Articles (EN)

Pain management of labor: epidural and other methods

2026-05-27 12:00 Childbirth
In short: pain in childbirth is different, and it is normal to ask for anesthesia. Epidural anesthesia is usually considered the most powerful method: it reduces pain, but does not "put the woman to sleep" and is not a general anesthesia. There are other options: nitrous oxide, opioid drugs, water, breathing, massage, changing positions and supporting a partner. The choice depends on the condition of the woman and the child, the course of labor, contraindications and the capabilities of the maternity hospital.

Why do you need anesthesia during childbirth?

Pain in labor is physiological, but its intensity varies greatly. For some women, it is tolerable and controllable, for others it is intolerable. International recommendations from the WHO and ACOG emphasize that the request for anesthesia is the legal right of a woman in labor, and most women have no medical contraindications to epidural anesthesia.
The right pain relief reduces stress, reduces the release of catecholamines (which can slow contractions), and allows a woman to maintain the strength to push. Discuss your options in detail with your doctor when planning your delivery.

Epidural anesthesia

Epidural anesthesia is the most effective and common method of anesthesia in labor. The anesthesiologist inserts a catheter into the epidural space (between the lumbar vertebrae). A local anesthetic and/or a low-dose opioid are given through the catheter.
Advantages:
  • Reliable pain relief in 85-90% of women.
  • The ability to move the legs is preserved (with a "mobile" epidural).
  • The catheter remains in place – if necessary, you can proceed to a cesarean section without general anesthesia.
Possible side effects:
  • Lowering blood pressure (controlled by a drip).
  • Slowing of the second stage of labor (slight).
  • Itching of the skin when opioid is added.
  • Headache after puncture (rarely, 1%).
Epidural anaesthesia does not increase the risk of caesarean section, according to meta-analyses by the Cochrane Library.

Nitrous oxide ("laughing gas")

Nitrous oxide (50/50 with oxygen) is inhaled through a mask at the beginning of the contraction. It does not relieve pain completely, but reduces anxiety and dulls the pain sensation.
Pros: quickly starts and ends the action, does not affect the contractile activity of the uterus, the woman herself regulates the dose. Cons: nausea and dizziness are possible, the effect is moderate - suitable for the initial phase.

Opioid analgesics

Promedol, fentanyl, or morphine may be administered intramuscularly or intravenously. They reduce the intensity of pain, have a sedative effect.
Limitations: opioids cross the placenta and can depress the respiratory center of the newborn - so they are not used immediately before birth. It is important for nursing mothers to know: the concentration in milk is minimal.

Non-drug methods

Many women effectively reduce pain in non-drug ways, especially at the beginning of labor:
  • Breathing techniques – for more details, see the article Breathing Techniques in Childbirth.
  • Hydrotherapy – shower or bath reduces pain by 30-40%.
  • Massage – especially of the sacrum and lower back.
  • TENS (transcutaneous electrical neurostimulation) – a weak current distracts nerve receptors.
  • Changing positions – vertical postures, ball, walking.
  • Support – the presence of a partner or doula reduces the need for pain relief.

Spinal anesthesia

Spinal anesthesia is a single injection into the subarachnoid space, which is used mainly for planned or emergency cesarean section. The effect comes quickly (5 minutes), but lasts for a limited time (2-3 hours).

General anesthesia

General anesthesia during childbirth is rarely used - in emergency cesarean, when there is no time for epidural or spinal anesthesia, or in the presence of contraindications. After general anesthesia, recovery takes longer, skin-to-skin contact with the baby may be delayed.

When to see a doctor

Inform the anesthesiologist or midwife immediately if, after an epidural:
  • your blood pressure has dropped sharply, you feel dizzy;
  • you cannot move your legs after 30 minutes (with a "mobile" epidural);
  • anesthesia is ineffective on the one hand ("unilateral" action);
  • A severe headache appeared in an upright position a few hours after the procedure.

Frequently Asked Questions

Will epidural anesthesia affect breastfeeding?

There is no evidence that epidural anesthesia disrupts breastfeeding. Short-term lethargy of the newborn is possible with high doses of opioids, but it passes quickly.

Is it possible to refuse anesthesia and somehow prepare for pain?

Yes. Pain in childbirth is bearable, especially if you are well prepared: take courses, master breathing techniques, provide support. The key is not to make promises to yourself in advance: if you need anesthesia, this is not a "failure".

Can an epidural be given for any opening?

In most modern maternity hospitals, yes, with any opening, if there are no contraindications. The outdated rule of "waiting for 4 cm" is not supported by current clinical guidelines.

Conclusion

Modern medicine offers a wide range of methods of pain relief, from breathing and massage to epidural anesthesia. There is no "right" or "wrong" choice: there are your choices based on information. Discuss your options with your doctor beforehand, include your preferences in your birth plan , and know that you can always change your mind in the process.

Bibliography

  1. WHO. WHO recommendations: intrapartum care for a positive childbirth experience. 2018. https://www.who.int/publications/i/item/9789241550215
  2. ACOG Practice Bulletin No. 177. Obstetric Analgesia and Anesthesia. Obstet Gynecol. 2017.
  3. Anim-Somuah M et al. Epidural versus non-epidural or no analgesia for pain management in labour. Cochrane Database. 2018. https://pubmed.ncbi.nlm.nih.gov/30307619/
  4. NICE guideline CG190. Intrapartum care. 2014 (updated 2017). https://www.who.int/publications/i/item/9789241550215
  5. Ministry of Health of the Russian Federation. Clinical recommendations: Normal delivery. 2021. https://cr.minzdrav.gov.ru/
  6. Jones L et al. Pain management for women in labour. Cochrane Database. 2012. https://pubmed.ncbi.nlm.nih.gov/22786479/
This material is for informational purposes only and does not constitute medical advice and is not a substitute for medical advice. If a child's sleep is accompanied by alarming symptoms, a pronounced deterioration in health, problems with breathing, feeding or weight gain, it is necessary to consult a qualified medical specialist as soon as possible, and not rely only on information from the Internet.