Pain relief is one of the most common topics of conversation before childbirth. Here we go through the most common forms of pharmacological pain relief, i.e. drug-based relief, and how they can be used during childbirth.

What is pharmacological pain relief?

In childbirth, you can choose between two main routes for pain relief:

• Non-pharmacological pain relief - natural methods without medicines.
• Pharmacological pain relief - medicines that affect the body's pain signals.

This article focuses on pharmacological options, that is, different medicines and anaesthetic methods which can reduce or block pain during childbirth.

Remember! There is no prestige in the type or amount of pain relief you choose. The most important thing is that you feel safe and involved in the decision.

Options for pharmacological pain relief

nitrous oxide

Nitrous oxide has been used in obstetrics for over 100 years. It is given in a mixture with oxygen and inhaled through a mask that you hold yourself.
About 14 % of all births use nitrous oxide alone. Many appreciate being able to control the pain relief themselves.

Epidural anesthesia (EDA)

Epidural anesthesia, or spinal anesthesia, is given in the epidural space - a space outside the spinal canal.
An anesthesiologist inserts a thin plastic catheter through which the anesthetic is given, either:

• via pump that you control yourself,
• via continuous dosing,
• or by repeated injections by the midwife.

Common side effects include itching (in 50-80 %) and a drop in blood pressure, which is often counteracted with fluids or drips.
For those who have pre-eclampsia (pre-eclampsia) EDA can have a positive effect by lowering blood pressure.

Research is still investigating the relationship between EDA and length of labor, pushing ability and risk of instrumental delivery. After delivery, the catheter is removed.

Spinal anesthesia

Spinal anesthesia is given inside the epidural space and acts quickly, but the effect lasts only 1-4 hours.
It is often used in faster labor progress, especially in women giving birth.

PCB - Paracervical blockade

PCB involves injecting a local anesthetic into the cervix to block nerves that send pain signals to the brain.
The effect is similar to the epidural, but does not stun vagina, pelvic floor or rectum. Therefore, PCBs are sometimes combined with PDB in the crystalline phase.

PDB - Pillow block (pelvic floor anesthesia)

By PDB local anesthesia is injected at pudenda nerves, near the spina bifida in the pelvis.
The method blocks pain in:

• vulva
• perineum (perineum)
• lower third of the vagina

The midwife or doctor can give the injection either internally or externally - both reach the same nerve area.

General anesthesia (sedation)

Anesthesia used in certain caesarean section, in consultation between anesthesiologist and obstetrician.
You will sleep throughout the procedure and wake up when the operation is finished.

FAQ - Frequently asked questions

1. What is the difference between non-pharmacological and pharmacological pain relief?
Non-pharmacological pain relief is natural methods without drugs. Pharmacological pain relief involves the use of medicines.

2. What percentage uses only nitrous oxide?
Approximately 14 % of all births are managed with nitrous oxide alone.

3. What does EDA mean?
EDA stands for epidural anesthesia, a form of spinal anesthesia given in the epidural space.

4. How long does spinal anesthesia last?
Approximately 1-4 hours.

5. What does the PDB assess?
PDB numbs the vulva, perineum and lower third of the vagina.

6. When is general anesthesia used?
In case of caesarean section, after consultation between anaesthetist and obstetrician.

Read about non-pharmacological pain relief here!