affect your baby or the progress of your labor. It is safe for most laboring women and is often recommended for women with medical problems.
Spinal/Epidural Combined Technique ('Lite Spinal')
Another form of pain relief during labor involves placing a needle into the epidural space and inserting another very thin spinal needle into the sac that surrounds the spinal canal. A small amount of a morphine-like medication (Fentanyl) is injected through the spinal needle. The needle is then removed and an epidural catheter remains in place. This procedure provides fast pain relief that lasts for several hours. After the initial medication wears off, pain relief can be continued by administering epidural medication through the catheter.
A spinal anesthetic may be administered during delivery if forceps are necessary. During this procedure, a small needle is inserted into your back, and a local anesthetic is injected into the sac below the bottom of the spinal cord. This anesthetic numbs your body from the waist down.
A local anesthetic (numbing medication) will be given if necessary for stitching any lacerations and/or episiotomy made during the delivery.
A pudendal block numbs the area of the vulva, vagina, and anus by injecting local anesthesia deep into the vagina. A pudendal block may be used for pain control during the second stage of labor and during delivery.